Impact of congenital spinal stenosis on the outcome of three-level anterior cervical discectomy and fusion in patients with cervical spondylotic myelopathy: a retrospective study

IF 2 3区医学 Q2 ORTHOPEDICS

International Orthopaedics Pub Date : 2024-09-13 DOI:10.1007/s00264-024-06278-2

Yibo Liu, Zheng Zeng, Shuanghe Liu

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Abstract

Purpose

To investigate whether congenital cervical spinal stenosis (CCSS) affects the outcome of three-level anterior cervical discectomy and fusion (ACDF) in patients with cervical spondylotic myelopathy (CSM).

Methods

One hundred seventeen patients with CSM who underwent three-level ACDF between January 2019 and January 2023 were retrospectively examined. Patients were grouped according to presence of CCSS, which was defined as Pavlov ratio ≤ 0.75. The CCSS and no CCSS groups comprised 68 (58.1%) and 49 (41.9%) patients, respectively.

Results

The Japanese Orthopaedic Association (JOA) score did not significantly differ between the two groups at any postoperative time point (p > 0.05). The JOA improvement rate was lower in the CCSS group 1 month after surgery (41.7% vs. 45.5%, p < 0.05), but showed no difference at any follow-up time point after one month. Multivariate logistic regression identified preoperative age (OR = 10.639), JOA score (OR = 0.370), increased signal intensity (ISI) in the spinal cord on T2-weighted MRI (T2-WI) (Grade 1: OR = 6.135; Grade 2: OR = 29.892), and degree of spinal cord compression (30-60%: OR = 17.919; ≥60%: OR = 46.624) as independent predictors of a poor one year outcome (JOA recovery rate < 50%).

Conclusion

Although early JOA improvement is slower in the CCSS group, it does not affect the final neurological improvement at 1 year. Therefore, CCSS should not be considered a contraindication for three-level ACDF in patients with CSM. The main factors influencing one year outcome were preoperative age, JOA score, ISI grade, and degree of spinal cord compression.

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先天性椎管狭窄对颈椎病患者三椎水平前路颈椎椎间盘切除术和融合术疗效的影响：一项回顾性研究

目的研究先天性颈椎椎管狭窄（CCSS）是否会影响颈椎病（CSM）患者三水平颈椎前路椎间盘切除融合术（ACDF）的治疗效果。方法回顾性研究了2019年1月至2023年1月期间接受三水平ACDF治疗的117例CSM患者。根据是否存在CCSS对患者进行分组，CCSS定义为帕夫洛夫比值≤0.75。结果两组患者在术后任何时间点的日本骨科协会（JOA）评分均无明显差异（p > 0.05）。CCSS 组术后 1 个月的 JOA 改善率较低（41.7% 对 45.5%，p < 0.05），但在 1 个月后的任何随访时间点均无差异。多变量逻辑回归确定了术前年龄（OR = 10.639）、JOA 评分（OR = 0.370）、T2 加权 MRI（T2-WI）脊髓信号强度（ISI）增加（1 级：OR = 6.135；2 级：OR = 29.892）和脊髓压迫程度（30%-60%：OR = 17.结论虽然 CCSS 组早期 JOA 改善较慢，但不影响 1 年后神经功能的最终改善。因此，CCSS 不应被视为 CSM 患者三水平 ACDF 的禁忌症。术前年龄、JOA评分、ISI分级和脊髓压迫程度是影响术后一年疗效的主要因素。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

International Orthopaedics 医学-整形外科

CiteScore

5.50

自引率

7.40%

发文量

360

审稿时长

1 months

期刊介绍： International Orthopaedics, the Official Journal of the Société Internationale de Chirurgie Orthopédique et de Traumatologie (SICOT) , publishes original papers from all over the world. The articles deal with clinical orthopaedic surgery or basic research directly connected with orthopaedic surgery. International Orthopaedics will also link all the members of SICOT by means of an insert that will be concerned with SICOT matters. Finally, it is expected that news and information regarding all aspects of orthopaedic surgery, including meetings, panels, instructional courses, etc. will be brought to the attention of the readers. Manuscripts submitted for publication must contain a statement to the effect that all human studies have been approved by the appropriate ethics committee and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki. It should also be stated clearly in the text that all persons gave their informed consent prior to their inclusion in the study. Details that might disclose the identity of the subjects under study should be omitted. Reports of animal experiments must state that the "Principles of laboratory animal care" (NIH publication No. 85-23, revised 1985) were followed, as well as specific national laws (e.g. the current version of the German Law on the Protection of Animals) where applicable. The editors reserve the right to reject manuscripts that do not comply with the above-mentioned requirements. The author will be held responsible for false statements or for failure to fulfil the above-mentioned requirements.