Spinal alignment, surgery, and outcomes in cervical deformity: A practical guide to aid the spine surgeon

Tundo, Frederico; Avila, Mauricio J.; Willard, Laura; Fanous, Sandra; Curri, Cloe; Hussain, Ibrahim; Baaj, Ali A.

doi:10.1016/j.clineuro.2019.105496

Cited by 13 publications

(15 citation statements)

References 62 publications

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“… 18 PEEK or titanium cages are popular but once the cage is placed, no further alignment changes can be made. 19 Expandable prostheses have also become popular because they allow for further lordotic correction of deformities. 20 The main negative aspect of these devices is that there is little room for bone grafting, which can impact the fusion rate.…”

Section: Discussionmentioning

confidence: 99%

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

et al. 2021

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BACKGROUND Expandable cages are often used to reconstruct cervical corpectomies but there are few long-term follow-up studies with large numbers. OBJECTIVE To analyze the clinical and radiographic results of cervical corpectomy reconstructed with expandable cages for degenerative stenosis. METHODS We performed a retrospective analysis of 78 patients with degenerative cervical stenosis treated with a corpectomy reconstructed with an expandable cage. We evaluated the clinical and radiographic outcomes, as well as complications of the procedure at a minimum 2-yr follow-up. RESULTS There was a decrease in the visual analog scale pain average from 75 mm to 8.5 mm (P = .02); a decrease in the Neck Disability Index average from 55% to 12% (P = .009); and improvement in the Japanese Orthopaedic Association average from 12 to 14 points (P = .01). There was a change in cervical lordosis (Cobb method) average from −9.3° to −15.1° (P = .002), without significant loss of lordosis (P = .63). The fusion rate, by criteria of the Cervical Spine Research Society (CSRS), was low: using dynamic X-rays – 50% (n = 39/78) and using computed tomography (CT) – 47.4% (n = 37/78). A total of 11 patients (14.1%) suffered complications. CONCLUSION To our knowledge, this is the largest series (78) with a minimum 2-yr follow-up in the literature and the first using the dynamic radiographic and CT criteria endorsed by the CSRS. Using these criteria, our fusion rates were much lower than all previous reports in the literature. Despite this, patient-reported outcomes were reasonable. There was a relatively low incidence of perioperative complications, most of which were likely not implant-specific and there was only 1 case of implant failure.

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Section: Discussionmentioning

confidence: 99%

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

et al. 2021

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“…1,5,7,15 In human medicine, many different surgical procedures have been developed for the treatment of vertebral deformities, but the most appropriate technique remains unclear and should be selected on case-by-case basis. 23 The common goals of those techniques include spinal decompression, correction of the deformity, restoration of anatomical alignment, spinal stabilization with fusion and avoidance of complications. 23 The surgical technique described here is intended to not only achieve stabilization and fusion but also the partial correction of the angle of deformity; the latter missing in previously described veterinary techniques.…”

Section: Discussionmentioning

confidence: 99%

“…23 The common goals of those techniques include spinal decompression, correction of the deformity, restoration of anatomical alignment, spinal stabilization with fusion and avoidance of complications. 23 The surgical technique described here is intended to not only achieve stabilization and fusion but also the partial correction of the angle of deformity; the latter missing in previously described veterinary techniques. Unfortunately, advance imaging was not performed in our cases during the follow-up; therefore, it was not possible to ensure that vertebral fusion occurred.…”

Section: Discussionmentioning

confidence: 99%

Transthoracic Vertebral Distraction and Stabilization in 10 Dogs with Congenital Thoracic Vertebral Malformations

Mariné¹,

Risio

Mascort³

et al. 2021

Vet Comp Orthop Traumatol

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Objective The aim of this study was to describe the surgical technique and outcomes of dogs with congenital thoracic vertebral body malformations (CTVBM) treated with unilateral vertebral distraction and stabilization with monocortical screws and polymethylmethacrylate (PMMA). Study Design Medical records of 10 client-owned dogs with CTVBM were retrospectively searched for signalment, history, neurological examination, neurological grade based on the modified Frankel scale (MFS), diagnostic method, CTVBM location, Cobb's angle, and vertebral canal angle (VCA), surgical procedure, complications and long-term follow-up. Results One dog suffered cardiac arrest 24 hours post-surgery and died. Median follow-up in nine dogs was 26.5 months (12–50 months). Cobb's angle improved from 33–83 to 10–46 degrees and the VCA ratio from 97–138 to 122–164 degrees. The MFS improved from 3 (n = 3)–4 (n = 7) to 4 (n = 2)–6 (n = 7). Seven dogs recovered full function. Nine dogs improved after surgery compared with preoperative status, recovering ambulation when lost or achieving normal neurological examination in seven cases. No complications were reported during the follow-up period (12–50 months). Conclusion Unilateral transthoracic vertebral distraction and stabilization with monocortical screws and PMMA for treatment of compressive myelopathy due to CTVBM achieved long-term neurological improvement in 9 of 10 dogs.

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“…The aims of surgical treatment are to completely alleviate the compression of dural sac, reconstruct the stability of the cervical spine, and restore the curvature of the cervical spine in accordance with the biomechanical characteristics. 2 , 3 , 4 Decompression and stabilization have been recognized surgical goals, and the techniques are generally well‐established. With the research progresses of sagittal balance, it is taken more and more seriously for cervical sagittal alignment.…”

Section: Introductionmentioning

confidence: 99%

The Difference of Sagittal Correction of Adult Subaxial Cervical Spine Surgery According to Age: A Retrospective Study

Guo

Yang

et al. 2022

Orthopaedic Surgery

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Objective At present, the true sagittal alignment of the cervical spine is uncertain, resulting in no standard reference for subaxial cervical surgery. So, we aimed to explore the age difference of normal cervical sagittal alignment and to further investigate the mid‐and long‐term changes of sagittal alignment after subaxial cervical spine surgery. Materials and Methods This was a retrospective study and 1223 asymptomatic volunteers and 79 patients undergoing subaxial cervical spine surgery were retrospectively reviewed in total. Asymptomatic volunteers and patients were divided into six subgroups: 20–29, 30–39, 40–49, 50–59, 60–69 and ≥70 groups. The age difference and trend with age of cervical sagittal parameters of asymptomatic volunteers were assessed by cervical lateral radiography and analyzed by ANOVA test, and the regression equation of C2‐7 Cobb was established via multiple linear regression. Based on the C2‐7 Cobb regression equations of different ages, the theoretical value, deviation value, loss value of the C2‐7 Cobb, and JOA recovery rate of patients were calculated, and the correlation among the loss value, deviation value of the C2‐7 Cobb, and JOA recovery rate of the 79 patients was evaluated by Pearson correlation analysis. Results For the asymptomatic volunteers, the C0‐2 Cobb decreased gradually with increasing age. The C2‐7 Cobb, C2‐7 SVA, T1S, NT, and TIA increased gradually with increasing age. The CBVA fluctuated with increasing age. T1S demonstrated a moderate correlation with C2‐7 Cobb ( r = 0.60, p < 0.01); C0‐2 Cobb, C2‐7 SVA, CBVA, and TIA demonstrated a fair correlation with C2‐7 Cobb ( r = −0.30, −0.33, 0.41, 0.40, p < 0.01); age demonstrated a poor correlation with C2‐7 Cobb ( r = 0.19, p < 0.01). The regression equations of C2‐7 Cobb were established using C0‐2 Cobb, C2‐7 SVA, CBVA, and T1S. For the patients with subaxial cervical spine surgery, the loss of C2‐7 Cobb was moderately correlated with the deviation of C2‐7 Cobb ( r = 0.33, p < 0.01). Conclusion The age difference of cervical sagittal alignment was obvious, and the C2‐7 Cobb increased with age especially. The closer the postoperative C2‐7 Cobb was to the theoretical value of corresponding age, the smaller the loss of correction angle was, and the better the mid‐ and long‐term outcomes. The personalized sagittal reconstruction should be performed according to age difference for subaxial cervical spine surgery.

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Spinal alignment, surgery, and outcomes in cervical deformity: A practical guide to aid the spine surgeon

Cited by 13 publications

References 62 publications

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

Poor Fusion Rates Following Cervical Corpectomy Reconstructed With an Expandable Cage: Minimum 2-Year Radiographic and Clinical Outcomes

Transthoracic Vertebral Distraction and Stabilization in 10 Dogs with Congenital Thoracic Vertebral Malformations

The Difference of Sagittal Correction of Adult Subaxial Cervical Spine Surgery According to Age: A Retrospective Study

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