World Neurosurg. 2022 Mar 5:S1878-8750(22)00286-8. doi: 10.1016/j.wneu.2022.03.005. Online ahead of print.
ABSTRACT
OBJECTIVES: This study aimed to clarify functional outcomes of facet joint distraction (FJD) and identify specific risk factors for excessive FJD during single-level anterior cervical discectomy and fusion (ACDF) for cervical spondylotic myelopathy (CSM).
METHODS: This study retrospectively analyzed 100 patients who underwent single-level ACDF for CSM from January 2016 to May 2020. Anteroposterior and lateral radiographs were obtained before surgery and 12 months after surgery. Radiographic parameters, including anterior intervertebral height (AIH), posterior intervertebral height, facet joint gap, cage posterior depth (CPD), upper vertebral length, cervical segmental cobb angle (CSCA), C2-C7 cobb angle and C2-C7 sagittal vertical axis were analyzed. Functional outcomes were evaluated using the modified Japanese Orthopedic Association Score (mJOA), Visual Analog Scale (VAS) and Neck Disability Index (NDI).
RESULTS: Comparison between the appropriate facet joint distraction and excessive facet joint distraction groups showed statistically significant differences in the NDI, VAS, CPD and ΔAIH (P<0.05). Multivariate logistic regression analysis showed independent factors associated with excessive FJD were: a ΔAIH>2.28mm (OR=6.792, 95%CI=1.885-24.470, P=0.003), CPD>12.45mm (OR=5.876, 95%CI=1.828-18.895, P=0.003) and post-CSCA<0° (OR=6.251, 95%CI=1.275-30.633, P=0.024). Furthermore, ROC curve analysis for the multi-level logistic regression model produced an area under the curve of 0.783 (P<0.001).
CONCLUSION: Patients with an FJD>0.905 mm had worse NDI and VAS pain scores, but not a poorer mJOA recovery rate. Our findings suggested that a ΔAIH>2.28 mm, CPD>12.45 mm and post-CSCA<0° were independent risk factors for excessive FJD after single-level ACDF for CSM.
PMID:35259505 | DOI:10.1016/j.wneu.2022.03.005
