关于从新加坡目前还没有共识opriate lower instrumented vertebra (LIV) for multilevel posterior cervical fusion (PCF) constructs between C7 and crossing the cervicothoracic junction (CTJ). The goal of the present study was to compare postoperative sagittal alignment and functional outcomes among adult patients presenting with cervical myelopathy undergoing multilevel PCF terminating at C7 versus spanning the CTJ.
开云体育世界杯赔率
A single-institution retrospective analysis (January 2017–December 2018) was performed of patients undergoing multilevel PCF for cervical myelopathy that involved the C6–7 vertebrae. Pre- and postoperative cervical spine radiographs were analyzed for cervical lordosis, cervical sagittal vertical axis (cSVA), and first thoracic (T1) vertebral slope (T1S) in two randomized independent trials. Modified Japanese Orthopaedic Association (mJOA) and Patient-Reported Outcomes Measurement Information System (PROMIS) scores were used to compare functional and patient-reported outcomes at the 12-month postoperative follow-up.
RESULTS
Sixty-six consecutive patients undergoing PCF and 53 age-matched controls were included in the study. There were 36 patients in the C7 LIV cohort and 30 patients in the LIV spanning the CTJ cohort. Despite significant correction, patients undergoing fusion remained less lordotic than asymptomatic controls, with a C2–7 Cobb angle of 17.7° versus 25.5° (p < 0.001) and a T1S of 25.6° versus 36.3° (p < 0.001). The CTJ cohort had superior alignment corrections in all radiographic parameters at the 12-month postoperative follow-up compared with the C7 cohort: increase in T1S (ΔT1S 14.1° vs 2.0°, p < 0.001), increase in C2–7 lordosis (ΔC2–7 lordosis 11.7° vs 1.5°, p < 0.001), and decrease in cSVA (ΔcSVA 8.9 vs 5.0 mm, p < 0.001). There were no differences in the mJOA motor and sensory scores between cohorts pre- and postoperatively. The C7 cohort reported significantly better PROMIS scores at 6 months (22.0 ± 3.2 vs 11.5 ± 0.5, p = 0.04) and 12 months (27.0 ± 5.2 vs 13.5 ± 0.9, p = 0.01) postoperatively.
CONCLUSIONS
Crossing the CTJ may provide a greater cervical sagittal alignment correction in multilevel PCF surgeries. However, the improved alignment may not be associated with improved functional outcomes as measured by the mJOA scale. A new finding is that crossing the CTJ may be associated with worse patient-reported outcomes at 6 and 12 months of postoperative follow-up as measured by the PROMIS, which should be considered in surgical decision-making. Future prospective studies evaluating long-term radiographic, patient-reported, and functional outcomes are warranted.
ABBREVIATIONS
cSVA = cervical sagittal vertical axis;CTJ = cervicothoracic junction;GMH = Global Mental Health;GPH = Global Physical Health;LIV = lower instrumented vertebra;mJOA = modified Japanese Orthopaedic Association;PCF = posterior cervical fusion;PROMIS = Patient-Reported Outcomes Measurement Information System;T1S = T1 slope.
INCLUDE WHEN CITINGPublished online March 3, 2023; DOI: 10.3171/2023.1.SPINE221013.
DisclosuresDr. Casper reported personal fees from Stryker and Cerapedics outside the submitted work; being a consultant for Stryker Spine and Cerapedics; and being the deputy editor of Clinical Spine Journal. Dr. Saifi reported nonfinancial support (stock) from Vertera Inc. (NuVasive), Alphatec Spine, and restor3d; and being a consultant for NuVasive outside the submitted work.
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