Analysis of Associating Factors With C2-7 Sagittal Vertical Axis After Two-level Anterior Cervical Fusion

Kwon, Woo Keun; Kim, Pyeong Soo; Ahn, Seong Yong; Song, Jye Young; Kim, Joo Han; Park, Youn Kwan; Kwon, Taek Hyun; Moon, Hong Joo

doi:10.1097/brs.0000000000001776

Cited by 56 publications

(52 citation statements)

References 21 publications

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“…Smith et al [15] found that C2-7 SVA was negatively correlated with JOA scores for cervical spondylotic myelopathy. The T1 s is known to have a significant correlation with the C2-7 SVA [16].…”

Section: Discussionmentioning

confidence: 99%

Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical Spondylotic myelopathy

Huang

Lan

2019

BMC Musculoskelet Disord

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BackgroundTo investigate the relationships between sagittal parameters and health-related quality of life (HRQOL) scores following anterior cervical hybrid decompression and fusion (ACHDF) of multilevel cervical spondylotic myelopathy (CSM) and to study the impact of the T1 slope (T1 s).MethodsIn total, 42 patients with complete radiographic measurements following ACHDF in the Spine Surgery Department of the First Affiliated Hospital of Fujian Medical University from August 2014 to January 2017 were retrospectively analysed. Radiographic measurements included C2–7 lordosis, T1 s, C2–7 sagittal vertical axis (SVA), cervical tilting and cranial tilting. The neck disability index (NDI) was used to evaluate the HRQOL. Spearman’s correlation coefficients were calculated between pairs of cervical sagittal parameters and NDI scores.ResultsPreoperative NDI scores were correlated with preoperative T1 s (r = 0.413); follow-up NDI scores were correlated with follow-up T1 s (r = 0.534). The regression analysis indicated that a preoperative T1 s value of 42.36° corresponded to a preoperative NDI score of 25 (r2 = 0.171, P < 0.001). A follow-up T1 s value of 48.61° corresponded to a follow-up NDI score of 25 (r2 = 0.421, P < 0.01). The differences in C2–7 SVA and cranial tilting before and after the operation were statistically significant (P < 0.05).ConclusionThis study showed that the sagittal balance of the cervical vertebrae changed significantly after ACHDF, showing a forward trend. The sagittal parameters after ACHDF were related to clinical prognosis. An excessive T1 s can be considered a risk factor. The T1 s could provide a reference value to determine the correction of the sagittal balance of the cervical spine.

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Section: Discussionmentioning

confidence: 99%

Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical Spondylotic myelopathy

Huang

Lan

2019

BMC Musculoskelet Disord

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“…Kwon et al [6] noted that a C2-C7 sagittal vertical axis (SVA) value of 40 mm was the cutoff score beyond which the NDI was vastly adversely affected. Weng et al [3] conducted a study on patients with degenerative cervical disease and found that T1 slope (T1s), measured at the vertebral body at the intersection of the cervical spine and thoracic spine, had a significantly greater influence than the C2-7 SVA on the prognosis of patients.…”

Section: Introductionmentioning

confidence: 99%

Analysis of a radiographic parameter K-line tilt following adjacent two-level anterior cervical discectomy and fusion: a retrospective study

Lan

et al. 2020

J Orthop Surg Res

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Background: T1s, C2-7 lordosis, and C2-7 sagittal vertical axis (SVA) are the three most important sagittal parameters in the cervical spine. This study was conducted to investigate the relationships between classical sagittal alignment parameters and a new parameter, K-line tilt, and to study the impact of K-line tilt. Material and methods: A total of 72 patients who underwent adjacent two-level anterior cervical discectomy and fusion (ACDF) were retrospectively analyzed. Radiographic measurements included T1 slope (T1s), C2-7 lordosis, segment angle (SA), C2-7 SVA, and K-line tilt. The Neck Disability Index (NDI) scores were used to evaluate the clinical prognosis. Pearson correlation coefficients were calculated between radiographic measures. Linear regression analysis was used to analyze the relationship between follow-up K-line tilt and NDI. Results: ΔNDI was positively correlated with ΔT1s (r = 0.620, p < 0.05), ΔC2-7 SVA (r = 0.645, p < 0.05), and ΔK-line tilt (r = 0.702, p < 0.01); ΔK-line tilt was positively correlated with ΔT1s (r = 0.650, p < 0.05), ΔSA (r = 0.269, p < 0.05), and ΔC2-7 SVA (r = 0.293, p < 0.05); ΔT1s was positively correlated with ΔC2-7 lordosis (r = 0.428, p < 0.05), ΔSA (r = 0.631, p < 0.01), and ΔC2-7 SVA (r = 0.235, p < 0.05); ΔC2-7 lordosis was positively correlated with ΔSA (r = 0.666, p < 0.05) and negatively correlated with ΔC2-7 SVA (r = − 0.467, p < 0.01). The preoperative and postoperative K-line tilt values were statistically significant (p < 0.01), increasing from (7.50 ± 6.48)°to (9.95 ± 5.09)°. Preoperative NDI was positively correlated with preoperative C2-7 SVA (r = 0.639, p = 0.011) and K-line tilt (r = 0.516, p = 0.026); follow-up NDI was positively correlated with follow-up T1s (r = 0.664, p = 0.038), C2-7 SVA (r = 0.756, p = 0.004), and K-line tilt (r = 0.832, p = 0.006). The linear regression model showed that when the follow-up K-lint tilt was > 23.75°, NDI scores were > 25 (R 2 = 0.737, p = 0.000). Conclusion: This study showed that the K-line tilt was strongly correlated with the C2-C7 SVA, indicating that the K-line tilt can be used as another cervical parameter to evaluate cervical alignment in adjacent two-level ACDF. Kline tilt is an important parameter similar to the classical parameter C2-C7 SVA. In particular, a K-line tilt greater than 23.75 corresponded to a worse clinical prognosis, which was defined as an NDI score greater than 25.

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“…Nevertheless, multivariate logistic regression showed different CK types was not the risk factor for the ANP, in spite of disc degeneration caused by abnormal kinematics. Previous studies demonstrated almost 20% asymptomatic individuals have cervical disc degeneration [28,29] . Therefore, similar to their study, disc degenration was also found in Non-ANP group.…”

Section: Discussionmentioning

confidence: 99%

The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Zhang

Shen

2020

Preprint

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Background:Cervical sagittal alignment is closely related with cervical disc degeneration and impacts the spinal function and quality of life, especially for cervical kyphosis (CK). The purpose of this study was to evaluate the influence of cervical sagittal parameters on the axial neck pain (ANP) in patients with CK.Methods: A retrospective analysis was performed of data from 263 patients who underwent to the authors' department of this institution between January 2012 and December 2018. Radiographic evaluations were performed at authors' department, including CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt and cervical tilt. Sagittal alignment of the cervical spine was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to evaluate these parameters as the risk factors for ANP.Results: Patients in this study were divided into 2 groups according to ANP. There were 92 patients in ANP group and 171 patients in Non-ANP group. There was no significant difference in age (P=0.196), gender (P=0.516), TIA(P=0.139), NT (P=0.676), CK types (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585) and cervical disc degeneration (P=0.695) between the two groups. T1 slope, C2-7 SVA in the ANP group was significantly higher than in the Non-ANP group (P < 0.05). After multivariate logistic regression analysis, C2-7 SVA (P=0.003, OR 2.318, 95% CI 1.373-4.651) and T1 slope (P=0.028, OR 2.563, 95% CI 1.186-4.669) were the two risk factors for the ANP.Conclusions: Based on this study, cervical sagittal parameters have a significant effect on the happening of axial neck pain in patients with CK. A higher T1 slope and larger C2-7 SVA are closely lead to the development of neck pain. BackgroundCervical sagittal imbalance is the one of the main reasons for decreased intervertebral disc height, further leads to the cervical degenerative disease [1, 2] . The misalignment exacerbates more distribution of the load on the intervertebral disc and posterior joints, accelerates the progression of spinal degenerative diseases during the range of motion. However, there is limited data exploring the relationship between cervical sagittal alignment and axial neck pain(ANP). JL carried out the manuscript preparation and experimental design, DZ conducted patient visits and statistical analysis of the data. JL and DZ carried out the statistical analysis of the data.YS revised the manuscript critically for important intellectual content and gave final approval of the version to be published.All authors read and approved the final version of this manuscript. Authors' information

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Analysis of Associating Factors With C2-7 Sagittal Vertical Axis After Two-level Anterior Cervical Fusion

Abstract: 3.

Cited by 56 publications

References 21 publications

Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical Spondylotic myelopathy

Analysis of sagittal alignment parameters following anterior cervical hybrid decompression and fusion of multilevel cervical Spondylotic myelopathy

Analysis of a radiographic parameter K-line tilt following adjacent two-level anterior cervical discectomy and fusion: a retrospective study

The impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

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