背景:对于多节段退行性颈椎病患者,椎板切除术和带器械的颈椎后路融合(PCF)是广泛接受的缓解症状的技术。然而,硬件故障并不罕见,会导致颈部疼痛甚至永久性神经损伤。目前尚无关于椎板切除术和带器械的PCF术后硬件相关并发症的深入研究。
方法:本研究是回顾性的,单中心,观察性研究。包括在2019年1月至2021年1月期间在单一机构中接受椎板切除术和PCF器械的患者。根据有无硬件故障将患者分为硬件故障组和无硬件故障组。数据,包括性,年龄,螺杆密度,末端椎骨(C7或T1),颈椎矢状位排列参数(C2-C7颈椎曲度,C2-C7矢状垂直轴,T1斜率,颈椎前凸矫正),螺钉轨迹和骨质疏松状态的区域亨氏单位(HU),收集并比较两组。
结果:我们分析了56例患者的临床资料。平均总随访时间为20.6个月(范围,12-30个月)。将患者分为硬件故障组(n=14)和无硬件故障组(n=42)。一般信息(年龄,性别,随访期)。融合率的差异,固定水平,和螺钉密度两组间差异无统计学意义(p>0.05)。T1时固定的故障率低于C7时(9%vs.36.3%)(p=0.019)。失效组椎弓根螺钉(PS)和侧块螺钉(LMS)的区域HU值均低于无失效组(PS:267±45vs.368±43,p=0.001;LMS:308±53vs.412±41,p=0.001)。两组术前及末次随访时矢状比对参数差异无统计学意义(p>0.05)。无骨质疏松患者的硬件故障率低于骨质疏松患者(14.3%vs.57.1%)(p=0.001)。
结论:骨质疏松症,固定结束于C7,螺钉轨迹的区域HU值低是椎板切除术和PCF后硬件失败的独立危险因素。未来的研究应该阐明,针对这些因素的预防措施是否有助于减少硬件故障,并确定更多的风险因素。并进行长期随访。
BACKGROUND: For patients with multilevel degenerative cervical myelopathy, laminectomy and posterior cervical fusions (PCF) with instrumentation are widely accepted techniques for symptom relief. However, hardware failure is not rare and results in neck pain or even permanent neurological lesions. There are no in-depth studies of hardware-related complications following laminectomy and PCF with instrumentation.
METHODS: The present study was a retrospective, single centre, observational study. Patients who underwent laminectomy and PCF with instrumentation in a single institution between January 2019 and January 2021 were included. Patients were divided into hardware failure and no hardware failure group according to whether there was a hardware failure. Data, including sex, age, screw density, end vertebra (C7 or T1), cervical sagittal alignment parameters (C2-C7 cervical lordosis, C2-C7 sagittal vertical axis, T1 slope, Cervical lordosis correction), regional Hounsfield units (HU) of the screw trajectory and osteoporosis status, were collected and compared between the two groups.
RESULTS: We analysed the clinical data of 56 patients in total. The mean overall follow-up duration was 20.6 months (range, 12-30 months). Patients were divided into the hardware failure group (n = 14) and no hardware failure group (n = 42). There were no significant differences in the general information (age, sex, follow-up period) of patients between the two groups. The differences in fusion rate, fixation levels, and screw density between the two groups were not statistically significant (p > 0.05). The failure rate of fixation ending at T1 was lower than that at C7 (9% vs. 36.3%) (p = 0.019). The regional HU values of the pedicle screw (PS) and lateral mass screw (LMS) in the failure group were lower than those in the no failure group (PS: 267 ± 45 vs. 368 ± 43, p = 0.001; LMS: 308 ± 53 vs. 412 ± 41, p = 0.001). The sagittal alignment parameters did not show significant differences between the two groups before surgery or at the final follow-up (p > 0.05). The hardware failure rate in patients without osteoporosis was lower than that in patients with osteoporosis (14.3% vs. 57.1%) (p = 0.001).
CONCLUSIONS: Osteoporosis, fixation ending at C7, and low regional HU value of the screw trajectory were the independent risk factors of hardware failure after laminectomy and PCF. Future studies should illuminate if preventive measures targeting these factors can help reduce hardware failure and identified more risk factors, and perform long-term follow-up.