Cervical curvature changes and neurological outcomes following non-fusion surgery for cervical space-occupying lesions in adults: a multicenter retrospective study

Kyphosis is a potential complication after resection of cervical space-occupying lesions, and whether non-fusion surgery can maintain cervical stability remains controversial. We aimed to investigate long-term changes in neurological function and cervical curvature after non-fusion surgery in adults, and to further explore the prognostic factors.

We reviewed adult patients who underwent non-fusion surgery for resection of cervical space-occupying lesions at three neurosurgical centers. The neurological function grade defined by modified McCormick scale, the change of cervical Cobb lordotic angle (CLA), and the incidence of progressive kyphotic deformity and secondary fusion surgery were described. We also conducted regression analyses to explore the factors influencing CLA and neurological function.

A total of 211 adults were enrolled in our study. The long-term follow-up showed that 84% patients achieved good neurological outcomes. The average change of CLA was 1.2 ± 7.2 degrees. There was no significant difference in CLA at follow-up compared with the preoperative value. Progressive kyphotic deformity was observed in 9(7%) patients and none of the patients underwent secondary spinal fixation surgery. Regression analysis identified LAMP surgery as a protective factor for CLA change (β = 5.519[1.994, 9.043]) while C-2 involvement as a risk factor (β=-3.433[-6.250, -0.616]).

The majority of patients undergoing non-fusion surgery for cervical space-occupying lesions achieve favorable neurological function and maintain ideal cervical curvature. Those patients whose C-2 were involved require more frequent follow-up.