Stopping at C2 Versus C3/4 in Elective Posterior Cervical Decompression and Fusion: A 5-Year Follow-up Study.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2025-02-01 Epub Date: 2024-05-30 DOI:10.1097/BSD.0000000000001646

Connor C Long, John E Dugan, Hani Chanbour, Jeffrey W Chen, Iyan Younus, Soren Jonzzon, Inamullah Khan, Douglas P Terry, Jacqueline S Pennings, Julian Lugo-Pico, Raymond J Gardocki, Amir M Abtahi, Byron F Stephens, Scott L Zuckerman

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Abstract

Study design: This is a retrospective cohort study.

Objective: In patients undergoing elective posterior cervical laminectomy and fusion (PCLF) with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with an upper instrumented vertebra (UIV) of C2 versus C3/4.

Summary of background data: The long-term outcomes of choosing between C2 versus C3/4 as the UIV in PCLF remain unclear.

Methods: A single-institution, retrospective cohort study from a prospective registry was conducted of patients undergoing elective, degenerative PCLF from December 2010 to June 2018. The primary exposure was UIV of C2 versus C3/4. The primary outcome was reoperation. Multivariable logistic regression controlled for age, smoking, diabetes, and fusion to the thoracic spine.

Results: Of the 68 patients who underwent PCLF with 5-year follow-up, 27(39.7%) had a UIV of C2, and 41(60.3%) had a UIV of either C3/4. Groups had similar duration of symptoms ( P =0.743), comorbidities ( P >0.999), and rates of instrumentation to the thoracic spine (70.4% vs. 53.7%, P =0.210). The C2 group had significantly longer operative time (231.8±65.9 vs. 181.6±44.1 mins, P <0.001) and more fused segments (5.9±1.8 vs. 4.2±0.9, P <0.001). Reoperation rate was lower in the C2 group compared with C3/4 (7.4% vs. 19.5%), though this did not reach statistical significance ( P =0.294). Multivariable logistic regression showed increased odds of reoperation for the C3/4 group compared with the C2 group (OR=3.29, 95%CI=0.59-18.11, P =0.170), though statistical significance was not reached. Similarly, the C2 group had a lower rate of instrumentation failure (7.4% vs. 12.2%, P =0.694) and adjacent segment disease/disk herniation (0% vs. 7.3%, P =0.271), though neither trend attained statistical significance.

Conclusions: Patients with a UIV of C2 had less than half the number of reoperations and less adjacent segment disease, though neither trend was statistically significant. Despite a lack of statistical significance, whether a clinically meaningful difference exists between UIV of C2 versus C3/4 should be validated in larger samples with long-term follow-up.

Level of evidence: Level-3.

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在选择性颈椎后路减压融合术中停止在 C2 与 C3/4：五年随访研究

研究设计这是一项回顾性队列研究：在接受至少 5 年随访的择期颈椎后路椎板切除融合术（PCLF）患者中，我们试图比较上部器械椎体（UIV）为 C2 与 C3/4 患者的再手术率：在 PCLF 中选择 C2 或 C3/4 作为 UIV 的长期结果仍不清楚：从 2010 年 12 月到 2018 年 6 月，对接受择期退行性 PCLF 的患者进行了一项前瞻性登记的单一机构回顾性队列研究。主要暴露是C2与C3/4的UIV。主要结果是再次手术。多变量逻辑回归控制了年龄、吸烟、糖尿病和胸椎融合：在接受PCLF手术并随访5年的68名患者中，27人（39.7%）的UIV为C2，41人（60.3%）的UIV为C3/4。两组患者的症状持续时间（P=0.743）、合并症（P>0.999）和胸椎器械植入率（70.4% vs. 53.7%，P=0.210）相似。C2组的手术时间明显更长（231.8±65.9 vs. 181.6±44.1分钟，PC结论：UIV为C2的患者再次手术的次数少于一半，邻近节段疾病也较少，但这两种趋势都没有统计学意义。尽管缺乏统计学意义，但C2与C3/4的UIV之间是否存在有临床意义的差异，应在更大样本中进行长期随访验证：证据级别：3 级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.