Association of Preoperative Cervical Spine Alignment With Spinal Cord Magnetic Resonance Imaging Hyperintensity and Myelopathy Severity

Mohanty, Chandan; Massicotte, Eric M.; Fehlings, Michael G.; Shamji, Mohammed F.

doi:10.1097/brs.0000000000000670

Cited by 42 publications

(20 citation statements)

References 28 publications

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“…According to the previous studies, the C2–C7 SVA values in asymptomatic normal volunteers are maintained in a tight range within 20 mm ( Iyer et al, 2016 ; Jun et al, 2014 ; Yokoyama et al, 2017 ). Consistent with a previous study, the mean C2–C7 SVA value in the current study in patients with CSM was 17.2 ± 12.1 mm within the normal value, indicating that most patients with CSM before surgery presented normal sagittal balance ( Mohanty et al, 2015 ). Moreover, there is no statistical difference between males and females in terms of sagittal alignment parameters in patients with CSM, which is in accordance with asymptomatic volunteers ( Yang et al, 2016 ).…”

Section: Discussionsupporting

confidence: 92%

Preoperative cervical sagittal alignment parameters and their impacts on myelopathy in patients with cervical spondylotic myelopathy: a retrospective study

Yuan

Zhu

et al. 2017

PeerJ

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BackgroundCervical sagittal alignment plays an important role in the pathogenesis of cervical spondylotic myelopathy (CSM), but there are limited studies on the cervical sagittal parameters in CSM patients and their correlations with myelopathy. The aim of this study is to investigate the correlations among the preoperative cervical sagittal alignment parameters and their correlations with the development of myelopathy in patients with CSM.MethodsWe retrospectively collected 212 patients with CSM who underwent surgical interventions. Gender, age, modified Japanese Orthopedic Association score (mJOA), cervical lordosis (CL), C2–C7 sagittal vertical axis (C2–C7 SVA), T1 slope (T1S), neck tilt (NT) and thoracic inlet angle (TIA) were collected before operation. Interobserver and intraobserver reliability were calculated for all measurements (intraclass correlation coefficient, ICC). Data were analyzed with Pearson and Spearman correlation tests and multiple linear regression analysis.ResultsA total of 212 patients with CSM were included in this study (male: 136, female: 76) with an average age of 54.5 ± 10.1 years old. Intraobserver and interobserver reliability for all included radiographic parameters presented good to excellent agreement (ICC > 0.7). No significant differences in demographic and radiological parameters have been observed between males and females (P > 0.05). We found statistically significant correlations among the following parameters: age with CL (r = 0.135, P = 0.049), age with T1S (r = 0.222, P = 0.001), CL with T1S (r = 0.291, P < 0.001), CL with C2-C7 SVA (r = − 0.395, P < 0.001), mJOA with age (r = − 0.274, P < 0.001), mJOA with C2–C7 SVA (r = − 0.219, P < 0.001) and mJOA with T1S(r = − 0.171, p = 0.013). Linear regression analysis showed that C2–C7 SVA was the predictor of CL (adjusted R2 = 0.152, P < 0.001) and multiple linear regression showed that age combined with C2–C7 SVA was a sensitive predictor of mJOA (adjusted R2 = 0.106, P < 0.001).DiscussionThere were significant correlations among certain preoperative cervical sagittal parameters in CSM patients. CL was the only predictor of C2–C7 SVA. Age combined with C2–C7 SVA could predict the severity of myelopathy.

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Section: Discussionsupporting

confidence: 92%

Preoperative cervical sagittal alignment parameters and their impacts on myelopathy in patients with cervical spondylotic myelopathy: a retrospective study

Yuan

Zhu

et al. 2017

PeerJ

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“…4,68 Therefore, assessment of the cervical spine should include evaluation for scoliosis, hyperlordosis, and kyphosis. Sagittal balance and alignment can be assessed optimally by using standing radiographs of the whole spine, but some measurements, made by using cervical MRI, have been reported, and they might prove useful in the absence of upright films.…”

Section: Sagittal Alignmentmentioning

confidence: 99%

Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

Nouri

Martín

Mikulis

et al. 2016

FOC

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149

111

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Degenerative cervical myelopathy encompasses a spectrum of age-related structural changes of the cervical spine that result in static and dynamic injury to the spinal cord and collectively represent the most common cause of myelopathy in adults. Although cervical myelopathy is determined clinically, the diagnosis requires confirmation via imaging, and MRI is the preferred modality. Because of the heterogeneity of the condition and evolution of MRI technology, multiple techniques have been developed over the years in an attempt to quantify the degree of baseline severity and potential for neurological recovery. In this review, these techniques are categorized anatomically into those that focus on bone, ligaments, discs, and the spinal cord. In addition, measurements for the cervical spine canal size and sagittal alignment are also described briefly. These tools have resulted collectively in the identification of numerous useful parameters. However, the development of multiple techniques for assessing the same feature, such as cord compression, has also resulted in a number of challenges, including introducing ambiguity in terms of which methods to use and hindering effective comparisons of analysis in the literature. In addition, newer techniques that use advanced MRI are emerging and providing exciting new tools for assessing the spinal cord in patients with degenerative cervical myelopathy.

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“…Kyphosis is thought to play an important role in the development of DCM by spinal cord tethering by the dentate ligaments and nerve roots, and also by angiostructural change [107]. Indeed, Smith et al and Mohanty et al showed that mJOA correlated with C2-C7 sagittal vertical axis in preoperative patients [108,109]. Preoperative kyphosis has also been identified as a risk factor for inferior surgical outcomes both in anterior and posterior surgery [12, 65, 110, 111, 112•].…”

Section: Importance Of Sagittal Balance/alignment On Treatment/outcomesmentioning

confidence: 99%

Degenerative Cervical Myelopathy

Nouri

Tetreault

Singh

et al. 2015

Spine

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658

348

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Cervical myelopathy is the most common cause of acquired spinal cord compromise. The concept of degenerative cervical myelopathy (DCM), defined as symptomatic myelopathy associated with degenerative arthropathic changes in the spine axis, is being introduced. Given its progressive nature, treatment options have to be chosen in a timely manner. Surgical options include anterior discectomy and fusion (ACDF), anterior corpectomy and fusion (ACCF), arthroplasty (in highly select cases), posterior laminectomy with/without fusion, and laminoplasty. Indications for each should be carefully considered in individual patients. Riluzole, a sodium-glutamate antagonist, is a promising option to optimize neurologic outcomes post-surgery and is being examined in the CSM-Protect Randomized Controlled Trial. Preoperative risk assessment is mandatory for prognostication. Sagittal alignment is known to play an important role to optimize surgical outcome. Guidelines for optimal management of DCM are in process. In principle, all but the mildest cases of DCM should be offered surgery for optimal outcome.

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Association of Preoperative Cervical Spine Alignment With Spinal Cord Magnetic Resonance Imaging Hyperintensity and Myelopathy Severity

Cited by 42 publications

References 28 publications

Preoperative cervical sagittal alignment parameters and their impacts on myelopathy in patients with cervical spondylotic myelopathy: a retrospective study

Preoperative cervical sagittal alignment parameters and their impacts on myelopathy in patients with cervical spondylotic myelopathy: a retrospective study

Magnetic resonance imaging assessment of degenerative cervical myelopathy: a review of structural changes and measurement techniques

Degenerative Cervical Myelopathy

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