Background
Methods
Patient recruitment and inclusion criteria
Surgical procedure
Clinical outcome assessment
Radiological evaluation
Statistical analysis
Results
Patient demographics (Table 1)
ACDF without UPR (n = 24) | ACDF with complete UPR (n = 24) | p-value | |
---|---|---|---|
Sex | |||
Female | 15 | 16 | |
Male | 9 | 8 | 0.763 |
Mean age (years) | 47.9 ± 9.78 | 49.1 ± 9.67 | 0.669 |
BMD (g/cm2) T-score | −0.66 ± 1.21 | −0.78 ± 0.77 | 0.681 |
BMI (kg/m2) | 23.5 ± 2.47 | 23.5 ± 2.02 | 0.984 |
DM | 5 | 6 | 0.731 |
Smoking | 9 | 6 | 0.351 |
Operation level | |||
C2/3 | 0 | 0 | |
C3/4 | 6 | 5 | |
C4/5 | 15 | 15 | 0.999 |
C5/6 | 3 | 4 | |
C6/7 | 0 | 0 | |
Resection side | |||
Unilateral | 20 | ||
Bilateral | 4 |
Comparison of intraoperative blood loss, operative time, days of hospitalization, and clinical parameters (Table 2)
ACDF without UPR (n = 24) Median (Q1-Q3),(min-max) N(%) | ACDF with complete UPR (n = 24) Median (Q1-Q3),(min-max) N(%) | p-value | |
---|---|---|---|
Intraoperative blood loss (ml) | 60.00(52.50–80.00),(50.00–100.00) | 77.50(57.50–90.00),(50.00–140.00) | 0.175 |
Operation time (min) | 100.00(90.00–120.00),(90.00–150.00) | 120.00(100.00–130.00),(90.00–155.00) | 0.086 |
Duration of hospitalization (day) | 6.00(6.00–7.00),(5.00–9.00) | 6.00(6.00–7.00),(5.00–9.00) | 0.866 |
Arm VAS | |||
Preoperation | 9.00(8.00–9.00), (7.00–9.00) | 8.50(8.00–9.00), (7.00–9.00) | 0.116 |
Postoperation | 4.00(3.00–5.00), (2.00–6.00) | 3.00(2.00–3.50), (2.00–5.00) | 0.003* |
2 years follow-up | 2.00(1.00–2.00), (1.00–3.00) | 2.00(1.00–2.00),(1.00–3.00) | 0.711 |
Neck VAS | |||
Preoperation | 9.00(8.00–9.00), (7.00–9.00) | 9.00(8.00–9.00), (7.00–9.00) | 0.817 |
Postoperation | 2.00(1.00–5.00), (1.00–5.00) | 2.00(2.00–3.50), (2.00–5.00) | 0.657 |
2 years follow-up | 1.00(1.00–2.00), (1.00–3.00) | 1.00(1.00–1.00), (1.00–2.00) | 0.281 |
NDI | |||
Preoperation | 38.00(37.00–41.50), (35.00–44.00) | 40.50(37.50–42.00), (35.00–44.00) | 0.464 |
Postoperation | 24.00(21.00–25.00), (15.00–29.00) | 22.00(19.00–25.00),(15.00–27.00) | 0.514 |
2 years follow-up | 14.00(13.50–16.50), (11.00–19.00) | 13.50(11.00–15.00),(11.00–17.00) | 0.069 |
Odom’s criteria | |||
Excellent | 9 | 9 | 0.999 |
Good | 15 | 14 | |
Fair | 0 | 1 | |
Poor | 0 | 0 |
Comparison of radiologic parameters (Table 3)
ACDF without UPR (n = 24) Mean ± SD, N(%) | ACDF with complete UPR (n = 24) Mean ± SD, N(%) | p-value | |
---|---|---|---|
C2–C7 lordosis (°) | |||
Preoperation | 15.50(9.45–17.60), (3.90–20.80) | 14.10(5.45–19.55), (3.90–26.40) | 0.781 |
Postoperation | 15.80(10.25–17.90), (7.70–27.90) | 17.25(8.50–19.10), (3.00–27.30) | 0.772 |
2 years follow-up | 15.95(13.45–24.15), (10.20–28.50) | 14.65(11.00–29.70), (1.10–45.50) | 0.877 |
2 years follow-up - Preoperation | 3.80(0.70–8.50),(− 5.70–17.00) | 5.20(− 3.60–15.30),(− 12.20–30.00) | 0.984 |
Segmental angle (°) | |||
Preoperation | 5.45(4.60–5.95), (1.80–7.10) | 4.95(4.00–5.50), (1.30–7.10) | 0.215 |
Postoperation | 5.85(2.90–7.45), (0.50–14.40) | 5.70(3.45–7.55), (1.00–14.40) | 0.918 |
2 years follow-up | 5.90(5.10–7.25), (1.20–9.60) | 5.20(3.75–6.10), (0.90–10.00) | 0.207 |
2 years follow-up - Preoperation | 0.70(− 0.75–2.90), (− 4.80–5.30) | 0.50(− 1.60–2.30), (− 4.80–6.90) | 0.643 |
Disc height (mm) | |||
Preoperation | 5.60(5.15–6.18), (4.23–7.90) | 5.96(5.58–6.26), (5.18–6.97) | 0.173 |
Postoperation | 7.16(6.46–7.90), (5.84–8.91) | 7.53(7.27–7.84), (6.52–8.91) | 0.117 |
2 years follow-up | 6.22(5.41–6.58), (4.82–13.12) | 5.19(5.15–5.55), (5.01–5.82) | < 0.001* |
2 years follow-up – Preoperation | 0.08(− 0.52–2.02), (− 1.42–6.95) | − 0.44(− 1.15--0.19), (− 1.78–0.45) | 0.007* |
C2–C7 SVA (mm) | |||
Preoperation Postoperation | 20.05(15.39–26.31), (12.46–30.53) 19.33(13.92–26.13), (9.77–29.04) | 17.06(15.15–24.72), (6.97–28.53) 18.58(13.25–29.88), (6.72–39.25) | 0.261 0.877 |
2 years follow-up | 15.78(12.36–21.51), (10.62–30.84) | 17.28(11.18–29.57), (4.42–41.93) | 0.703 |
2 years follow-up - Preoperation | −3.98(− 5.80--2.84), (− 9.62–7.01) | − 0.26(− 4.15–5.88), (− 5.32–15.96) | 0.005* |
St-SVA (mm) | |||
Preoperation | 30.77(24.05–35.06), (15.71–42.98) | 25.68(20.72–29.36), (13.25–55.43) | 0.018* |
Postoperation | 27.65(17.49–28.63), (10.59–52.27) | 28.94(17.12–30.42), (4.40–61.23) | 0.414 |
2 years follow-up | 24.53(11.82–32.77), (9.37–48.84) | 28.56(11.53–41.36), (4.74–77.58) | 0.496 |
2 years follow-up - Preoperation | −1.30(− 3.00–1.25), (− 14.90–2.90) | 0.50(− 0.70–2.75), (− 15.40–7.10) | 0.066 |
T1 slope (°) | |||
Preoperation | 25.15(20.25–27.90), (12.00–31.60) | 24.10(22.00–25.90), (11.90–44.00) | 0.687 |
Postoperation | 24.85(17.10–28.10), (13.60–32.80) | 25.40(20.50–27.55), (14.80–32.50) | 0.599 |
Last follow-up | 23.50(17.60–27.00), (12.00–33.20) | 25.80(20.75–28.00), (15.40–49.20) | 0.327 |
Last follow-up - Preoperation | −1.30(− 3.00–1.25), (− 14.90–2.90) | 0.50(− 0.70–2.75), (− 15.40–7.10) | 0.066 |
SCA (°) | |||
Preoperation | 104.65(101.20–108.65), (89.90–115.90) | 111.05(107.85–114.70), (101.20–120.00) | < 0.001* |
Postoperation | 104.75(100.90–108.45), (94.60–117.00) | 105.90(103.65–111.45), (95.50–113.60) | 0.397 |
2 years follow-up | 105.80(100.60–111.60), (92.80–115.50) | 105.80(99.10–107.30), (87.30–121.40) | 0.634 |
2 years follow-up - Preoperation | 3.65(−4.50–8.35), (− 13.30–10.70) | −8.15(− 15.15–2.70), (− 20.10–9.80) | 0.004* |
Subsidence | 1 (4%) | 8 (33%) | 0.023* |
Fusion | 22 (92%) | 22 (92%) | 0.999 |
Binary multiple logistic regression of the five measurements as significant parameters on subsidence (Table 4)
Factor | Odds Ratio | 95% CI | p-value |
---|---|---|---|
Preoperative C2–C7 SVA | 1.034 | 0.896–1.192 | 0.651 |
Preoperative St-SVA | 0.946 | 0.863–1.037 | 0.238 |
Preoperative SCA | 1.237 | 1.074–1.425 | 0.003* |
Preoperative CL | 0.950 | 0.817–1.104 | 0.503 |
Preoperative T1-slope | 0.998 | 0.870–1.145 | 0.978 |