Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Understanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>Consecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>A total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0–55 mm), 10.4° (range −6.0° to 44°), and 28.3° (range 14.0°–51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p &lt; 0.001) and 12 months (p &lt; 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p &lt; 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p &lt; 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>ACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.</jats:p></jats:sec>

Risk Factors for Dysphagia after Anterior Cervical Discectomy and Fusion with the Zero-P Implant system: A Study with Minimum of 2 Years Follow-up

“…[17][18][19] And the result of some studies indicated the Cobb angle, T1 slope and some other parameters are closely related to clinical outcomes. [20][21][22] To the best of our knowledge, few reports have described the effect of the difference between postoperative and preoperative sagittal balance on postoperative dysphagia after ACDF with Zero-P. Consequently, one objective of this retrospective analysis was to summarize and identify the effect of the cervical sagittal balance and other possible related factors on dysphagia. And provides for future spinal surgeries with evidence on how to reduce the incidence of dysphagia after ACDF with Zero-P.…”

Cervical Sagittal Alignment: Literature Review and Future Directions

“…Lee et al [ 61 ] (2016) reported no significant difference of HRQoL or number of fusion levels in patients had solid anterior cervical fusion without correlation with SVA or CL. Bao et al [ 62 ] (2017) and Lau et al [ 63 ] (2020) have also failed to identify significant association between CL and HRQoL outcomes in their cervical fusion cohort. This implies there could be a range of alignment providing forgiveness without affecting the HRQoL.…”

The Impact of Single-Level Anterior Cervical Discectomy and Fusion on Cervical Sagittal Parameters and Its Correlation With Pain and Functional Outcome of Patients With Neck Pain

“…N ´u ˜nez-Pereira et al 14 used C7 slope as an index of global sagittal balance in the cervical region and showed that there is no difference between C7 slope changes and function of patients after ACDF. Also, in a recent study, Lau et al 15 reported on a series of patients who underwent from single-level to 3-level ACDF and plate fixation. They found that cervical lordosis, C2-C7 SVA, and T1 slope were not significantly associated with functional outcomes, specifically NDI and VAS scores of the patients.…”