Abstract

Objective. To identify factors leading to the loss of correction and re-dislocation of the vertebrae after isolated anterior reconstruction and stabilization in the surgical treatment of subaxial cervical dislocations. Material and Methods. A retrospective cohort STROBE-type study was carried out using data of 175 patients with dislocations of vertebrae in the subaxial cervical spine who were operated on in 2010–2019. The key parameters of the study were the relevant indices of the cervical sagittal balance and morphological characteristics of the injury: thoracic inlet angle (TIA), T1 vertebra slope, neck tilt, regional cervical C2–C7 lordosis, fracture of the vertebral body, and fracture of the articular process at the level of dislocation. Statistical analysis of the obtained data was carried out in the RStudio program. Results. At preoperative TIA value of 74.5°, the risk of correction loss corresponds to 28 %. In the group with TIA < 74.5° and that with TIA ≥ 74.5°, the risk of correction loss is 17.3 % (95 % CI: 7–37 %) and 85.7 % (95 % CI: 60–96 %), respectively. With an increase in TIA by 10°, the chance of recurrence increases by 23.3 times. The effect of the articular process fracture on the loss of correction is equivalent to an increase in TIA by 10°, namely, it increases the chance of recurrence by 20.7 times. The parameter “duration of injury” has an effect on the loss of correction, but it is statistically insignificant (p > 0.05). Conclusion. The parameter of the cervical sagittal balance, thoracic inlet angle, as well as the fracture of the articular process at the level of injury are statistically significant factors that determine the initial stability in isolated anterior surgical reconstruction and stabilization of the lower cervical spine for Allen type 3 flexion-distraction injuries.

Highlights

  • The parameter of the cervical sagittal balance, thoracic inlet angle, as well as the fracture of the articular process at the level of injury are statistically significant factors that determine the initial stability in isolated anterior surgical reconstruction and stabilization of the lower cervical spine for Allen type 3 flexion-distraction injuries

  • На основании этого мы провели моделирование прогноза формирования рецидива с использованием значения TIA = 70,0° и 74,5°

  • В группах с TIA < 74,5° и с TIA ≥ 74,5° риски потери коррекции равны 17,3 % (95 % ДИ: 7–37 %) и 85,7 % (95 % ДИ: 60–96 %) соответственно (p < 0,001, ОР = 4,9, 95 % ДИ: 2,0–12,3 %)

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Summary

Objective

To identify factors leading to the loss of correction and re-dislocation of the vertebrae after isolated anterior reconstruction and stabilization in the surgical treatment of subaxial cervical dislocations. A.D. Lastevsky et al Predicting the loss of correction after isolated anterior stabilization by 10°, the chance of recurrence increases by 23.3 times. The parameter of the cervical sagittal balance, thoracic inlet angle, as well as the fracture of the articular process at the level of injury are statistically significant factors that determine the initial stability in isolated anterior surgical reconstruction and stabilization of the lower cervical spine for Allen type 3 flexion-distraction injuries. Цель исследования – выявление факторов, приводящих к потере коррекции и редислокации позвонков после изолированной передней хирургической реконструкции и стабилизации при вывихах субаксиальной локализации. Научная гипотеза исследования заключается в том, что имеется значимое влияние определенных параметров сагиттального шейного баланса и особенностей морфологии повреждения на индукцию процесса редислокации, то есть потерю интраоперационно достигнутой коррекции после изолированной передней стабилизации при флексионно-дистракционных повреждениях на уровне С6–С7 типа 3 по Allen [18]. Дизайн исследования: ретроспективное когортное типа STROBE [19]

Материал и методы
Давность травмы
Findings
Частота случаев
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