Basic data and the comparison among the different surgical method groups.
This study was a retrospective study. From January 2017 to January 2020, a total of 57 patients with multilevel cervical spondylotic myelopathy who underwent three-level ACDF(n = 22) or ACDF + ACCF(n = 35) were enrolled, and the follow-up time was 2 years. The patients were divided into two groups according to the postoperative mJOA improvement rate: group A (excellent improvement group, mJOA improvement rate > 50%,n = 39) and group B (poor improvement group, mJOA improvement rate ≤ 50%,n = 18).
In the three-segment ACDF group, there were 22 patients, including 18 males (81.8%) and 4 females (18.2%), with an average age of (54.5 ± 10.8) years and an average BMI of 24.1 ± 2.8kg/m2. Mean symptom duration: 2.0 (0.9–6.3) months.
In the ACDF + ACCF group, there were 35 cases, including 28 males (80.0%) and 7 females (20.0%), with an average age of (58.5 ± 10.7) years and an average BMI of 23.8 ± 3.1kg/m2. Mean symptom duration: 6.0 (2.0–12.0) months.
We found that there were no statistically significant differences in age, gender, BMI, duration of symptoms, severity of preoperative symptoms, and postoperative recovery between the different surgical groups, but only statistically significant differences in postoperative SA, SA (postoperative to preoperative), operation time, and blood loss. Therefore, the differences in postoperative recovery were comparable between different surgical groups. (Table 2).
Table 2
Basic data and comparison among different surgical methods group.
| Three-ACDF (N = 22) | ACDF + ACCF (N = 35) | ×2 / T / Z | P-value |
Age | 54.5 ± 10.8 | 58.5 ± 10.7 | -1.352 | 0.182 |
Gender (Female, n (%)) | 4 (18.2%) | 7 (20.0%) | 0.029 | 0.866 |
BMI | 24.1 ± 2.8 | 23.8 ± 3.1 | 0.480 | 0.633 |
Duration of symptoms(Month) | 2.0 (0.9 ~ 6.3) | 6.0 (2.0 ~ 12.0) | -1.816 | 0.069 |
Smoking (n (%)) | 6 (27.3%) | 14 (40.0%) | 0.961 | 0.327 |
Drinking (n (%)) | 7 (31.8%) | 13 (37.1%) | 0.168 | 0.682 |
高血压病 | 5 (22.7%) | 9 (25.7%) | 0.065 | 0.799 |
糖尿病 | 3 (13.6%) | 1 (2.9%) | 2.405 | 0.121 |
冠心病 | 2 (9.1%) | 1 (2.9%) | 1.053 | 0.305 |
CCI | 2.1 ± 1.5 | 1.7 ± 1.5 | -0.836 | 0.407 |
CCI classification (0–1 point, n (%)) | 16 (72.7%) | 24 (68.6%) | 0.111 | 0.738 |
CL | 16.5 ± 8.9 | 15.9 ± 10.9 | 0.227 | 0.821 |
T1S | 24.7 ± 6.9 | 25.6 ± 6.9 | -0.460 | 0.647 |
C2-7SVA (mm) | 19.1 ± 12.9 | 20.0 ± 12.5 | -0.254 | 0.800 |
CL(F) | -19.4 ± 10.3 | -17.9 ± 9.0 | -0.551 | 0.584 |
CL(E) | 24.1 ± 9.5 | 23.3 ± 11.5 | 0.298 | 0.767 |
CL(ROM) | 43.5 ± 15.2 | 41.2 ± 14.0 | 0.585 | 0.561 |
SA术前 | 9.3 ± 6.9 | 10.6 ± 6.1 | -0.708 | 0.482 |
CL (术后) | 22.1 ± 7.5 | 19.3 ± 11.2 | 1.063 | 0.292 |
T1S (术后) | 33.9 ± 6.2 | 30.9 ± 5.4 | 1.913 | 0.061 |
C2-7SVA (术后) | 28.1 ± 1.1 | 28.5 ± 1.0 | -0.139 | 0.890 |
SA术后 | 17.7 ± 6.8 | 12.2 ± 6.5 | 3.116 | 0.003** |
CL (术后-术前) | 5.7 ± 10.4 | 3.4 ± 9.9 | 0.824 | 0.414 |
SA (术后-术前) | 8.4 ± 7.5 | 1.6 ± 7.7 | 3.292 | 0.002** |
Surgical time (min) | 189.0 ± 50.2 | 161.5 ± 42.4 | 2.222 | 0.030* |
Blood loss (ml) | 90.0 ± 33.5 | 202.4 ± 86.7 | -5.798 | < 0.001** |
住院天数 | 10.9 ± 11.3 | 9.3 ± 4.0 | 0.773 | 0.443 |
Pre-VAS | 3.7 ± 2.8 | 3.1 ± 2.5 | 0.825 | 0.413 |
Pre-NDI | 16.5 ± 12.8 | 15.2 ± 10.2 | 0.424 | 0.673 |
Pre-mJOA | 8.6 ± 2.1 | 8.8 ± 1.3 | -0.504 | 0.617 |
Post-VAS | 0.7 ± 1.0 | 1.1 ± 1.0 | -1.561 | 0.124 |
Post-NDI | 4.5 ± 5.7 | 6.1 ± 5.2 | -1.094 | 0.279 |
Post-mJOA | 14.6 ± 2.0 | 14.2 ± 2.0 | 0.648 | 0.520 |
mJOA recovery rate% | 63.6 ± 17.7 | 58.6 ± 20.4 | 0.934 | 0.354 |
*and lighter gray shading signify that P < 0.05. **and dark gray shading signify that P < 0.01. |
Comparison between the excellent improvement group and poor improvement group.
Patients were divided into two groups according to the mJOA improvement rate at 2 years after surgery: group A (excellent improvement group, mJOA improvement rate > 50%,n = 39) and group B (poor improvement group, mJOA improvement rate ≤ 50%,n = 18).
Group A (excellent improvement group, mJOA improvement rate > 50%) : a total of 39 patients, including 32 males (82.1%) and 7 females (17.9%), with an average age of (55.3 ± 11.0) years and an average BMI of 24.1 ± 2.8kg/m2. Mean duration of symptoms: 2.0 (1.0 to 6.0) months.
Group B (poor improvement group, mJOA improvement rate ≤ 50%) : a total of 18 patients, including 14 males (77.8%) and 4 females (22.2%), with an average age of (60.4 ± 9.8) years and an average BMI of 23.5 ± 3.5 kg/m2. Mean duration of symptoms: 11.0 (2.8 to 15.0) months. See Table 3 for details.
Table 3
Basic data and comparison between Group A and Group B.
| Group A (Excellent improvement) (n = 39) | Group B (Poor improvement) (n = 18) | T / ×2 / Z | P-value |
Age | 55.3 ± 11.0 | 60.4 ± 9.8 | 1.691 | 0.096 |
Gender (Female, n (%)) | 7 (17.9%) | 4 (22.2%) | 0.144 | 0.704 |
BMI | 24.1 ± 2.8 | 23.5 ± 3.5 | -0.624 | 0.535 |
Duration of symptoms (Month) | 2.0 (1.0 ~ 6.0) | 11.0 (2.8 ~ 15.0) | -2.723 | 0.006** |
Smoking (n (%)) | 16 (41.0%) | 4 (22.2%) | 1.912 | 0.167 |
Drinking (n (%)) | 14 (35.9%) | 6 (33.3%) | 0.036 | 0.850 |
高血压病 | 11 (28.2%) | 3 (16.7%) | 0.885 | 0.347 |
糖尿病 | 4 (10.3%) | 0 (0.0%) | 1.985 | 0.159 |
冠心病 | 2 (5.1%) | 1 (5.6%) | 0.005 | 0.946 |
Surgical methods —Three-ACDF | 18 (46.2%) | 4 (22.2%) | 2.976 | 0.084 |
—ACDF + ACCF | 21 (53.8%) | 14 (77.8%) |
Surgical time (min) | 171.0 ± 46.0 | 174.5 ± 50.7 | 0.259 | 0.797 |
Blood loss (ml) | 152.2 ± 91.6 | 173.8 ± 85.8 | 0.846 | 0.401 |
住院天数 | 9.5 ± 7.5 | 10.7 ± 8.0 | 0.529 | 0.599 |
CCI | 0.9 ± 1.1 | 1.3 ± 1.3 | 1.300 | 0.199 |
CCI classification — 0–1 point | 29 (74.4%) | 11 (61.1%) | 1.033 | 0.310 |
≥ 2 points | 10 (25.6%) | 7 (38.9%) |
CL | 17.3 ± 10.1 | 13.4 ± 9.8 | -1.377 | 0.174 |
T1S | 25.8 ± 6.4 | 24.0 ± 7.7 | -0.959 | 0.342 |
C2-7SVA (mm) | 15.6 ± 10.2 | 28.4 ± 12.8 | 4.038 | < 0.001** |
CL(F) | -18.7 ± 9.9 | -18.0 ± 8.8 | 0.252 | 0.802 |
CL(E) | 23.7 ± 11.8 | 23.5 ± 8.0 | -0.053 | 0.958 |
CL(ROM) | 42.3 ± 16.3 | 41.5 ± 9.2 | -0.205 | 0.838 |
SA术前 | 9.9 ± 6.1 | 10.5 ± 7.2 | 0.327 | 0.745 |
CL (术后) | 20.2 ± 10.4 | 20.6 ± 9.3 | 0.137 | 0.892 |
T1S (术后) | 32.6 ± 4.8 | 31.0 ± 7.6 | -0.911 | 0.366 |
C2-7SVA (术后) | 27.9 ± 1.0 | 29.3 ± 10.9 | 0.481 | 0.632 |
SA术后 | 15.6 ± 7.1 | 11.6 ± 6.5 | -2.050 | 0.045* |
CL (术后-术前) | 2.9 ± 9.5 | 7.2 ± 10.9 | 1.532 | 0.131 |
SA (术后-术前) | 5.7 ± 7.8 | 1.1 ± 8.6 | -2.018 | 0.048* |
Pre-VAS | 3.1 ± 2.5 | 3.9 ± 2.9 | 1.141 | 0.259 |
Pre-NDI | 14.6 ± 10.3 | 18.2 ± 12.9 | 1.132 | 0.262 |
Pre-mJOA | 8.7 ± 1.5 | 8.7 ± 1.9 | -0.054 | 0.957 |
Post-VAS | 0.7 ± 0.8 | 1.7 ± 1.0 | 3.984 | < 0.001** |
Post-NDI | 3.8 ± 4.3 | 9.0 ± 6.0 | 3.765 | < 0.001** |
Post-mJOA | 15.4 ± 1.1 | 12.1 ± 1.5 | -9.292 | < 0.001** |
mJOA recovery rate% | 71.6 ± 10.2 | 36.5 ± 10.4 | / | / |
*and lighter gray shading signify that P < 0.05. **and dark gray shading signify that P < 0.01. |
We get: Age, sex, BMI, smoking history, drinking history, hypertension, diabetes, coronary heart disease, operation method, operation time, blood loss, length of hospital stay, CCI, CCI grade, CL, T1S, CL(F), CL(E), CL(ROM), SA (preoperative), CL(postoperative), T1S (postoperative), and C2-7S were evaluated in group A and group B There was no significant difference in VA (postoperative), CL (postoperative - preoperative), Pre-VAS, Pre-NDI and Pre-mJOA. There were significant differences in symptom duration, C2-7SVA, SA (postoperative), SA (postoperative - preoperative) (P < 0.05). See Table 3 for details.
In order to better evaluate the independent risk factors of symptom duration, C2-7SVA, SA (postoperative), and SA (postoperative - preoperative), binary logistic regression analysis was used to compare the symptom duration, C2-7SVA, SA (postoperative), and SA (postoperative - preoperative). (Figure3)We obtained that only C2-7SVA was an independent risk factor for differences in postoperative improvement (Table 4). At the same time, the critical value calculated by ROC curve showed that when C2-7SVA > 25mm, the prognosis of patients was more likely to be poor (Fig. 1). The probability of poor prognosis increased 0.103 times for each 1mm increase in C2-7SVA (P = 0.006,OR = 1.103).
Table 4
Using Binary Logistic Regression Analysis to Judge Independent Risk Factors.
| B | P-value | OR | 95% Confidence Interval of OR |
Lower Bound | Upper Bound |
Duration of symptoms(M) | 0.030 | 0.211 | 1.031 | 0.983 | 1.081 |
C2-7SVA (mm) | 0.982 | 0.006** | 1.103 | 1.029 | 1.183 |
SA术后 | -0.053 | 0.430 | 0.948 | 0.830 | 1.083 |
SA (术后-术前) | -0.032 | 0.556 | 0.969 | 0.871 | 1.077 |
**and dark gray shading signify that P < 0.01 |
Correlation between preoperative basic data and imaging parameters and postoperative improvement
Pearson and Spearman correlation coefficients were used to calculate the correlation between preoperative basic data and imaging parameters and postoperative improvement. We found that age was positively correlated with postoperative VAS and postoperative NDI, and negatively correlated with postoperative mJOA and mJOA recovery rate. BMI was negatively correlated with postoperative VAS. Symptom duration was negatively correlated with mJOA recovery rate. Diabetes mellitus was negatively correlated with preoperative mJOA. The length of hospital stay was positively correlated with preoperative VAS, preoperative NDI, postoperative VAS and postoperative NDI, and negatively correlated with preoperative mJOA and postoperative mJOA. CCI was positively correlated with postoperative VAS and postoperative NDI. CCI group was positively correlated with postoperative VAS and postoperative NDI. T1S was positively correlated with preoperative NDI. C2-7SVA was positively correlated with postoperative VAS and NDI, and negatively correlated with postoperative mJOA and mJOA recovery rate. See Table 5 for details.
Table 5
Correlation between basic data and functional scores.
| Pre-VAS | Pre-NDI | Pre-mJOA | Post-VAS | Post-NDI | Post-mJOA | mJOA recovery rate |
Age | 0.146 | 0.170 | -0.223 | 0.326* | 0.378** | -0.404** | -0.370** |
Gender | 0.122 | 0.135 | -0.095 | 0.082 | 0.140 | -0.100 | -0.098 |
BMI | -0.198 | -0.221 | 0.031 | -0.282* | -0.207 | 0.147 | 0.143 |
Duration of symptoms | 0.137 | 0.074 | 0.125 | 0.140 | 0.102 | -0.240 | -0.345** |
Smoking | -0.005 | 0.007 | 0.052 | 0.013 | 0.119 | 0.216 | 0.199 |
Drinking | -0.005 | 0.016 | -0.038 | 0.088 | 0.180 | -0.051 | -0.025 |
高血压病 | -0.018 | -0.058 | 0.061 | -0.114 | -0.123 | 0.176 | 0.161 |
糖尿病 | 0.174 | 0.168 | -0.285* | 0.215 | 0.119 | -0.012 | 0.085 |
冠心病 | 0.058 | 0.056 | 0.094 | 0.084 | 0.157 | -0.041 | -0.078 |
Surgical methods | -0.111 | -0.057 | 0.068 | 0.206 | 0.146 | -0.087 | -0.125 |
Surgical time | 0.136 | 0.210 | -0.097 | -0.020 | 0.111 | -0.100 | -0.058 |
Blood loss | -0.224 | -0.184 | 0.163 | 0.034 | 0.007 | 0.021 | -0.046 |
住院天数 | 0.388** | 0.488** | -0.712** | 0.414** | 0.398** | -0.371** | -0.092 |
CCI | -0.092 | -0.066 | -0.180 | 0.292* | 0.281* | -0.208 | -0.139 |
CCI classification | 0.011 | 0.049 | -0.227 | 0.285* | 0.291* | -0.152 | -0.060 |
CL | 0.066 | 0.088 | -0.188 | 0.177 | 0.089 | 0.010 | 0.117 |
T1S | 0.211 | 0.262* | -0.072 | 0.142 | 0.152 | 0.053 | 0.065 |
C2-7SVA | 0.209 | 0.239 | -0.179 | 0.275* | 0.350** | -0.437** | -0.430** |
CL(F) | 0.068 | 0.052 | 0.066 | 0.168 | 0.139 | 0.034 | -0.023 |
CL(E) | 0.000 | 0.022 | 0.006 | 0.081 | 0.010 | -0.093 | -0.098 |
CL(ROM) | -0.045 | -0.018 | -0.039 | -0.051 | -0.085 | -0.091 | -0.057 |
SA术前 | 0.005 | 0.060 | -0.151 | 0.061 | 0.062 | -0.126 | -0.063 |
CL (术后) | 0.045 | 0.095 | -0.136 | 0.156 | 0.066 | -0.130 | -0.097 |
T1S (术后) | 0.190 | 0.126 | -0.008 | 0.046 | -0.065 | 0.100 | 0.043 |
C2-7SVA (术后) | -0.115 | -0.119 | -0.041 | -0.001 | -0.036 | -0.087 | -0.112 |
SA术后 | 0.028 | 0.041 | -0.105 | -0.004 | -0.078 | 0.065 | 0.115 |
CL (术后-术前) | -0.022 | 0.006 | 0.054 | -0.023 | -0.024 | -0.139 | -0.215 |
SA (术后-术前) | 0.020 | -0.011 | 0.027 | -0.050 | -0.115 | 0.153 | 0.147 |
*and lighter gray shading signify that the correlation is significant at the 0.05 level (2-tailed). |
**and dark gray shading signify that the correlation is significant at the 0.01 level (2-tailed). |