Abstract：
BACKGROUND: Prior studies have hypothesized that degenerative cervical spondylolisthesis (DCS) may be influenced by loss of stability due to disc, facet joint or cervical alignment. Meanwhile, it is commonly believed that the facet joints and paraspinal muscles participate in maintaining cervical spine stability. However, the impact of paraspinal muscle morphology and detailed facet joint features on DCS requires further investigation.
OBJECTIVE: To compare facet joint characteristics, disc degeneration and muscle morphology between patients with DCS and those without DCS.
METHODS: Retrospective cohort study.
METHODS: Consecutive surgical patients with degenerative cervical spondylosis from June 2016 to August 2023 were recruited.
METHODS: DCS was assessed on X-ray based on the translation distance. Cervical facet joint degeneration (CFD), the facet joint angle on the axial plane (FA-A) and the facet joint angle on the sagittal plane (FA-S), and facet joint tropism (FT) were measured on computerized tomography (CT). Paraspinal muscle degeneration was assessed on magnetic resonance imaging (MRI) including by the adjusted cross-sectional area (aCSA), the functional aCSA, the fat infiltration ratio (FI%). The Pfirrmann grade of the cervical disc was also evaluated.
METHODS: Demographic and clinical data were compared in matched and unmatched cohorts. Disc degeneration, muscle degeneration and facet joint characteristics, including FA, FT and CFD, were compared between patients with and without DCS. Furthermore, the degree of CFD was compared with that of adjacent segments in both groups. Additionally, logistic regression was performed to determine independent risk factors for DCS. Finally, the receiver operating characteristic (ROC) curve, area under the curve (AUC) and cutoff value for the risk factors were calculated.
RESULTS: A total of 431 surgical patients were propensity score matched for age, sex and BMI, and 146 patients were included in the final analysis, with 73 patients in the DCS group and 73 patients in the non-DCS group. DCS patients exhibited more severe CFD at C4/5 (segment with spondylolisthesis). Additionally, DCS was generally associated with more severe CFD, a more horizontal FA-S, more FT and worse paraspinal muscle health but similar disc degeneration. In addition, anterior spondylolisthesis was related to more severe CFD and decreased functional aCSA of the flexors and extensors. Finally, more severe CFD, a more horizontal FA-S and a higher FI% on deep extensor were revealed to be risk factors for DCS, with cutoff values of 1.5, 44.5̊, and 37.1%, respectively.
CONCLUSIONS: This study demonstrated that CFD, the FA and FT and parasipnal muscle degeneration were associated with DCS. And may provide novel insight into the pathogenesis and nature history of DCS and suggest the evolution of degeneration in the cervical spine.
OBJECTIVE: To compare facet joint characteristics, disc degeneration and muscle morphology between patients with DCS and those without DCS.
METHODS: Retrospective cohort study.
METHODS: Consecutive surgical patients with degenerative cervical spondylosis from June 2016 to August 2023 were recruited.
METHODS: DCS was assessed on X-ray based on the translation distance. Cervical facet joint degeneration (CFD), the facet joint angle on the axial plane (FA-A) and the facet joint angle on the sagittal plane (FA-S), and facet joint tropism (FT) were measured on computerized tomography (CT). Paraspinal muscle degeneration was assessed on magnetic resonance imaging (MRI) including by the adjusted cross-sectional area (aCSA), the functional aCSA, the fat infiltration ratio (FI%). The Pfirrmann grade of the cervical disc was also evaluated.
METHODS: Demographic and clinical data were compared in matched and unmatched cohorts. Disc degeneration, muscle degeneration and facet joint characteristics, including FA, FT and CFD, were compared between patients with and without DCS. Furthermore, the degree of CFD was compared with that of adjacent segments in both groups. Additionally, logistic regression was performed to determine independent risk factors for DCS. Finally, the receiver operating characteristic (ROC) curve, area under the curve (AUC) and cutoff value for the risk factors were calculated.
RESULTS: A total of 431 surgical patients were propensity score matched for age, sex and BMI, and 146 patients were included in the final analysis, with 73 patients in the DCS group and 73 patients in the non-DCS group. DCS patients exhibited more severe CFD at C4/5 (segment with spondylolisthesis). Additionally, DCS was generally associated with more severe CFD, a more horizontal FA-S, more FT and worse paraspinal muscle health but similar disc degeneration. In addition, anterior spondylolisthesis was related to more severe CFD and decreased functional aCSA of the flexors and extensors. Finally, more severe CFD, a more horizontal FA-S and a higher FI% on deep extensor were revealed to be risk factors for DCS, with cutoff values of 1.5, 44.5̊, and 37.1%, respectively.
CONCLUSIONS: This study demonstrated that CFD, the FA and FT and parasipnal muscle degeneration were associated with DCS. And may provide novel insight into the pathogenesis and nature history of DCS and suggest the evolution of degeneration in the cervical spine.
摘要：
背景：先前的研究假设退行性颈椎滑脱（DCS）可能受到椎间盘稳定性丧失的影响，小关节或颈椎对齐。同时,通常认为小关节和椎旁肌肉参与维持颈椎的稳定性。然而,椎旁肌形态和关节突关节详细特征对DCS的影响需要进一步研究。
目的：为了比较小关节特征，DCS患者和无DCS患者之间的椎间盘退变和肌肉形态。
方法：回顾性队列研究。
方法：选取2016年6月至2023年8月连续手术治疗退行性颈椎病的患者。
方法：基于平移距离在X射线上评估DCS。颈椎小关节退变(CFD),轴平面上的小关节角（FA-A）和矢状平面上的小关节角（FA-S），在计算机断层扫描（CT）上测量和小关节向性（FT）。通过磁共振成像（MRI）评估椎旁肌肉变性，包括通过调整横截面积（aCSA），功能性ACSA，脂肪浸润率(FI%)。还评估了颈椎间盘的Pfirrmann等级。
方法：比较匹配和不匹配队列中的人口统计学和临床数据。椎间盘退变,肌肉退化和小关节特征，包括FA，FT和CFD,比较有和没有DCS的患者。此外，将CFD程度与两组相邻节段的CFD程度进行比较。此外,采用logistic回归分析确定DCS的独立危险因素.最后,接收器工作特性(ROC)曲线，计算了危险因素的曲线下面积(AUC)和临界值.
结果：总共431名手术患者的倾向评分与年龄相匹配，性别和BMI，146名患者被纳入最终分析，DCS组73例，非DCS组73例。DCS患者在C4/5时表现出更严重的CFD（腰椎滑脱段）。此外,DCS通常与更严重的CFD相关，更水平的FA-S，更多的FT和更差的椎旁肌肉健康，但类似的椎间盘退变。此外,前腰椎滑脱与更严重的CFD以及屈肌和伸肌功能aCSA降低有关。最后,更严重的CFD，更水平的FA-S和深伸肌上更高的FI％被发现是DCS的危险因素，截止值为1.5、44.5和37.1%，分别。
结论：这项研究表明，CFD，FA和FT以及寄生肌变性与DCS相关。并可能为DCS的发病机理和自然史提供新的见解，并提示颈椎退变的演变。
目的：为了比较小关节特征，DCS患者和无DCS患者之间的椎间盘退变和肌肉形态。
方法：回顾性队列研究。
方法：选取2016年6月至2023年8月连续手术治疗退行性颈椎病的患者。
方法：基于平移距离在X射线上评估DCS。颈椎小关节退变(CFD),轴平面上的小关节角（FA-A）和矢状平面上的小关节角（FA-S），在计算机断层扫描（CT）上测量和小关节向性（FT）。通过磁共振成像（MRI）评估椎旁肌肉变性，包括通过调整横截面积（aCSA），功能性ACSA，脂肪浸润率(FI%)。还评估了颈椎间盘的Pfirrmann等级。
方法：比较匹配和不匹配队列中的人口统计学和临床数据。椎间盘退变,肌肉退化和小关节特征，包括FA，FT和CFD,比较有和没有DCS的患者。此外，将CFD程度与两组相邻节段的CFD程度进行比较。此外,采用logistic回归分析确定DCS的独立危险因素.最后,接收器工作特性(ROC)曲线，计算了危险因素的曲线下面积(AUC)和临界值.
结果：总共431名手术患者的倾向评分与年龄相匹配，性别和BMI，146名患者被纳入最终分析，DCS组73例，非DCS组73例。DCS患者在C4/5时表现出更严重的CFD（腰椎滑脱段）。此外,DCS通常与更严重的CFD相关，更水平的FA-S，更多的FT和更差的椎旁肌肉健康，但类似的椎间盘退变。此外,前腰椎滑脱与更严重的CFD以及屈肌和伸肌功能aCSA降低有关。最后,更严重的CFD，更水平的FA-S和深伸肌上更高的FI％被发现是DCS的危险因素，截止值为1.5、44.5和37.1%，分别。
结论：这项研究表明，CFD，FA和FT以及寄生肌变性与DCS相关。并可能为DCS的发病机理和自然史提供新的见解，并提示颈椎退变的演变。
