Abstract
BackgroundCervical sagittal parameters were closely related with clinical outcomes after multi-level ACDF. Our purpose was to evaluate the clinical outcomes and cervical sagittal parameters in patients with MCSM after ACDF and to identify the risk factors of poor clinical outcomes.Material and methodsACDF was performed in 89 patients with MCSM. Based on average JOA recovery rate, patients were divided good-outcome group (group GO) and poor-outcome group (group PO). The cervical sagittal parameters including Cobb angle, SVA, T1S, cranial tilt and cervical tilt were measured. Multivariate logistic regression was used to identify risk factors.ResultsFifty-four patients (60.67%) were divided into group GO, while 35 patients (39.33%) were divided into group PO. Cobb angle, SVA and T1S was corrected from preoperative average 11.80° ± 9.63°, 23.69 mm ± 11.69 mm and 24.43° ± 11.78° to postoperative average 15.08° ± 9.05°, 18.79 mm ± 10.78 mm and 26.92° ± 11.94° respectively (p < 0.001). △Cobb angle (p = 0.008) and △SVA (p = 0.009) showed significantly statistical differences between two groups. Longer symptom duration, lower preoperative JOA score, smaller △Cobb angle and larger △SVA were identified as risk factors of poor clinical outcomes.ConclusionMulti-level ACDF is an effective surgical method to treat patients with MCSM. However, long duration of preoperative symptoms, lower preoperative JOA score, smaller △Cobb angle and larger △SVA are risk factors for poor outcomes in patients with MCSM after ACDF. Sagittal parameters should be paid attention to in surgery.
Highlights
Cervical spondylotic myelopathy (CSM) is caused by spinal cord compression as a result of multiple pathological changes such as disc herniation, degeneration and/or osteophyte formation at the posterior margin of the vertebral body [1]
Many previous studies had discussed different cervical sagittal parameters in healthy people or different cervical diseases [10, 12]; few studies have focused on the correlations between cervical sagittal parameters and clinical outcomes, especially in patients with Multi-level cervical spondylotic myelopathy (MCSM) after Anterior cervical discectomy and fusion (ACDF)
ACDF surgery was performed in 89 MCSM patients with an average follow-up visit of 2.57 years and the results showed neurological function was significantly improved at the last follow-up visit
Summary
Cervical spondylotic myelopathy (CSM) is caused by spinal cord compression as a result of multiple pathological changes such as disc herniation, degeneration and/or osteophyte formation at the posterior margin of the vertebral body [1]. As an anterior procedure surgery, multi-level ACDF was widely used in treating MCSM [9]. Cervical sagittal parameters, including cervical lordosis (CL) (that is Cobb angle in our study), C2-C7 sagittal vertical axis (SVA) and T1 slope (T1S) were proved to be related with clinical outcomes after ACDF in patients with CSM [10, 11]. The aim of the study was to evaluate the clinical outcomes and cervical sagittal parameters in patients with MCSM after ACDF and to identify the risk factors of poor clinical outcomes, which could help to make reasonable surgical program and achieve better clinical outcomes. Cervical sagittal parameters were closely related with clinical outcomes after multi-level ACDF. Our purpose was to evaluate the clinical outcomes and cervical sagittal parameters in patients with MCSM after ACDF and to identify the risk factors of poor clinical outcomes
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