Axial Symptoms and Cervical Alignments After Cervical Anterior Spinal Fusion for Patients with Cervical Myelopathy

Kawakami, Mamoru; Tamaki, Toru; Yoshida, Munehito; Hayashi, Nobuhiro; Ando, Muneharu; Yamada, Hiroshi

doi:10.1097/00002517-199902000-00008

Cited by 131 publications

(89 citation statements)

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“…Many reports have demonstrated that improper sagittal alignment is a major source of pain, disability, and poor health. 2,3,14 Proper global sagittal spinal alignment and balance are critical in maintaining an energy efficient, pain-free, and upright posture.…”

Section: Discussionmentioning

confidence: 99%

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Lee

Shin

et al. 2016

SPI

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OBJECT The goal of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS Fifty consecutive patients who underwent a cervical laminoplasty for OPLL between January 2012 and January 2013 and who were followed up for at least 1 year were analyzed in this study. Standing plain radiographs of the cervical spine, CT (midsagittal view), and MRI (T2-weighted sagittal view) were obtained (anteroposterior, lateral, flexion, and extension) pre- and postoperatively. Cervical spine alignment was assessed with the following 3 parameters: the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), and T-1 slope minus C2–7 Cobb angle. The change in cervical sagittal alignment was defined as the difference between the post- and preoperative C2–7 Cobb angles, C2–7 SVAs, and T-1 slope minus C2–7 Cobb angles. Outcome assessments (visual analog scale [VAS], Oswestry Neck Disability Index [NDI], 36-Item Short-Form Health Survey [SF-36], and Japanese Orthopaedic Association [JOA] scores) were obtained in all patients pre- and postoperatively. RESULTS The average patient age was 56.3 years (range 38–72 years). There were 34 male patients and 16 female patients. Cervical laminoplasty for OPLL helped alleviate radiculomyelopathy. Compared with the preoperative scores, improvement was seen in postoperative VAS and JOA scores. After laminoplasty, 35 patients had kyphotic changes, and 15 had lordotic changes. However, cervical sagittal alignment after laminoplasty was not significantly associated with clinical outcomes in terms of postoperative improvement of the JOA score (C2–7 Cobb angle: p = 0.633; C2–7 SVA: p = 0.817; T-1 slope minus C2–7 lordosis: p = 0.554), the SF-36 score (C2–7 Cobb angle: p = 0.554; C2–7 SVA: p = 0.793; T-1 slope minus C2–7 lordosis: p = 0.829), the VAS neck score (C2–7 Cobb angle: p = 0.263; C2–7 SVA: p = 0.716; T-1 slope minus C2–7 lordosis: p = 0.497), or the NDI score (C2–7 Cobb angle: p = 0.568; C2–7 SVA: p = 0.279; T-1 slope minus C2–7 lordosis: p = 0.966). Similarly, the change in cervical sagittal alignment was not related to the JOA (p = 0.604), SF-36 (p = 0.308), VAS neck (p = 0.832), or NDI (p = 0.608) scores. CONCLUSIONS Cervical laminoplasty for OPLL improved radiculomyelopathy. Cervical laminoplasty increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment and clinical outcomes were not clearly related.

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Section: Discussionmentioning

confidence: 99%

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Lee

Shin

et al. 2016

SPI

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“…In particular, studies evaluating the effects of scoliosis surgery on cervical spine sagittal alignment are scarce and it is not clear if scoliotic patients treated with surgery have a greater incidence of neck pain as compared to normal subjects [13]. Recent publications have shown a correlation between cervical kyphosis and axial neck pain or new-onset neurologic symptoms [14][15][16]. In particular, Edgar and Metha [13], in their long-term follow-up of fused and unfused idiopathic scoliosis patients, found an incidence of cervicodorsal pain in 17.6% of the patients who had undergone fusion and 7.8% of the patients who had not.…”

Section: Discussionmentioning

confidence: 99%

“…Studies evaluating the effects of scoliosis surgery on cervical spine sagittal alignment are scarce and it is possible that scoliotic patients treated with surgery have a greater incidence of cervicodorsal pain when compared with normal subjects [13]. Recent publications have shown correlations between cervical kyphosis and axial neck pain, and between the loss of thoracic kyphosis and the development of cervical kyphosis in pre-operative radiographs of patients with adolescent idiopathic scoliosis [14][15][16][17].…”

Section: Introductionmentioning

confidence: 99%

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

et al. 2011

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The aim of this study is to quantify the changes in the sagittal alignment of the cervical spine in patients with adolescent idiopathic scoliosis following posterior spinal fusion. Patients eligible for study inclusion included those with a diagnosis of mainly thoracic adolescent idiopathic scoliosis treated by means of posterior multisegmented hook and screw instrumentation. Pre and post-operative anterior-posterior and lateral radiographs of the entire spine were reviewed to assess the changes of cervical sagittal alignment. Thirty-two patients (3 boys, 29 girls) met the inclusion criteria for the study. The average pre-operative cervical sagittal alignment (CSA) was 4.0°± 12.3°(range -30°to 40°) of lordosis. Postoperatively, the average CSA was 1.7°± 11.4°(range -24°to 30°). After surgery, it was less than 20°in 27 patients (84.4%) and between 20°and 40°in 5 patients (15.6%). The results of the present study suggest that even if rod precontouring is performed and postoperative thoracic sagittal alignment is restored, improved or remains unchanged after significant correction of the deformity on the frontal plane, the inherent rigidity of the cervical spine limits changes in the CSA as the cervical spine becomes rigid over time.

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“…More than two-thirds of patients developing symptomatic ASD had failure of conservative treatment and required additional operative procedures. However, no agreement exists as to the etiology of ASD [7,8,[22][23][24]. In J. T. Zhang and J. M. Cao contributed equally to this study.…”

Section: Introductionmentioning

confidence: 99%

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis

et al. 2015

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Purpose Adjacent segment degeneration (ASD) is known to occur after anterior cervical arthrodesis. However, it is not known whether cervical canal stenosis enhances the risk of ASD. The purpose of this study was to explore whether congenital stenosis could be used as a predictor of ASD after anterior cervical decompression and fusion (ACDF). Methods We enrolled 141 patients who had undergone ACDF for cervical myelopathy and/or radiculopathy, and had at least 6 years of follow-up. In standard radiographs of cervical spine in lateral view, bony congenital stenosis was evaluated and all patients were divided into two groups: stenosis (n = 63) and non-stenosis (n = 78). Radiographic ASD was assessed according to the criteria of Kellgren and Lawrence and correlated with symptomatic ASD. Clinical and radiological parameters were compared between the groups. The primary outcome was the rate of radiographic ASD after initial ACDF. The incidence of symptomatic ASD was assessed by Kaplan-Meier method. Results Radiographic ASD and symptomatic ASD developed in 46.8 % and 18.4 % of all patients, respectively. There was a significant association between congenital stenosis and radiographic ASD. The area under the receiver operating characteristic curve of preoperative anteroposterior (AP) diameter of cervical canal for predicting radiographic ASD was 0.756. 13.0 mm was the cutoff value of preoperative AP diameter of cervical canal predicting radiographic ASD. Kaplan-Meier analysis predicted a disease-free survival rate of symptomatic ASD in 97.2 % of patients at 5 years and 78.0 % at 10 years after ACDF. There was no significant difference in survival rates of the adjacent segment between the two groups via log-rank analysis (P = 0.102). Conclusion Congenital stenosis can increase the rate of radiographic ASD after initial ACDF. The cutoff value of 13.0 mm for preoperative AP diameter of cervical canal had the highest validity for predicting radiographic ASD.

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Axial Symptoms and Cervical Alignments After Cervical Anterior Spinal Fusion for Patients with Cervical Myelopathy

Cited by 131 publications

References 0 publications

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Cervical spine sagittal alignment variations following posterior spinal fusion and instrumentation for adolescent idiopathic scoliosis

Cervical canal stenosis and adjacent segment degeneration after anterior cervical arthrodesis

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