Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy.
Postoperative cervical sagittal imbalance negatively affects outcomes after surgery for cervical spondylotic myelopathy.
复制标题
DOI：
10.1097/brs.0000000000000641
复制
发表时间：
2014-12-01
期刊：
影响因子：
3
通讯作者：
Ghogawala Z
中科院分区：
文献类型：
--
作者：
Roguski M;Benzel EC;Curran JN;Magge SN;Bisson EF;Krishnaney AA;Steinmetz MP;Butler WE;Heary RF;Ghogawala Z
前瞻性观察队列研究旨在确定颈椎术后矢状平衡是否是CSM术后HR-QOL结果的独立预测因子。脊髓型颈椎病（CSM）的腹侧和背侧融合术都能有效减轻脊髓病的症状。颈椎矢状面平衡在预测脊髓型颈椎病腹侧与背侧手术后总体HR-QOL结果中的重要性此前尚未得到探讨。对49例脊髓型颈椎病接受背侧和腹侧融合手术的患者进行前瞻性、非随机队列研究。术前和术后在站立颈椎侧位片上测量C2-C7矢状垂直轴（SVA）。采用两种疾病特异性指标（mJOA量表和Oswestry NDI）和两种广义指标（sf - 36pcs和EQ-5D）评估结果。术前、术后3个月、6个月和1年分别进行评估。采用SAS v.9.3 （Cary， NC）进行统计学分析。无论采用何种方法，大多数患者在所有结果测量中均有改善。术前和术后C2-C7 SVA测量是SF-36 PCS评分临床显著改善的独立预测因子（p=0.03和p=0.02）。尽管脊髓病有所改善，但大多数C2-C7 SVA值大于40mm的患者从总体HR-QOL角度（sf - 36pcs）来看并没有改善。术后矢状面平衡值与接受背侧手术而非腹侧手术的患者SF-36 PCS评分的临床显著改善呈负相关（p=0.03对p=0.93）。术前和术后矢状平衡测量独立预测CSM手术后的临床结果。
Prospective observational cohort study To determine if postoperative cervical sagittal balance is an independent predictor of HR-QOL outcome following surgery for CSM. Both ventral and dorsal fusion procedures for cervical spondylotic myelopathy (CSM) are effective at reducing the symptoms of myelopathy. The importance of cervical sagittal balance in predicting overall HR-QOL outcome following ventral versus dorsal surgery for CSM has not been previously explored. A prospective, nonrandomized cohort of 49 patients undergoing dorsal and ventral fusion surgery for CSM was examined. Preoperative and postoperative C2-C7 sagittal vertical axis (SVA) was measured on standing lateral cervical spine radiographs. Outcome was assessed with two disease-specific measures – the mJOA scale and the Oswestry NDI- and two generalized outcome measures – the SF-36 PCS and EQ-5D. Assessments were performed preoperatively, and at 3 months, 6 months, and 1 year postoperatively. Statistical analyses were performed using SAS v.9.3 (Cary, NC). Most patients experienced improvement in all outcome measures regardless of approach. Both preoperative and postoperative C2-C7 SVA measurements were independent predictors of clinically significant improvement in SF-36 PCS scores (p=0.03 and p=0.02). The majority of patients with C2-C7 SVA values greater than 40mm did not improve from an overall HR-QOL perspective (SF-36 PCS) despite improvement in myelopathy. The postoperative sagittal balance value was inversely correlated with a clinically significant improvement of SF-36 PCS scores in patients undergoing dorsal surgery but not ventral surgery (p=0.03 vs. p=0.93). Preoperative and postoperative sagittal balance measurements independently predict clinical outcomes following surgery for CSM.