The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery.
The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery.
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DOI：
10.1227/01.neu.0000462074.66077.2b
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发表时间：
2015-03-01
期刊：
影响因子：
4.8
通讯作者：
Ames, Christopher P
中科院分区：
文献类型：
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作者：
Tang, Jessica A;Scheer, Justin K;Ames, Christopher P
背景技术背景：积极的脊柱区域和整体矢状面对准不良已被反复证明与疼痛和残疾的胸腰椎fusion.OBJECTIVE：评价区域颈椎矢状面对准和术后结果之间的关系，为患者接受多节段颈椎后路fusion.METHODS：从2006年至2010年，113例患者接受多节段颈椎后路融合颈椎狭窄，脊髓病和脊柱后凸。中期随访时进行的影像学测量包括：（1）C1-C2脊柱前凸，（2）C2-C7脊柱前凸，（3）C2-C7矢状垂直轴（C2-C7 SVA; C2铅垂线与C7之间的距离），（4）头部SVA重心（CGH-C7 SVA），（5）C1-C7 SVA。健康相关的生活质量指标包括颈部残疾指数（NDI）、视觉模拟疼痛量表和SF-36身体成分评分。Pearson积差相关系数计算放射学测量和健康相关的生活质量scores.Results：C2-C7 SVA和CGH-C7 SVA与SF-36身体成分评分呈负相关（r =-0.43，P <0.001和r =-0.36，P = 0.005）。C2-C7 SVA与NDI评分呈正相关（r = 0.20，P = 0.036）。C2-C7 SVA与C1-C2脊柱前凸呈正相关（r = 0.33，P = 0.001）。对于C2-C7 SVA和NDI评分之间的显着相关性，回归模型预测的阈值C2-C7 SVA值约为40 mm，超过此相关性是最显着的。结论：我们的研究结果表明，类似于胸腰椎脊柱，残疾的严重程度增加与积极的矢状面对准不良手术重建。
BACKGROUND: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.OBJECTIVE: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.METHODS: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r =-0.43, P< .001 and r =-0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.CONCLUSION: Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.