| Objective: To explore the significance of sagittal parameters of cervical vertebrae in clinical treatment by studying the changes of sagittal parameters in patients undergoing anterior cervical spine surgery.Methods: A retrospective study of 52 patients with cervical spondylosis who underwent cervical anterior decompression surgery in the Department of Orthopedics,the First Affiliated Hospital of China Medical University from2010 to 2017,including 28 males and 24 females.The average age was55.82±7.947 years,and the average follow-up time was 37.667±24.93 months.Among them,20 cases underwent anterior cervical discectomy and fusion(ACDF),and 29 cases underwent anterior cervical corpectomy decompression and fusion(ACCF).Mixed surgery(ACDF+ACCF)in 3 cases.Sagittal parameters were measured on the upright neutral lateral cervical radiographs one week preoperatively and at the last follow-up: C2-7 Cobb angle,T1 tilt angle(T1S),thoracic inlet angle(TIA),neck tilt angle(NT),the cervical sagittal vertical axis(c SVA)of the cervical spine and the patient’s JOA score and improvement rate were recorded.Preoperative and postoperative parameters were compared using paired t-test;the improvement rate was compared by chi-square test;the differences between groups were tested by independent sample t test;for each sagittal parameter and between sagittal parameters and clinical indicators we use bivariate Pearson correlation analysis.Results: 1.Compared with the last follow-up data,there was no significant change in C2-7 Cobb angle,TIA,T1 S and NT(P>0.05).c SVA improved from16.59±11.13 mm to 19.97±11.02mm(P<0.05),and JOA increased from10.82±2.674 to 14.06±2.063(P<0.01).2.Preoperative c SVA<15mm group,25>c SVA≥15mm and c SVA≥25mm group: There was no significant difference in the JOA scores between the three groups(P>0.05),but the improvement rate of c SVA≥25mm group was better than the other two groups(P<0.05).3.The preoperative TIA value of 80° was used as the dividing line to make further analyze: There was no significant difference in JOA score between the two groups before and after operation(P>0.05),while the TIA>80° group had higher improvement rate(TIA<80° group:41.57%,TI>80° group: 52.14%,P<0.05).4.Bivariate Pearson correlation analysis between the parameters of preoperative total data: C2-7Cobb angle was negatively correlated with c SVA(r=-0.391,P<0.01),and C2-7Cobb angle was positively correlated with JOA(r=0.322,P<0.05).),C2-7Cobb angle is positively correlated with T1 Slope angle(r=0.369,P<0.01),T1 S is positively correlated with TIA(r=0.519,P<0.01),improvement rate compared with TIA(r=0.346,P<0.05)and T1S(r=0.294,P<0.05)was positively correlated.5.Bivariate Pearson correlation analysis was performed on the changes between preoperative and postoperative data.The follow-up time was positively correlated with ΔJOA(r=0.288,P<0.05)and negatively correlated with ΔTIA(r=-0.394,P<0.01).ΔJOA was negatively correlated with ΔTIA(r=-0.304,P<0.05).Conclusion: Cervical anterior surgery has a significant effect on cervical spondylosis.The cervical sagittal parameters are closely related to each other and clinical symptoms.Preoperative TIA>80° or c SVA> The 25 mm patient has a good prognosis.It is recommended to maintain the postoperative TIA between 75-85° and the c SVA between 25-40 mm. |
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