Abstract：
OBJECTIVE: To investigate the incidence of cervical spine deformity and instability after posterior cervical spinal cord tumor (CSCT) resection without fusion or fixation in adults and examine relevant risk factors by reviewing and summarizing previously reported studies.
METHODS: We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient\'s data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI).
RESULTS: Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 ∼ -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 ∼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 ∼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery.
CONCLUSIONS: Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients.
METHODS: We selected peer reviewed articles published between January 1990 and December 2020 from the MEDLINE and Cochrane Library databases using relevant key words. Articles in which the authors mainly described spinal cord tumor resection through posterior surgery without fusion or fixation in adults were selected for analysis. Patient\'s data including age, sex, extensive number of laminectomy levels, laminectomy at C2, C3, or C7, multilevel facetectomy, facet destruction, preoperative cervical kyphosis, and preoperative motor deficit were documented. Comparable factors were assessed using the odds ratio (OR) and weighted mean difference (WMD) of 95% confidence intervals (CI).
RESULTS: Among 133 articles identified, 18 met selection criteria. Overall incidence of deformity and instability after CSCT surgery was 0%-41.7% and 0%-20.5%, respectively. Younger age (WMD, -5.5; 95% CI, -10.52 ∼ -0.49; P = 0.03), C2 laminectomy (OR, 5.33; 95% CI, 2.39 ∼ 11.91; P < 0.0001), more laminectomy level (WMD, 2.77; 95% CI, 1.78 ∼ 3.76; P < 0.00001) were identified as risk factors for deformity and instability after CSCT surgery.
CONCLUSIONS: Patients undergoing CSCT resection should receive careful follow-up for postoperative spinal deformity and instability. Younger age, C2 laminectomy, and more laminectomy level were significantly associated with occurrence of deformity and instability after CSCT surgery. Upfront spinal fixation at the time of resection should be considered in selected patients.
摘要：
目的：通过回顾和总结以往报道的研究，探讨成人后路颈脊髓肿瘤（CSCT）切除不融合或固定后颈椎畸形和不稳定的发生率，并探讨相关危险因素。
方法：我们从MEDLINE和CochraneLibrary数据库中选择了1990年1月至2020年12月之间发表的同行评审文章，使用相关关键词。选择作者主要描述成人通过后路手术切除脊髓肿瘤而不进行融合或固定的文章进行分析。患者数据，包括年龄，性别,大量的椎板切除术，C2，C3或C7的椎板切除术，多级别小平面切除术，刻面破坏，术前颈椎后凸畸形,和术前运动障碍记录。使用95％置信区间（CI）的比值比（OR）和加权平均差（WMD）评估可比因素。
结果：在确定的133篇文章中，18符合选择标准。CSCT术后畸形和不稳定的总发生率为0%-41.7%和0%-20.5%,分别。年龄较小（大规模杀伤性武器，-5.5；95%CI，-10.52~-0.49；P=0.03），C2椎板切除术(或,5.33；95%CI，2.39~11.91；P<0.0001），更多的椎板切除术水平(WMD，2.77；95%CI，1.78~3.76；P<0.00001）是CSCT术后畸形和不稳定的危险因素。
结论：接受CSCT切除术的患者应该对术后脊柱畸形和不稳定进行仔细的随访。年龄更小,C2椎板切除术,更多的椎板切除水平与CSCT手术后畸形和不稳定的发生显著相关。在某些患者中，应考虑在切除时进行前期脊柱固定。
方法：我们从MEDLINE和CochraneLibrary数据库中选择了1990年1月至2020年12月之间发表的同行评审文章，使用相关关键词。选择作者主要描述成人通过后路手术切除脊髓肿瘤而不进行融合或固定的文章进行分析。患者数据，包括年龄，性别,大量的椎板切除术，C2，C3或C7的椎板切除术，多级别小平面切除术，刻面破坏，术前颈椎后凸畸形,和术前运动障碍记录。使用95％置信区间（CI）的比值比（OR）和加权平均差（WMD）评估可比因素。
结果：在确定的133篇文章中，18符合选择标准。CSCT术后畸形和不稳定的总发生率为0%-41.7%和0%-20.5%,分别。年龄较小（大规模杀伤性武器，-5.5；95%CI，-10.52~-0.49；P=0.03），C2椎板切除术(或,5.33；95%CI，2.39~11.91；P<0.0001），更多的椎板切除术水平(WMD，2.77；95%CI，1.78~3.76；P<0.00001）是CSCT术后畸形和不稳定的危险因素。
结论：接受CSCT切除术的患者应该对术后脊柱畸形和不稳定进行仔细的随访。年龄更小,C2椎板切除术,更多的椎板切除水平与CSCT手术后畸形和不稳定的发生显著相关。在某些患者中，应考虑在切除时进行前期脊柱固定。
