Defining Cervical Sagittal Plane Deformity – When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?

Abstract

Objective: It remains unclear whether cervical sagittal deformity (CSD) should be defined by radiographic parameters alone versus both clinical and radiographic factors, and whether radiographic malalignment by itself warrants a CSD corrective surgery in patients who present primarily with neurologic symptoms.Methods: We administered a survey to a group of expert surgeons to evaluate whether radiographic parameters alone were sufficient to diagnose CSD, and in which scenarios surgeons recommend a CSD realignment procedure versus addressing the neurologic symptoms alone.Results: No single radiographic criteria reached a 50% threshold as being sufficient to establish the diagnosis of CSD. When asymptomatic radiographic malalignment was present, a sagittal deformity correction was more likely to be recommended in patients with myelopathy versus those with radiculopathy alone. The majority of surgeons recommended deformity correction when symptoms of cervical deformity were present in addition to radiographic malalignment (85% with deformity symptoms and radiculopathy, 93% with deformity symptoms and myelopathy).Conclusion: There is no consensus on which radiographic and/or clinical criteria are necessary to define the presence of CSD. We recommend that symptoms of cervical deformity, in addition to radiographic parameters, be considered when deciding whether to perform deformity correction in patients who present primarily with myelopathy or radiculopathy.

From the Spinopelvic Parameters to Global Alignment and Proportion Scores in Adult Spinal Deformity

“…In the last 20 years, sagittal alignment and balance of the spine have become one of the most important issues in the field of spine surgery [ 1 ]. Adult spinal deformity (ASD) is caused by a number of factors that lead to structural changes in spinal alignment, followed by changes in balance mechanisms to achieve the most economical upright posture [ 2 ]. The resulting disability and significant loss of quality of life require surgical treatment.…”

“…1 Adult spinal deformity (ASD) is caused by a number of factors that lead to structural changes in spinal alignment, followed by changes in balance mechanisms to achieve the most economical upright posture. 2 The resulting disability and significant loss of quality of life require surgical treatment. However, if the intended sagittal alignment is insufficiently restored after surgery, patients often complain of persistent low back pain due to the so-called flatback syndrome.…”

Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning

“…Adult spinal deformity (ASD) surgery primarily aims to restore and maintain spinal alignment. 1,2 However, proximal junctional kyphosis (PJK), a well-known complication of ASD surgery, may occur. PJK occurs in 17%-39% of ASD cases; one cause of PJK is regarded to be inappropriate curve correction.…”

“…Adult spinal deformity (ASD) surgery primarily aims to restore and maintain spinal alignment [ 1 , 2 ]. However, proximal junctional kyphosis (PJK), a well-known complication of ASD surgery, may occur.…”

The Sagittal Balance of Cervical Spine : Comprehensive Review of Recent Update

“…Various parameters have been proposed to evaluate cervical sagittal alignment as an attempt to understand its unique characteristics. Extensive researches have been conducted to explore the clinical significance of these parameters, their association with pre-and postoperative symptoms, and their implications in surgical interventions 1,2,[5][6][7]9,11,13,15,[18][19][20]21,24,25,[29][30][31]35,37,39) . Ames et al 2) pre-sented a classification system for cervical spine deformity through a modified Delphi approach, adopting widely accepted cervical alignment parameters as modifiers.…”