Background: ACDF treatment of CSM is currently recognized as a surgical method with reliable efficacy. However, the cervical radiographic findings in a certain group of patients showed that the symptoms were not completely relieved. This study will investigate the relationship between cervical parameters and prognoses after ACDF surgery. Methods: This study collected cases of CSM treated with ACDF in Zhongda Hospital from May 2014 to June 2018. The investigators recorded gender, age, cervical sagittal parameters, fusion segment, BMI, symptom duration, and NDI score. To compare the changes of parameters after surgery and explore the correlation between each factor and NDI score. Results: Generally, cervical lordosis increased and TS-CL decreased after surgery and during follow-up. Postoperative T1S, SVA and SCA decreased significantly compared to preoperative. T1S was positively correlated with CL (r = 0.245), SVA (r = 0.184), and negatively correlated with SCA (r = − 0.314) and NT (r = − 0.222). The last follow-up NDI score was positively correlated with T1S (r = 0.689), SVA (r = 0.155), TS-CL (r = 0.496), and age (r = 0.194), while negatively correlated with SCA (r = − 0.142). A linear regression model was established with the following formula: NDI = 0.809 × (T1S) − 0.152 × (CL) + 1.962 × (Sex) + 0.110 × (Age). T1S (B = 0.205, P < 0.001), CL (B = − 0.094, P = 0.041), and NT (B = 0.142, P = 0.023) were independent risk factors that affected whether the last follow-up NDI score was greater than preoperative. Conclusions: In ACDF treatment of CSM, there exists a close correlation between cervical sagittal parameters and NDI scores. T1S, CL, sex, and age were linearly dependent on NDI scores. The increase of T1S, NT, and the decrease of CL were risk factors that affected follow-up NDI score greater than preoperative. Reducing T1S is beneficial to clinical recovery.
Purpose: After ACDF, cervical lordosis loss, high C2-7 SVA and postoperative T1S will worsen the surgical prognosis. Therefore, this study evaluated the changes of cervical parameters after surgery and correlation with surgical prognosis. Methods: This study enrolled 212 cervical compressive myelopathy patients who underwent ACDF. We collect gender, age, BMI, NDI scores and cervical parameters. And then, we compare the changes of parameters after surgery, and explore the correlation between parameters and NDI score. Results: C2-7 Cobb Angle, SVA, T1S and TS-CL were all improved after surgery, but T1S at the last follow-up was larger than that before the surgery. T1S is positively correlated with TIA (p=0.018, r=0.081), CL (p<0.01, r=0.150) and SVA (p<0.01, r=0.131), but negatively correlated with SCA (p<0.01, r=-0.166). We also found that TIA was highly correlated with the sum of T1S+NT (p<0.01, r=0.459). Preoperative NDI was negatively correlated with preoperative c2-7 Cobb Angle (r=-0.147, p=0.033), positively correlated with SVA (r=0.157, p=0.022). The last follow-up NDI score was negatively correlated with C2-7 Cobb Angle (r=-0.222 p=0.001), positively correlated with SVA (r=0.498, p<0.001) and TS-CL (r=0.165, p=0.016). The risk factors with poor follow-up NDI score (the last follow-up NDI score greater than 30%) were SVA (B=0.337, P=<0.001), CL (B=-0.147, P=0.029) and gender (B=2.153, P=0.017). Conclusions: After ACDF, most postoperative cervical parameters have improved, but T1S deteriorated over time. There was a close correlation between cervical sagittal parameters. Preoperative NDI score was correlated with c2-7 Cobb Angle and SVA. Follow-up NDI score was correlated with CL, TS-CL and SVA. High SVA, loss of cervical lordosis and male patient were risk factors for the deterioration of postoperative NDI score.
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