Quantifying the Importance of Upper Cervical Extension Reserve in Adult Cervical Deformity Surgery and Its Impact on Baseline Presentation and Outcomes

作者：Peter G. Passias, Jamshaid Mir, Andrew J. Schoenfeld, Anthony Yung, Justin S. Smith, Virginie Lafage, Renaud Lafage, Bassel G. Diebo, Alan H Daniels, Breton Line, Robert K. Eastlack, Gregory M. Mundis, Khaled M. Kebaish, Jeffrey P. Mullin, Richard G. Fessler, Praveen V. Mummaneni, Dean Chou, D. Kojo Hamilton, Sang‐Hun Lee, Alex Soroceanu, Justin K. Scheer, Themistocles S. Protopsaltis, Han Jo Kim, Thomas J. Buell, Richard A. Hostin, Munish Kumar Gupta, Eric O. Klineberg, K. Daniel Riew, Douglas C. Burton, Frank J. Schwab, Shay Bess, Christopher I. Shaffrey, Christopher P. Ames, on behalf of the International Spine Study Group · 发表于：Neurosurgery · 年份：2025 · DOI：10.1227/neu.0000000000003538 · 被引用次数：3 · 研究领域：Cervical and Thoracic Myelopathy、Scoliosis diagnosis and treatment、Spinal Fractures and Fixation Techniques

BACKGROUND AND OBJECTIVES: The concept of upper cervical ( C0-C2) extension reserve (ER) capacity, ER relaxation, and their impact on outcomes following surgical correction of adult cervical deformity (ACD) has not been extensively studied. We aimed to evaluate the impact of upper cervical ER on postoperative disability and outcomes. METHODS: Patients with ACD, from a retrospective cohort study of a prospectively collected multicenter database, undergoing subaxial cervical fusion with 2-year (2Y) follow-up data were included. ER was defined as: ΔC0-C2 sagittal Cobb angle between neutral and extension. Relaxation of ER was defined as the ER mean in those that met all ideal thresholds in radiographic parameters for Passias et al CD modifiers. We used multivariable logistic regression to adjust for confounding, with conditional inference tree approaches used to determine thresholds that affect postoperative ER resolution on patient-reported outcomes. RESULTS: A total of 108 patients with ACD met inclusion. Preoperative C0-C2 ER was 8.7° ± 9.0°, and at last follow-up was 10.3° ± 11.1°. Preoperatively 29% of the cohort had adequate ER, whereas 60% had improved ER postoperatively, with 50% achieving adequate ER by 2Y. Lower ER correlated with greater CD ( P < .05). Preoperatively, greater ER had lower Neck Disability Index ( P < .001). Controlled analysis found improved ER to have a greater likelihood of achieving Neck Disability Index minimum clinically important difference (odds ...