Relative Risks and Benefits of Crossing the Cervicothoracic Junction During Multilevel Posterior Cervical Fusion: A Multicenter Cohort
Relative Risks and Benefits of Crossing the Cervicothoracic Junction During Multilevel Posterior Cervical Fusion: A Multicenter Cohort
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多层次后颈融合过程中穿过颈胸交界处的相对风险和益处：多中心队列
DOI：
10.1016/j.wneu.2021.06.091
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发表时间：
2021
影响因子：
2
通讯作者：
Oshima Yasushi
中科院分区：
文献类型：
--
作者：
Okamoto Naoki;Kato So;Doi Toru;Matsubayashi Yoshitaka;Taniguchi Yuki;Yoshida Yuichi;Kawamura Naohiro;Nakarai Hiroyuki;Higashikawa Akiro;Tozawa Keiichiro;Takeshita Yujiro;Yu Jim;Hara Nobuhiro;Sasaki Katsuyuki;Azuma Seiichi;Tanaka Sakae;Oshima Yasushi
目的比较多节段颈椎后路融合术患者的临床和影像学结果及并发症，结束于C7或跨越颈胸交界处（CTJ. MethodsA共96例患者接受多节段颈椎后路融合术结束于C7，T1，或T2进行了筛选。符合入选标准的患者根据下内固定椎体（LIV）水平分为2组：C7组（结束于C7）和T1-T2组（穿过CTJ）。影像学和临床结果进行了比较，并在LIV.ResultsIn总数，73例（76%）完成至少1年的随访，分为C7组（n= 43）和组T1-T2（n= 30）仪器故障的危险因素进行了调查。两组之间的术前和术后影像学参数、日本骨科协会评分和患者报告的结局没有显著差异。在T1-T2组中观察到手术时间显著延长，失血量增加，围手术期或术后并发症发生率较高。另一方面，C7组LIV时的仪器故障发生率显著更高。多因素分析显示，在C7结束，跳过邻近LIV的近端椎体的螺钉插入，以及术后颈椎矢状垂直轴较大（>40 mm）是LIV时器械失效的危险因素。结论在多节段颈椎后路融合术中，穿过CTJ减少了LIV时器械失效，但增加了手术侵入性和围手术期及术后并发症。
ObjectiveTo compare the clinical and radiographic outcomes and complications in patients undergoing multilevel posterior cervical fusion surgery, ending at C7 or crossing the cervicothoracic junction (CTJ).MethodsA total of 96 patients undergoing multilevel posterior cervical fusion surgery ending at C7, T1, or T2 were screened. The patients who fulfilled the inclusion criteria were divided into 2 groups based on the lower instrumented vertebra (LIV) level: group C7 (ending at C7) and group T1-T2 (crossing the CTJ). The radiographic and clinical outcomes were compared between the 2 groups, and the risk factors for instrument failure at LIV were investigated.ResultsIn total, 73 patients (76%) completed at least 1 year follow-up and divided into group C7 (n= 43) and group T1-T2 (n= 30). Preoperative and postoperative radiographic parameters, the Japanese Orthopaedic Association score, and patient-reported outcomes were not significantly different between the 2 groups. Significantly longer surgical time, increased blood loss, and higher incidence rates of perioperative or postoperative complications were noted in group T1-T2. On the other hand, the incidence of instrument failures at LIV was significantly higher in group C7. Multivariate analysis showed that ending at C7, skipping screw insertion at the proximal vertebra adjacent to LIV, and a large postoperative cervical sagittal vertical axis (>40 mm) were risk factors for instrument failure at LIV.ConclusionsCrossing the CTJ during multilevel posterior cervical fusion surgery reduced instrument failures at LIV, but increased the surgical invasiveness and perioperative and postoperative complications.