Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty

Lin, Benjamin C.; Hong, Kun-Ting; Lin, Chin-Ta; Chung, Tzu-Tsao; Tang, Chi‐Tun; Hueng, Dueng‐Yuan; Hsia, Chung-Ching; Ju, Da‐Tong; Ma, Hsin‐I; Liu, Mingying; Chen, Yuan-Hao

doi:10.1097/md.0000000000013111

Cited by 29 publications

(37 citation statements)

References 28 publications

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“…In addition to age, the effect of preoperative T1S should be also considered to evaluate the radiological outcomes after laminoplasty between the CSM and OPLL groups. The preoperative high T1S is already known to be an important factor related to the development and deterioration of sagittal imbalance after laminoplasty [3,4]. In our study, T1S showed no signi cant differences between the two groups pre-and postoperatively.…”

Section: Discussioncontrasting

confidence: 45%

Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

Kim

Jeon

2020

Preprint

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Objective The purpose of this study was to compare the radiological and functional outcomes between patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) after multi-level laminoplasty. Methods This study included 75 patients (32 with CSM and 43 with OPLL) with preserved cervical sagittal balance who underwent multi-level laminoplasty for cervical myelopathy. The radiological outcomes were analyzed using the following parameters: C2–C7 Cobb angle in neutral (C27AN), flexed (C27AF), and extended (C27AE) neck postures; C2–C7 range of motion (C27ROM); T1 slope (T1S); and C2–C7 sagittal vertical axis (C27SVA). The functional outcomes were analyzed using the modified Japanese Orthopedic Association (mJOA) score, Nurick grade, and recovery rate. The radiological and functional outcomes between the two groups were evaluated 12-months postoperatively. Results C27AF, C27ROM, and C27SVA in the CSM group and C27ROM in the OPLL group decreased significantly (p < 0.05). There was a significant difference in ΔC27SVA between the two groups (9.41 ± 17.06 mm vs. 1.10 ± 17.15 mm, p < 0.05). However, there were no significant intra- or intergroup changes and differences in C27AN (p > 0.05). The functional outcomes including mJOA score (p = 0.251), Nurick grade (p = 0.316), and recovery rate (p = 0.435) showed no significant intergroup differences. Conclusions Although there were no significant differences in functional outcomes between the two groups, the CSM group showed a greater deterioration in sagittal balance with an increase of C27SVA than the OPLL group after multi-level laminoplasty.

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Section: Discussioncontrasting

confidence: 45%

Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

Kim

Jeon

2020

Preprint

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“…A study conducted by Lin et al [ 19 ] have shown that T1 slope and C2–C7 SVA are goof predictors of LCL, in combination. They classified patients into four categories:…”

Section: Resultsmentioning

confidence: 99%

“…Various studies have described various indices to predict LCL in patients undergoing laminoplasty. [ 18 19 20 21 ] The indices which may play an important role in predicting LCL are described in Table 1 and Figure 1 .…”

Section: Methodsmentioning

confidence: 99%

Factors predicting loss of cervical lordosis following cervical laminoplasty: A critical review

Alam

Sharma

Borkar

et al. 2020

J Craniovert Jun Spine

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Background: Laminoplasty is a method of posterior cervical decompression which indirectly decompresses the spinal column. Unfortunately, many patients undergoing laminoplasty develops postoperative loss of cervical lordosis (LCL) or kyphotic alignment of cervical spine even though they have sufficient preoperative lordosis which results in poor surgical outcome. Objective: We would like to highlight the relationship between various radiological parameters of cervical alignment and postoperative LCL in patients undergoing laminoplasty. Methods: We performed extensive literature search using PubMed, Google Scholar, and Web of Science for relevant articles that report factors affecting cervical alignment following laminoplasty. Results: On reviewing the literature, patients with high T1 slope have more lordotic alignment of cervical spine preoperatively. They also have more chances of LCL following laminoplasty. C2–C7 sagittal vertical axis (SVA) has no role in predicting LCL following laminoplasty though patients with low T1 slope (≤20°) and high C2–C7 SVA (>22 mm) had correction of kyphotic deformity following laminoplasty. C2–C7 lordosis, Neck Tilt, cervical range of motion, and thoracic kyphosis has no predictive value for LCL. Lower value of T1 slope (T1S-CL) and CL/T1S has more incidence of developing LCL following laminoplasty. The role of C2–C3 disc angle has not yet been evaluated in patients undergoing laminoplasty. Dynamic extension reserve determines the contraction reserve of SPMLC and lower dynamic extension reserve is associated with higher chances of LCL following laminoplasty. Conclusions: Cervical lordotic alignment is important in maintaining cervical sagittal balance which ultimately is responsible for global spinal sagittal balance and horizontal gaze. Among various radiological parameters, T1 Slope has been reported to be the most important factor affecting cervical alignment following laminoplasty.

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“…Another limitation of this study is that only cervical spinal radiographs were analyzed, as there were no data regarding the overall sagittal alignment of the spine. Although previous studies have reported that cervical curvature can be affected by overall spinal sagittal imbalance [16][17][18][19], only normal subjects with a normal cervical curvature were included in our present study, and we found no difference in OC4Ds as a function of changes in cervical curvature in neutral, flexion, and extension positions. However, we also recognize that cervical curvature changes can accelerate cervical degeneration, which may affect the results of OC4D measurements.…”

Section: Discussionmentioning

confidence: 51%

A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance

Tang

Yang

Liao

et al. 2020

BMC Musculoskelet Disord

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Background: The aim of the present study was to describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects, as a proposed tool to guide restoration of vertical dislocations of the occipitocervical region in patients with basilar invaginations and for performing standardized testing of occipitocervical constructs. Methods: We analyzed neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) that were judged to be normal. The mean age of the included asymptomatic subjects was 48.0 ± 8.4 years old (range 20-69 years old; 48.4 ± 10.2 years old for males and 47.6 ± 6.4 years old for females). The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor's line. Occipitocervical distances (OCDs) were measured and analyzed its correlation with OC4Ds. Two spine surgeons each performed three measurements of the OC4D and OCD from each asymptomatic subject, from which our reported average values were derived. The height, weight, and body mass index (BMI) of each subject were recorded and analyzed for their correlations with the OC4D and OCD. Results: The OC4Ds from neutral, flexion, and extension lateral cervical spine radiographs were 69.0 ± 6.9, 68.9 ± 6.8, and 68.1 ± 6.9 mm, respectively. There was no significant difference in the OC4D values among neutral, flexion, and extension lateral cervical spine radiographs (P > 0.05). The neutral, flexion, and extension OCDs were 23.0 ± 4.8, 27.6 ± 6.0, and 13.8 ± 4.7 mm, respectively. In particular, the neutral OCD was significantly different from those in flexion and extension lateral cervical spine radiographs (P < 0.001). There was no significant correlation between OC4D and OCD in neutral, flexion, and extension (P > 0.05 for all). There were positive correlations between OC4D and height, as well as OC4D and weight, in neutral, flexion, and extension lateral cervical spine radiographs (P < 0.001 for all). Furthermore, the intra-class correlation coefficients for inter-and intra-observer reliabilities of OC4Ds in neutral, flexion, and extension lateral cervical spine radiographs were significantly higher than those for OCDs (P < 0.001).

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Impact of global spine balance and cervical regional alignment on determination of postoperative cervical alignment after laminoplasty

Cited by 29 publications

References 28 publications

Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

Factors predicting loss of cervical lordosis following cervical laminoplasty: A critical review

A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance

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