C2-3椎间盘角度对脊髓型颈椎病术后不良事件的影响

Effect of C2-3 disc angle on postoperative adverse events of cervical spondylotic myelopathy

目的探讨C 2-3椎间盘角度对脊髓型颈椎病(cervical spondylotic myelopathy,CSM)后路减压联合侧块螺钉固定术后不良事件的影响。方法选择2014年9月~2017年3月在本院就诊的CSM患者作为研究对象,以术后是否发生进行性后凸、是否邻近关节退变、是否假关节形成,分别对患者进行分组,观察不同分组患者手术前后Cobb角、C 2-7矢状面垂直轴(sagittal vertical axis,SVA)、C 2-3椎间盘角度、T 1斜率等指标的变化。结果患者术后不良事件发生率为31.09%。是否发生进行性后凸、是否邻近关节退变、是否假关节形成这3种方式分组的患者术前Cobb角、SVA、C 2-3椎间盘角度、T 1斜率均不存在统计学差异(P>0.05),术后不同分组间C 2-3椎间盘角度比较,均存在统计学差异(P<0.05)。多因素分析显示,C 2-3椎间盘角度≥32°是影响术后2年内不良事件发生的风险因素(P<0.05)。结论C 2-3椎间盘角度与术后不良事件的发生存在显著相关性,可用做CSM术后评估颈椎矢状位对齐恢复程度的重要参考指标。

Objective To investigate the effect of C 2-3 disc angle on adverse events after posterior decompression combined with lateral block screw fixation for cervical spondylotic myelopathy(CSM).Methods Patients with CSM who admitted to our hospital from September 2014 to March 2017 were selected as subjects.Patients were grouped according to whether patients with progressive kyphosis,adjacent joint degeneration,and pseudo-articular formation.The Cobb angle,C 2-7 sagittal vertical axis(SVA),C 2-3 intervertebral disc angle and T 1 slope were observed before and after operation.Results The incidence rate of postoperative adverse events was 31.09%.There were no statistically significant differences in preoperative Cobb angle,SVA,C 2-3 intervertebral disc angle,and T 1 slope in patients with progressive kyphosis,adjacent joint degeneration,or pseudo-articular formation(P>0.05).There were significant differences in C 2-3 intervertebral disc angle among different groups after operation(P<0.05).Multivariate analysis showed that C 2-3 disc angle≥32°was the influencing factor of adverse events within 2 years after operation(P<0.05).Conclusion There is a significant correlation between C 2-3 intervertebral disc angle and the incidence of postoperative adverse events.C 2-3 disc angle can be used as an important reference index for assessing the degree of sagittal alignment of cervical vertebrae after CSM.