颈椎前路椎间盘切除融合术后C5神经根麻痹的危险因素

Risk factors of C5 nerve root palsy after anterior cervical discectomy and fusion

目的:分析颈椎前路椎间盘切除融合(anterior cervical discectomy and fusion,ACDF)术后发生C5神经根麻痹的相关危险因素,为预测术后C5神经根麻痹发生风险提供参考依据.方法:回顾性收集2020年8月~2021年8月因颈椎病于我院接受ACDF术治疗的99例患者的临床资料并进行病例对照研究.根据患者术后是否出现C5神经根麻痹,将患者分为C5神经根麻痹组(C5 palsy组)、无C5神经根麻痹组(无C5 palsy组).采集两组患者基本资料,包括性别、年龄、体质指数(body mass index,BMI)、高血压病史、糖尿病病史;临床指标,包括日本骨科学会(Japanese Orthopaedic Association,JOA)评分、疼痛视觉模拟(visual analogue scale,VAS)评分及颈椎功能障碍指数(neck disability index,NDI);颈椎X线、CT和MRI等影像学参数,包括术前及术后1d两组患者的颈椎生理曲度、C4/5椎间隙高度、术前C4/5椎间孔横径和手术节段数,以及患者术前颈椎MRI T2像C4/5节段高信号情况.采用卡方检验、Logistic回归分析,探究术后C5神经根麻痹发生的危险因素.结果:99例患者中9例在术后7d内出现C5神经根麻痹症状.两组患者间术前C4/5椎间孔横径(2.70±0.88mm vs 3.93±1.06mm,P=0.001)、C4/5椎间隙高度变化(术后高度-术前高度)(3.02±2.03mm vs 1.33±1.45mm,P=0.002)存在差异,其他指标间无显著性差异(P>0.05).多因素Logistic回归分析显示,术后C4/5椎间隙高度[OR=1.698(1.041~2.769),P=0.034]、术前C4/5椎间孔横径[OR=0.207(0.064~0.672),P=0.009]是C5神经根麻痹发生的危险因素.结论:对于行ACDF术的患者术前C4/5椎间孔横径较小、术后C4/5椎间隙高度增加的患者术后发生C5神经根麻痹的可能性较高.术中避免过度撑开C4/5椎间隙并选择大小合适的融合器,保证术后合理C4/5椎间隙且C4/5椎间孔适度减压,以降低术后C5神经根麻痹发生率.

Objectives:To investigate the risk factom of C5 nerve root palsy after anterior cervical discectomy and fusion(ACDF),and to provide references for the prediction of postoperative C5 nerve root palsy.Methods:Clinical data of 99 patients who underwent ACDF for cervical spondy’losis in our hospital from Au—gust 2020 to August 2021 were collected and a case-control study Was conducted.The patients were divided into the C5 nerve root palsy group(C5 palsy group)and the non—C5 nerve root palsy group(non—C5 palsy group)according to whether the patients had C5 nerve root palsy after surgery.Basic information of patients,such as gender,age,body mass index(BMI),history of hypertension,and history of diabetes;clinical indica—tors,such as Japanese Orthopaedic Association(JOA)score,visual analogue scale(VAS)and neck disability in—dex(NDI);and imaging parameters of cervical X-ray,CT and MRI examinations,such as cervical physiological curvature,and the height of C4/5 intervertebral space before operation and on postoperative ld,the preopera—five transverse diameter of C415 intervertebral foramen,surgical levels,and the preoperative high-intensity zone at C4/5 segment of the cervical spine MRI T2 image of patients,were collected.Chi-square test and 10—gistic regression analysis were used to explore the risk factors of postoperative C5 nerve root palsy.Results:9 out of 99 patients developed C5 nerve root palsy within 7d after surgery.The preoperative transverse dianaeter of C4/5 intervertebral foramen(2.70±0.88ram VS 3.93±1.06mm,P=0.001)and the change of height of C4/5 intervertebral space(postoperative height-preoperative height)(3.02±2.03mm VS 1.33±1.45ram,P=0.002)between the two groups had significant difference,but there were no significant differences in other indicators.Multivariate logistic regression analysis showed that the changes in the height of C415 intervertebral space[OR=1.698(1.041-2.769),P=O.034]and the preoperative transverse diameter of C4/5 intervertebral foramen[OR=0.207(0.064-0.672),P=O.009]were the risk factors for the C5 nerve root palsy.Conclusions:For patients underwent ACDF for cervical spondylosis,those with a smaller transverse diameter of C4/5 intervertebral foramen before surgery and an increased height of C4/5 intervertebral space after surgery gate more likely to develop C5 nerve root palsy after surgery.Avoiding over—enlargement of C4/5 intervertebral space and choosing appropriately sized cage during operation to insure that C415 intervertebral space is reasonable after operation and is properly decompressed,SO as to reduce the incidence of postoperative C5 nerve root palsy.