Cervical lordosis ratio can be used as a decision-making indicator for selection of posterior surgical approach for multi-level cervical spondylotic myelopathy

doi:10.12307/2025.136

Abstract

Abstract: BACKGROUND: At present, research has only shown that the cervical lordosis ratio can be an important factor in predicting the loss of lordosis curvature after laminoplasty, and no one has studied whether the cervical lordosis ratio, a dynamic level indicator, can be one of the decision-making factors for the selection of posterior cervical surgical procedures.
OBJECTIVE: To investigate whether the cervical lordosis ratio, an index of cervical hyperextension and hyperflexion, can be used as a selective index for laminoplasty and laminectomy fusion.
METHODS: A retrospective review of 141 patients who had undergone posterior cervical surgery more than one year of follow-up due to multi-level cervical spondylotic myelopathy from December 2015 to March 2020 was performed. Among them, 63 patients received laminectomy and fusion (laminectomy and fusion group) and 78 patients received laminoplasty (laminoplasty group). The demographic statistics (gender, age, body mass index, follow-up time), imaging indexes such as C2-7 Cobb angle, C2-7 range of motion, flexion Cobb angle, extension Cobb angle, flexion range of motion and extension range of motion, clinical effect indexes such as Japanese Orthopaedic Association score and visual analog scale score were compared between the two groups. The evaluation index of cervical lordosis alignment change was C2-7 Cobb angle difference before and after operation (ΔCL). Cervical lordosis ratio was equal to 100% × flexion range of motion / C2-7 range of motion. Receiver operating characteristic curve analysis was used to determine the role of cervical lordosis ratio in predicting postoperative severe cervical lordosis loss (ΔCL≤-10°). According to the critical value of cervical lordosis ratio (68.5%), all patients were divided into low cervical lordosis ratio group and high cervical lordosis ratio group. In these two ratio groups, the cervical lordosis alignment index and clinical effect index between the two operation groups were discussed again.

RESULTS AND CONCLUSION: (1) Cervical lordosis alignment decreased after laminectomy and fusion and laminoplasty (P=0.039, P=0.002), and cervical lordosis alignment change in laminoplasty group (ΔCL) was greater than that of laminectomy and fusion group, and the difference between the two groups was statistically significant. (2) Based on receiver operating characteristic curve analysis, cervical lordosis ratio in predicting severe cervical lordosis alignment change (ΔCL≤-10°) had good identification ability (area under the curve=0.792). (3) In low cervical lordosis ratio group, there was no significant difference in cervical lordosis alignment change (ΔCL) between laminectomy and fusion group and laminoplasty group (P=0.141). (4) In high cervical lordosis ratio group, the ΔCL of laminoplasty group was greater than that in laminectomy and fusion group (P=0.001), which had a higher probability of postoperative severe cervical lordosis alignment change (ΔCL≤-10°) (43%, 29%). (5) It is indicated that cervical lordosis ratio can be used as a decision-making index for the choice of posterior surgery for multi-level cervical spondylotic myelopathy. Laminoplasty can be considered in the low cervical lordosis ratio group, while laminectomy and fusion can be considered in the high cervical lordosis ratio group.

中国组织工程研究杂志出版内容重点：人工关节；骨植入物；脊柱；骨折；内固定；数字化骨科；组织工程

Key words: multi-level cervical spondylotic myelopathy, laminoplasty, laminectomy and fusion, cervical lordosis ratio, dynamic imaging indicator, postoperative cervical lordosis alignment

CLC Number:

R459.9|R318|R678

Miao Jiahang, Ma Sheng, Li Qupeng, Yu Huilin, Hu Tianyu, Gao Xiao, Feng Hu. Cervical lordosis ratio can be used as a decision-making indicator for selection of posterior surgical approach for multi-level cervical spondylotic myelopathy[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(9): 1796-1802.

Figures/Tables 6

2.6 CLR对术后颈椎前凸曲度丢失过多(ΔCL≤-10°)预测的ROC曲线分析通过ROC曲线分析(图4)，曲线下面积为0.792，状态变量为ΔCL≤-10°，临界值为68.5%，敏感性为81%，特异性为63.6%。根据CLR临界值将患者分为高比率组(≥68.5%)和低比率组(< 68.5%)。 2.7 不同CLR比率组下两种术式的临床效果评分的比较通过对不同比率组患者的临床结果进行比较，在低比率组中，椎板切除融合术和椎板成形术在目测类比评分改变、JOA评分恢复率方面差异无显著性意义(P > 0.05)，在高比率组中，椎板切除融合术和椎板成形术在目测类比评分改变方面差异无显著性意义(P=0.849)，但在JOA评分恢复率方面，差异有显著性意义(P=0.001)。见表5。 2.8 不同CLR比率组下两术式组颈椎前凸曲度相关指标的比较在不同比率组下进一步对两个术式的术后颈椎前凸曲度变化进行比较，在低比率组中，两术式组间术后颈椎前凸曲度变化(ΔCL)差异无显著性意义(P=0.141)，在术后前凸曲度丢失过多(ΔCL≤-10°)方面，椎板切除融合组和椎板成形组分别为14%和17%，差别较小；在后凸畸形方面，椎板切除融合组和椎板成形组分别为5%和0%。在高比率组中，两术式组之间术后颈椎前凸曲度变化差异有显著性意义(P=0.001)，在术后前凸曲度丢失过多(ΔCL≤-10°)方面，椎板切除融合组和椎板成形组分别为29%和43%，差别较大；在术后后凸畸形方面，椎板切除融合组和椎板成形组分别为7%和11%。此外，无论是椎板切除融合术还是椎板成形术，高比率组的颈椎前凸曲度变化(ΔCL)始终是要大于低比率组(P=0.045，P < 0.001)。见表6。 2.9 典型病例见图5，6。 2.10 不良事件此次研究纳入141例患者在并发症方面，共有2例患者发生C5神经根麻痹，其中椎板成形组1例(1.3%)，椎板切除融合组1例(1.6%)，全部在术后3-6个月显著好转；共3例患者出现术后切口感染，其中椎板成形组2例，椎板切除融合组1例，术后使用敏感抗生素两三周后感染消退(症状好转，辅助检查指标恢复正常)；所有患者均未出现其他手术相关并发症，如脑脊液漏、血肿、食管气管瘘、声音嘶哑、脊髓神经损伤、肌力进行性下降等不良事件；均未出现患者伤残、危及生命或死亡等严重不良事件。"

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