Abstract
ObjectiveThis study was a retrospective multivariable analysis for risk factors of poor outcome in patients who underwent anterior hybrid approach, and discussed the causes of worsening of postoperative local alignment.MethodsA total of 86 patients with progressive spinal cord compression and local kyphosis underwent an anterior hybrid approach (ACDF+ACCF), between June 2011 and June 2017. We evaluated clinical outcome by the Japanese Orthopaedic Association (JOA) score and recovery rate. Patients were divided into two groups according to the worsening and improving of postoperative local alignment. Multivariate logistic regression analysis was applied to the evaluation of risk factors. Mann-Whitney U test, independent t test, and chi-squared test were performed for the comparison of local kyphosis between postoperative and last follow-up.ResultsThere were twenty patients who had a recovery rate of less than 50%. Advance age, longer duration of symptoms, bigger T1 slope angle, and lower change of local kyphosis angle were significantly associated with a poor clinical outcome by multivariate logistic regression analysis. The cause of worsening of postoperative local alignment had T1 slope, C2–7 sagittal vertical axis (SVA), adjacent segment degeneration (ASD), and implant subsidence.ConclusionsThe change of local kyphosis was a predictor of clinical outcome after the hybrid approach. Furthermore, postoperative ASD, implant subsidence, T1 slope, and C2–7 Cobb were associated with recurrence of postoperative cervical kyphosis.
Highlights
Cervical spondylotic myelopathy (CSM) as a result of cervical stepwise degeneration usually has a deterioration of neurological function
Conservative treatment could improve this disease to a certain extent, surgery remained the key to decompression of the spinal cord and correction of kyphosis [6,7,8]
The poor group had a significant difference in age (p < 0.001), duration of symptoms (p = 0.002), preoperative T1 slope angle (p = 0.001), change of local angle (CLA) (p < 0.001), local kyphotic angle (LKA) at last follow-up (p = 0.003), and worsening of postoperative local alignment (WPLA) (p = 0.032)
Summary
Cervical spondylotic myelopathy (CSM) as a result of cervical stepwise degeneration usually has a deterioration of neurological function. Conservative treatment could improve this disease to a certain extent, surgery remained the key to decompression of the spinal cord and correction of kyphosis [6,7,8]. The approaches of treatment of multilevel CSM (m-CSM) with CK included anterior cervical discectomy and fusion (ACDF), anterior cervical corpectomy and fusion (ACCF), and posterior laminectomy and laminoplasty. Both anterior and posterior approaches were able to improve the clinical recovery of neurological function, but the selection of approaches remained controversial [9, 10]
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