颈椎矢状面平衡参数与颈椎手术关系的研究进展

Advance on relationship between cervical sagittal balance and cervical surgery

颈椎矢状面平衡(cervical sagittal balance)是用于对站立位颈椎位置的一种描述,通过相应的矢状面参数评估颈椎的矢状面位置。颈椎常用的矢状面参数包括颈椎前凸角(cervical lordosis,CL)、颈椎矢状面轴向距离(cervical sagittal vertical axis, cSVA)和T1倾斜角(T1 Slope, T1S)等。颈椎矢状面平衡与脊柱整体的平衡息息相关,其矢状面参数失衡与颈椎疾病进展、手术方式选择和术后疗效有密切的关系。近些年,越来越多的研究者开始关注颈椎矢状面整体平衡性,尤其是颈椎手术后矢状面参数变化,能够预测患者术后神经功能恢复、长期疗效及并发症的发生情况。但由于颈椎手术方式多种多样、颈椎矢状面平衡参数种类繁多,已有的研究只能从某一方面反映二者之间的关系,缺少总体、全面的描述。通过系统地检索文献,筛选相关的研究,对颈椎矢状面平衡参数与颈椎手术的关系进行综述。综述结果显示不同手术方式,术后颈椎的矢状面参数有不同的转归倾向。颈前路手术能够保持或改善颈椎的矢状面平衡,其中颈前路椎间盘切除椎间植骨融合术(anterior cervical discectomy and fusion,ACDF)具有更好的效果;颈后路手术后颈椎矢状面参数倾向于出现失衡或代偿,术前存在矢状面失衡、高龄、合并复杂后纵韧带骨化更容易出现术后失衡或失衡加重。因此,临床实践过程中应注意术前评估,合理设计手术方案,预防患者术后发生颈椎矢状面失衡情况。

The cervical sagittal balance is a description of cervical spine at the standing position.The position of cervical spine is measured by the corresponding sagittal parameters.The commonly used sagittal parameters of cervical spine include cervical lordosis(CL),cervical sagittal vertical axis(cSVA),T1 Slope(T1S),etc.Cervical sagittal balance is closely related to the overall balance of the spine,and the imbalance of sagittal parameter is also related to the progression of cervical disease,the choice of surgical methods and the postoperative efficacy.In recent years,more and more researchers have begun to pay attention to the sagittal balance of the cervical spine,especially the variation of sagittal parameters after cervical surgery,which can predict the postoperative neurological recovery and the change of long-term efficacy or complications.However,due to the variety of cervical surgery methods and the variety of cervical sagittal balance parameters,the existing studies can only reflect the relationship between the two from a certain aspect,while lacking overall and comprehensive description.In this paper,the relationship between sagittal plane balance and cervical surgery was reviewed by systematically searching literatures and screening relevant studies.According to our review,the cervical sagittal parameters have different tendency after different cervical surgery.Generally,anterior cervical surgery can maintain or improve the sagittal plane balance of the cervical spine,among which anterior cervical discectomy and fusion(ACDF)surgery has a best effect.After posterior cervical surgery,the cervical sagittal parameters tend to be unbalanced or compensated,and patients with preoperative sagittal imbalance,advanced age,and complex OPLL are more likely to have postoperative imbalance or imbalance aggravation.Therefore,attention should be paid to preoperative evaluation and reasonable surgical design in clinical practice to prevent the occurrence of sagittal imbalance of patients after surgery.