Combined lateral mass–transfacet fixation for subaxial cervical spondylosis: clinical outcomes and development of a prognostic nomogram
Interdisciplinary Neurosurgery: Advanced Techniques and Case Management, cilt.45, 2026 (ESCI, Scopus)
- Yayın Türü: Makale / Tam Makale
- Cilt numarası: 45
- Basım Tarihi: 2026
- Doi Numarası: 10.1016/j.inat.2026.102356
- Dergi Adı: Interdisciplinary Neurosurgery: Advanced Techniques and Case Management
- Derginin Tarandığı İndeksler: Emerging Sources Citation Index (ESCI), Scopus, EMBASE, Directory of Open Access Journals
- Anahtar Kelimeler: Lateral mass fixation, Nomogram, Posterior decompression, Subaxial cervical spondylosis, Transfacet fixation
- Ankara Yıldırım Beyazıt Üniversitesi Adresli: Evet
Özet
Background: To develop a nomogram for predicting postoperative neurological recovery in patients with subaxial cervical spondylosis and to compare the outcomes of conventional lateral mass fixation and combined lateral mass–transfacet fixation. Methods: This single-center retrospective cohort study included 204 patients with subaxial cervical spondylosis who underwent conventional lateral mass or combined lateral mass–transfacet fixation. The primary endpoint was postoperative neurological recovery assessed using mJOA scores. Potential clinical, surgical, and radiological predictors were evaluated using univariable and multivariable logistic regression. Model discrimination and calibration were assessed, with internal validation performed using 1,000 bootstrap resamples. Results: Of 204 patients, 78 underwent combined lateral mass–transfacet fixation. Multivariable logistic regression showed that surgical technique [OR = 18.03; 95% CI: 1.08–318.35; p = 0.042] and preoperative sagittal spinal canal diameter [OR = 0.59; 95% CI: 0.39–0.87; p = 0.010] were independently associated with postoperative neurological recovery. The final nomogram demonstrated good discrimination [AUC = 0.796; 95% CI: 0.729–0.862]. Bootstrap internal validation demonstrated limited optimism, with an optimism-corrected C-index of 0.797 and a corrected calibration slope of 0.961. Conclusions: Combined lateral mass–transfacet fixation was associated with shorter operative times and favorable postoperative outcomes compared with conventional lateral mass fixation, suggesting that it may represent a feasible alternative for posterior cervical decompression and instrumented fixation in selected patients.