Degenerative Cervical Disc Disease: Long-term Changes in Sagittal Alignment and Their Clinical Implications After Cervical Interbody Fusion Cage Subsidence

Tomé-Bermejo, Félix; Morales-Valencia, Julián A.; Moreno-Pérez, J.; Marfil-Pérez, Juan; Díaz-Dominguez, Elena; Piñera, Ángel R.; Álvarez, Luis

doi:10.1097/bsd.0000000000000293

Cited by 34 publications

(23 citation statements)

References 40 publications

(9 reference statements)

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“…Previous investigations showed that implant subsidence does not have a significant association with clinical outcome after anterior operation. [4,16,22] Our findings corroborated the conclusion of previous investigations. Furthermore, we found that the CSA, C2-C7 SVA distance, and grade of ISI were significantly associated with postoperative outcome.…”

Section: Discussionsupporting

confidence: 92%

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Risk factors of cage subsidence after removal of localized heterotopic ossification by anterior cervical discectomy and fusion

Zhang²,

Shen

et al. 2019

Medicine

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The purpose of the study was to identify risk factors of cage subsidence and evaluate surgical outcome by at least 12 months postoperative follow-up.We retrospectively investigated 113 consecutive patients who underwent anterior surgery to relieve spine cord compression resulted from localized heterotopic ossification, from July, 2011 to February, 2016. We divided the patients into 2 groups: cage subsidence <2 mm group and ≥2 mm group. According to magnetic resonance imaging (MRI), the severity of increased signal intensity (ISI) was classified into grade 0, 1, and 2. Clinical outcome was assessed by the Japanese Orthopedic Association (JOA) scoring system. Logistic regression analysis and receiver-operating characteristic (ROC) curve were utilized for predicting risk factors of cage subsidence, and the recovery rate was evaluated by Kruskal–Wallis test or Mann–Whitney U test.Logistic regression with cage subsidence as the dependent variable showed independent risks associated with a cervical sagittal malalignment (odds ratio [OR] 11.23, 95% confidence interval [CI] 3.595–35.064, P < .001), thoracic 1 (T1) slope angle (OR 1.59, 95% CI 1.259–1.945, P < .001), and excisional thickness (OR 2.38, 95% CI 1.163–4.888.0, P = .018). The cut-off values of T1 slope and excisional thickness were 19.65 angle and 3.7 mm, respectively. Patients with high occupying ratio (P = .001) and high ISI grade (P = .012) are more likely to occur lower recovery rate.Patients with high T1 slope angle or preoperative kyphotic deformity should avoid excessive removal of endplate and vertebral body so as to reduce the occurrence of cage subsidence. Poor outcome was closely related to cervical sagittal malalignment and higher ISI grade.

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Section: Discussionsupporting

confidence: 92%

“…Nevertheless, one research reported that the implant subsidence usually occurred at the posterior upper endplates of the caudal bodies. [22] We thought the cause was the function of head gravity center. Historically, T1 slope angle was related to the cervical sagittal balance.…”

Section: Discussionmentioning

confidence: 99%

Risk factors of cage subsidence after removal of localized heterotopic ossification by anterior cervical discectomy and fusion

Zhang²,

Shen

et al. 2019

Medicine

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“…The ACDF directly removes the anterior compression lesion and increases the height of the neural foramen, which also results in the indirect decompression [ 33 ]. However, graft failures, such as subsidence and pseudarthrosis have been reported frequently [ 12 , 34 , 35 ], which may diminish the effectiveness of indirect decompression and resulted in the recurrence of symptoms [ 35 ]. Our recent study reported that subsidence was associated with PRE T1s [ 36 ].…”

Section: Discussionmentioning

confidence: 99%

“…Because these parameters are of significance in predicting the changes that occur when the balance between gravity and force of extension from the posterior neck muscle is disturbed, these factors have been predominantly studied in laminoplasty (LP), a procedure that severely invades the posterior neck muscular-ligament complex [ 4 - 8 ]. Because anterior cervical discectomy and fusion (ACDF) does not damage the posterior neck muscular-ligament complex, studies regarding the influence of preoperative parameters are limited; however, several studies have focused on preoperative C2–7 cervical angle (CA) [ 9 - 12 ]. Recently, Kwon et al [ 13 ] approached post-ACDF cervical alignment using T1 slope (T1s) and sagittal vertical axis (SVA).…”

Section: Introductionmentioning

confidence: 99%

Differences in Cervical Sagittal Alignment Changes in Patients Undergoing Laminoplasty and Anterior Cervical Discectomy and Fusion

et al. 2018

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ObjectiveAnterior cervical discectomy and fusion (ACDF) and laminoplasty (LP) are the most commonly performed procedures for degenerative cervical spondylosis. Cervical sagittal alignment (CSA) has recently been studied as an important predictor of clinical and radiological outcomes. The data from previous studies are insufficient for analysis using the recently designed CSA parameters, T1 slope (T1s), and T1s minus cervical angle (T1sCA). MethodsWe retrospectively collected data from patients who underwent ACDF and LP from January 2013 to May 2016. The CSA parameters included CA, sagittal vertical axis, T1s, and T1sCA. T1sCA values were used to evaluate the preoperative cervical balance (T1sCA>20°: imbalance). Clinical results were evaluated using the neck disability index (NDI) and recovery rate (RR) according to the Japanese Orthopedic Association scoring system. ResultsWe analyzed the data of 72 patients (ACDF, n=39; LP, n=33). Imbalance on ACDF was associated with an increase in CA (balance: preoperative [PRE], 15.64° → follow-up [F/U], 15.74°, p=0.953; imbalance: PRE, −1.14° → F/U, 8.045°, p=0.008), whereas balance on LP was associated with a significant decrease in CA (balance: PRE, 16.26°→ F/U, 11.59°, p=0.009; imbalance: PRE, 5.36°→ F/U, 2.38°, p=0.249). No significant difference was found in the RR and NDI changes in the ACDF group based on balance, but a significant difference was found in RR in the LP group (balance: 61.65%±19.88%, imbalance: 46.90%±15.71%, p=0.046). ConclusionWe found a significant difference in postoperative alignment in cases of ACDF and LP according to preoperative cervical sagittal balance. The postoperative clinical results of the LP group were more affected by F/U alignment than by the degree of alignment change.

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“…However, in a randomized clinical study by Villavicencio et al,20 the authors showed that the use of lordotically shaped allografts does not increase cervical segmental sagittal alignment in comparison with the parallelly shaped ones. In addition, cage subsidence was common in patients treated without the plate 21,22. The addition of an anterior plate system was considered to reduce the problem that the height tended to return gradually toward preoperative value 23.…”

Section: Discussionmentioning

confidence: 99%

Is correction of segmental kyphosis necessary in single-level anterior cervical fusion surgery? An observational study

Sun

Bai

et al. 2018

TCRM

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BackgroundThis study was conducted to determine whether sagittal lordotic alignment and clinical outcomes could be improved by the correction of segmental kyphosis after single-level anterior cervical discectomy and fusion (ACDF) surgery.Patients and methodsWe retrospectively reviewed patients who underwent single-level ACDF surgery in our hospital between January 2014 and February 2017. Basic characteristics of patients included age at surgery, gender, diagnosis, duration of symptoms, and location of target level. Pre- and postoperative radiographs at the 6-month follow-up were used to evaluate the following parameters, such as segmental angle, C2–C7 angle, T1 slope, and C2–C7 sagittal vertical axis (SVA). Postoperative clinical outcomes were assessed by the Neck Disability Index and VAS. According to the segmental angle of postoperative radiographs, patients were divided into noncorrection group and correction group.ResultsA total of 181 patients (99 males and 82 females) were analyzed in our study. There were 32 patients in the noncorrection group and 149 patients in the correction group. There was no significant difference in demographic and clinical data between the two groups before surgery. However, patients in the correction group showed larger C2–C7 angle and lower C2–C7 SVA after surgery in comparison with those in the noncorrection group. Besides, changes in the segmental angle were positively correlated with changes in C2–C7 angle and negatively correlated with changes in C2–C7 SVA.ConclusionSurgical correction of segmental kyphosis in single-level cervical surgery contributed to balanced cervical alignment in comparison with those without satisfactory correction. However, we could not demonstrate that the correction of segmental alignment is associated with a better recovery in clinical outcomes.

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Degenerative Cervical Disc Disease: Long-term Changes in Sagittal Alignment and Their Clinical Implications After Cervical Interbody Fusion Cage Subsidence

Cited by 34 publications

References 40 publications

Risk factors of cage subsidence after removal of localized heterotopic ossification by anterior cervical discectomy and fusion

Risk factors of cage subsidence after removal of localized heterotopic ossification by anterior cervical discectomy and fusion

Differences in Cervical Sagittal Alignment Changes in Patients Undergoing Laminoplasty and Anterior Cervical Discectomy and Fusion

Is correction of segmental kyphosis necessary in single-level anterior cervical fusion surgery? An observational study

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