Cervical sagittal alignment as a predictor of adjacent-level ossification development.
Cervical sagittal alignment as a predictor of adjacent-level ossification development.
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宫颈矢状排列作为邻近水平骨化发展的预测因子
DOI：
10.2147/jpr.s160472
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发表时间：
2018
影响因子：
2.7
通讯作者：
Cai W
中科院分区：
文献类型：
--
作者：
Liu W;Rong Y;Chen J;Luo Y;Tang P;Zhou Z;Fan J;Cai W
目的 探讨颈椎矢状面对位在颈椎前路自锁独立聚醚醚酮椎间盘切除融合术患者发生邻节骨化发展（ALOD）中的作用，以及颈椎矢状面对位与临床结局的关系。背景技术颈椎前路钢板系统因其优点已成为治疗颈椎间盘突出症患者的经典手术方法。然而，钢板与相邻椎间盘间隙的距离（<5 毫米）已被证明是 ALOD 的关键风险因素。颈椎矢状位如何影响 ALOD 的发展尚不清楚，其在 ALOD 中的作用需要澄清。患者和方法回顾性招募2013年12月至2015年12月期间因颈椎神经根病或脊髓病接受前路颈椎间盘切除融合自锁独立聚醚醚酮融合器的118名成人。其中，15 名患者出现 ALOD，103 名患者未出现 ALOD，代表两组进行比较。测量颈椎矢状参数，包括C2-C7科布角（Cobb）、融合节段角、颈椎倾斜（CT）、T1斜率（T1S）和C2-C7矢状垂直轴。手术前后使用视觉模拟量表、日本骨科协会（JOA）评分和颈部残疾指数（NDI）评分评估临床结果和疗效。结果 两组患者的人口统计数据无显着差异。两组间Cobb值（P<0.05）、CT（P<0.05）和T1S（P<0.05）差异有统计学意义，而融合节段角度（P>0.05）和C2~C7矢状纵轴（P>0.05）无差异。与术前比较，术后各时间点视觉模拟量表、JOA、NDI评分均有改善（P<0.05）。然而，与 ALOD 组相比，NO-ALOD 组术后 24 个月的评分有更大的改善（P<0.05）。 Cobb与CT之间存在显着相关性（r=0.607，P<0.05），CT与T1S之间存在显着相关性（r=0.681，P<0.05）。此外，T1S 与临床结果显着相关（JOA：r=0.689，P<0.05；NDI：r=-0.710，P<0.05）。结论 保持颈椎前凸矢状排列与降低 ALOD 风险和改善临床结果相关。
Purpose To explore the role of cervical sagittal alignment in the occurrence of adjacent-level ossification development (ALOD) in patients who underwent anterior cervical discectomy fusion with self-locking stand-alone polyetheretherketone cage, and the relationship between cervical sagittal alignment and clinical outcomes. Background Because of its advantages, anterior cervical plating systems have been used as the classic surgical method in the treatment of patients with cervical disc herniation. However, the proximity (<5 mm) of the plate to the adjacent disc space has proven to be a critical risk factor for ALOD. How cervical sagittal alignment influences the development of ALOD is unknown and its role in ALOD needs clarification. Patients and methods One hundred and eighteen adults who underwent anterior cervical discectomy fusion with self-locking stand-alone polyetheretherketone cage for cervical radiculopathy or myelopathy between December 2013 and December 2015 were retrospectively recruited. Of these, 15 patients developed ALOD and 103 patients did not, representing two groups for comparison. The cervical sagittal parameters were measured, including C2–C7 Cobb angle (Cobb), fused segment angle, cervical tilt (CT), T1 slope (T1S) and C2–C7 sagittal vertical axis. Clinical outcomes and efficacy were evaluated using a visual analog scale, Japanese Orthopedic Association (JOA) score and neck disability index (NDI) score before and after surgery. Results There were no significant differences in patient demographics between the two groups. Cobb value (P<0.05), CT (P<0.05) and T1S (P<0.05) were significantly different between the two groups, while fused segment angle (P>0.05) and C2–C7 sagittal vertical axis (P>0.05) showed no difference. Compared with preoperative scores, improvement was seen in postoperative visual analog scale, JOA and NDI scores at each time point (P<0.05). However, the postoperative scores at 24 months in the NO-ALOD group indicated greater improvements compared with the ALOD group (P<0.05). There were significant correlations between Cobb and CT (r=0.607, P<0.05) and CT and T1S (r=0.681, P<0.05). Also, T1S was significantly correlated with clinical outcomes (JOA: r=0.689, P<0.05; NDI: r=−0.710, P<0.05). Conclusion Maintaining a lordotic cervical sagittal alignment was related to a lower risk of ALOD and improved clinical outcomes.