神经根型颈椎病患者术前颈椎矢状面参数对术后神经功能改善的影响

Effect of preoperative cervical sagittal balance on postoperative neurological function improvement of patients with cervical spondylotic radiculopathy

目的探讨神经根型颈椎病(CSR)患者术前颈椎矢状面参数对颈椎前路椎间盘切除融合术(ACDF)术后神经功能改善的影响。方法回顾性分析2016年1月—2020年1月接受ACDF治疗且随访时间≥6个月的171例单节段CSR患者资料。测量患者术前矢状面参数及责任节段椎间孔宽度,其中矢状面参数包括C_(2~7)Cobb角、C_(1~7)矢状面轴向距离(SVA)、C_(2~7)SVA、T_(1)倾斜角(T_(1)S)。采用颈椎功能障碍指数(NDI)评估患者术前及术后6个月的神经功能。根据患者术后6个月NDI将其分为症状缓解组(NDI<15分,n=138)和症状缓解不良组(NDI≥15分,n=33),比较2组术前颈椎矢状面参数、术前症状持续时间及椎间孔宽度的差异,利用多因素logistic回归模型分析术后神经症状缓解不良的危险因素。结果2组术前C_(2~7)Cobb角、C_(1~7)SVA、C_(2~7)SVA差异无统计学意义(P>0.05);症状缓解不良组术前T_(1)S高于症状缓解组,椎间孔宽度低于症状缓解组,症状持续时间长于症状缓解组,差异均有统计学意义(P<0.05)。多因素logistic回归分析结果显示,术前T_(1)S较高、椎间孔宽度过小及症状持续时间较长是术后6个月神经症状缓解不良的危险因素。结论对于单节段CSR患者,术后神经功能改善不良与术前T_(1)S较高、椎间孔宽度较小及症状持续时间较长有关。

Objective To analyze the effect of the preoperative cervical sagittal balance parameters on postoperative neurological function improvement of patients with cervical spondylotic radiculopathy(CSR)treated with anterior cervical discectomy and fusion(ACDF).Methods The data of 171 patients with single level CSR who received ACDF treatment from January 2016 to January 2020 and followed up for more than 6 months were retrospectively analyzed.The preoperative sagittal parameters and the intervertebral foramen width at the responsible segment were measured.The sagittal parameters included C_(2-7) Cobb angle,C_(1-7) sagittal axial distance(SVA),C_(2-7) SVA and T_(1) slope(T_(1)S).Neck disabilitv index(NDI)was used to evaluate the neurological function of patients before surgery and 6 months after surgery.Patients were divided into 2 groups based on NDI score at the 6-month follow-up(symptom relief group,NDI<15,n=138;persistent symptom group,NDI≥15,n=33).The differences in cervical sagittal parameters,preoperative symptom duration and intervertebral foramen width between the 2 groups were compared.The risk factors for poor postoperative neurological symptom relief were analyzed by multivariate logistic regression model.Results There was no significant difference in C_(2-7) Cobb angle,C_(1-7) SVA and C_(2-7) SVA between the 2 groups(P>0.05).The preoperative T_(1)S in persistent symptom group was higher than that in the symptom relief group,the intervertebral foramen width was smaller than that in the symptom relief group,and the symptom duration was longer than that in the symptom relief group,and the difference was statistically significant(P<0.05).The multivariate logistic regression analysis showed that high T_(1)S,too small intervertebral foramen width and long symptom duration were the risk factors for poor neurological symptom relief at 6 months after operation.Conclusion For patients with single level CSR,poor postoperative neurological improvement is related to higher T_(1)S,smaller intervertebral foramen width and longer duration of symptoms.