Do multiple reconstructive surgeries increase loss of cervical lordosis in patients with multilevel degenerative cervical diseases? A retrospective cohort study.

Abstract

Study design: A retrospective cohort study.

Background and objective: There are no data on changes in cervical sagittal alignment and curvature after second and third surgeries in patients with multilevel cervical degenerative diseases (CDD). This study aimed to explore these changes following multiple decompression and reconstruction surgeries.

Methods: 145 patients with multilevel CDD were enrolled based on medical records extracted from 2015 to 2023. They were divided into three groups according to the number of surgeries. 63 patients underwent first decompression and reconstruction surgery (Group 1), 53 patients underwent second surgery (Group 2) and 29 patients underwent third surgery (Group 3). Clinical parameters (Japanese Orthopedic Association (JOA) score for neural functional recovery, visual analogue scale (VAS) and neck disability index (NDI) for neck pain) and radiologic parameters (T1 slope (T1S), cervical lordosis (C2-7CL), C2-7 sagittal vertical axis (C2-7SVA)) were reviewed and analyzed.

Results: The mean period between final surgery and last follow-up was more than 12 months. There were significant differences among 3 groups in terms of operation time, blood loss and hospital stay (P < 0.001). Functional scores changed significantly after decompression surgeries (P < 0.001) in 3 groups. Radiographic parameters increased after surgery in group 1 (P < 0.001), while C2-7CL and T1S decreased after second and third surgery in group 2 and group 3 (P < 0.001). Comparing with group 1, there were significant differences showed in terms of C2-7CL, T1S, NDI and VAS in group 2 and group 3 (P < 0.05), NDI and VAS were significantly larger in group3 compare with group 2 (P < 0.05).

Conclusion: Multiple surgeries may exacerbate cervical lordosis loss and increase axial pain, necessitating cautious surgical planning for multilevel CDD.