Shuai Xu

The short-segment instrument for precision treatment of lumbar stenosis syndrome (LSS) combined with degenerative thoracolumbar kyphosis (DTLK) receives more attention and the reasonable range of sagittal parameters is debatable in these elderly patients. This study aimed to include LSS patients combined with DTLK performed short-segmental fixation on LSS, to evaluate the efficacy of this procedure, and to determine the reasonable threshold of sagittal parameters. Overall 138 patients (female, 62.3%) were eligible (mean age of 68.8 ± 7.7 years) with a follow-up time of 24.6 ± 11.1 months. Spinopelvic sagittal parameters containing TLK, lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sagittal vertical axis were obtained at baseline and final visit, where |PI-LL|, PT, and sagittal vertical axis were seen as the main parameters. Quality of life was evaluated by the Oswestry Disability Index (ODI), which were divided into 4 quarters orderly. The reasonable threshold of parameters corresponding to ODI was determined by both linear regression and logistic regression. For all participants, TLK decreased by a mean of 8.3° and cases got TLK correction occupied 40.4%. ODI got improvement by the change of 29.9 ± 9.9. At baseline, ODI was correlated to |PI-LL|, while at final, ODI was correlated to |PI-LL| and PT. The independent factor affecting preoperative ODI was |PI-LL|, with ODI = 0.19 × |PI-LL| + 36.9 and the mean threshold of preoperative |PI-LL| was 10.7°. At final, PT was the influencing factor with ODI = 0.21 × PT + 3.16 and PT = 0.60 × |PI-LL| + 12.22. The mean threshold of postoperative |PI-LL| was 16.0° and PT was 23.1° by both linear regression and logistic regression. With short-segment fixation on LSS, >40% of patients with DTLK acquired TLK correction. |PI-LL| = 16.0° and PT = 23.1° was the “reasonable threshold” of sagittal parameters with the procedure for this population.

Purpose: To compare sagittal alignment and clinical outcomes between three-level hybrid surgery (HS) and anterior cervical discectomy and fusion (ACDF) on cervical spondylotic myelopathy (CSM) over a 5-year follow-up. Method: The study included 32 patients with ACDF, 36 patients with 1 prosthesis and 2 cages (HS1 group), and 25 cases with 2 prostheses and 1 cage (HS2 group). Alignment parameters included C2–C7 cervical lordosis (CL), C2–C7 sagittal vertical axis (SVA), T1 slope (T1S), and T1S minus CL (T1SCL). Radiographic parameters were range of motion (ROM), upper and lower adjacent ROM (UROM and LROM), and operated-segment lordosis (OPCL), as well as adjacent segment degeneration (ASD). Clinical outcomes included the neck disability index (NDI) and Japanese Orthopedic Association (JOA) score. Results: Three groups were well-matched in demographics. All groups gained comparable improvement on NDI and JOA (P < 0.01). All groups gained CL improvement at the final visit (P < 0.05). There were no statistical differences on SVA and T1SCL among the groups and among preoperation, 1 week later, and final follow-up (P > 0.05) while T1S improved at 1 week later and final follow-up with HS2. The final change of all alignment parameters among the three groups was of no differences. ROM decreased and OPCL increased in all groups at the final follow-up (P < 0.05). UROM and LROM increased with ACDF but kept stable with HS1 and HS2. There was no inter-group difference on the incidence of ASD (P > 0.05). Conclusion: Cervical alignment was comparably improved. HS and ACDF provided identified mid-term efficacy, and it was not necessary to have to use prosthesis on three-level CSM.