目的:颈椎前路髓核摘除融合术(ACDF)在治疗脊髓型颈椎病(CSM)中并发症发生率较低。然而,术后颈轴性疼痛仍然很常见,以及影响因素未知。这里,我们回顾性分析了在单级别CSM中进行ACDF与零轮廓植入术后轴性疼痛的危险因素.
方法:回顾了在2018年1月至2020年12月期间接受单级别CSM和零轮廓植入ACDF的患者。在180名单级别CSM患者中,纳入144名通过纳入标准的患者。根据术后颈部视觉模拟评分法(nVAS)测量术后轴性疼痛的严重程度将患者分为两组。临床参数包括年龄,性别,吸烟史,症状持续时间,体重指数(BMI),日本骨科协会(JOA)评分,以及术前和术后获得的放射学参数,比较两组数据。实施Pearson卡方检验和Mann-WhitneyU检验,以确定分类和连续数据的亚组之间的统计学差异。分别;否则,数据采用学生t检验。使用logistic回归分析确定危险因素。
结果:患者(97.8%)获得了满意的神经功能恢复,88.2%的患者在1年随访时实现融合。33%的患者(144例患者中的48例)在手术后持续术后轴性疼痛。不同严重程度组的比较,除了术前和术后C2-C7Cobb角(6.33±6.53vs.11.88±7.41,P<0.05;13.49±5.31vs16.64±7.34,P<0.05)。此外,相关分析显示,术前C2-C7Cobb角与术后轴性疼痛严重程度显著相关(R2=0.83,P<0.01)。此外,Logistic回归分析显示,术前C2-C7Cobb角是术后轴性疼痛的独立预测因子(P<0.01,OR=0.53)。进一步的受试者工作特征(ROC)分析显示,术前C2-C7Cobb角的曲线下面积(AUC)为0.78(P<0.01),最佳临界值为8.4°(敏感性0.77,特异性0.65)。
结论:术前C2-C7Cobb角是颈椎前路髓核切除术和零轮廓椎间融合术后严重术后轴性疼痛的危险因素,当计划使用零剖面椎间治疗这类患者的脊髓病患者术前发现C2-C7Cobb角差时,我们应该谨慎。
OBJECTIVE: Anterior cervical discectomy and fusion (ACDF) with zero-profile interbody has a lower incidence of complications in treating cervical spondylotic myelopathy (CSM). However, postoperative axial neck pain is still commonly occurred, and the factors affecting which is not known. Here, we retrospectively analyze the risk factors for postoperative axial pain after performing ACDF with zero-profile implant in single-level CSM.
METHODS: Patients who suffered from single-level CSM and who received ACDF with zero-profile implant between 2018 January to 2020 December were reviewed. Of 180 single-level CSM patients, 144 patients who passed the inclusion criteria were enrolled. Patients were divided into two groups according to the severity of postoperative axial pain as measured by postoperative neck visual analogue scale (nVAS). Clinical parameters including age, sex, smoking history, symptom duration, body mass index (BMI), the Japanese Orthopaedic Association (JOA) scores, as well as radiological parameters were obtained pre- and post-operatively, and the data were compared between two groups. Pearson\'s chi-square tests and Mann-Whitney U tests were implemented to identify statistically significant differences between subgroups for categorical and continuous data, respectively; otherwise, the data were tested with Student\'s t-test. Risk factors were identified using logistic regression.
RESULTS: Of the patients (97.8%) achieved satisfied neurological recovery, and 88.2% of the patients achieved fusion at 1-year follow-up. 33% of the patients (48 patients out of 144) had sustained postoperative axial pain after the surgery. Comparison of different severity groups exhibited no significant differences in terms of the possible risk factors (P > 0.05) except for pre- and post-operative C2-C7 Cobb angles (6.33 ± 6.53 vs. 11.88 ± 7.41, P < 0.05; 13.49 ± 5.31 vs 16.64 ± 7.34, P < 0.05). Furthermore, correlation analysis showed that the preoperative C2-C7 Cobb angle is significantly correlated with the severity of the postoperative axial pain (R2 = 0.83, P < 0.01). In addition, logistic regression analysis demonstrated that the preoperative C2-C7 Cobb angle is an independent predictor of postoperative axial pain (P < 0.01, OR = 0.53). Further receiver operating characteristic (ROC) analysis displayed an area under the curve (AUC) of 0.78 (P < 0.01) for preoperative C2-C7 Cobb angle, and the optimal cutoff was 8.4° (sensitivity 0.77, specificity 0.65).
CONCLUSIONS: The pre-operative C2-C7 Cobb angle is a risk factor for severe postoperative axial pain after anterior cervical discectomy and fusion with zero-profile interbody, and we should be cautious when poor preoperative C2-C7 Cobb angle is found in myelopathy patients planning to use zero-profile interbody to treat such patients.