Surgical Impact on Global Sagittal Alignment and Health-Related Quality of Life Following Cervical Kyphosis Correction Surgery: Systematic Review

Abstract

When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. These compensations occur through mobile spine segments as well as pelvic tilt and lower extremities. The purpose of this review was to understand the surgical impact on global sagittal alignment and health-related quality of life (HRQoL) following cervical kyphosis correction surgery. The cervical kyphosis correction surgery induces reciprocal changes in craniocervical and thoracolumbar alignment. Successful cervical deformity correction needs to focus not only on restoring proper cervical lordosis, but also on achieving global balance of the cervical spine with other parts of the spine. The goal of the surgery is to achieve occiputtrunk (OT) concordance (the center of gravity-C7 sagittal vertical axis < 30 mm) and cervical sagittal balance. Once OT-concordance is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize global spinal alignment. Reciprocal changes after surgery exhibit different patterns depending on whether patients have compensation ability in their thoracolumbar spine or not. C2-7 sagittal vertical axis and sagittal morphotype of the cervical kyphosis are correlated with HRQoL. Changes in cervical lordosis minus T1 slope correlate to HRQoL improvements.

Adolescent Idiopathic Scoliosis Treated by Posterior Spinal Segmental Instrumented Fusion : When Is Fusion to L3 Stable?

“…Optimal LIV to avoid AO or DJK is extremely idiosyncratic. Various concepts and rules were introduced by previous researchers such as Harrington stable zone, SV and NV theory, disc reversal and LTV 1,[3][4][5][6][9][10][11]13) . However, poor inter-rater reliability for LIV selection was reported even among 17 SRS surgeons 8) .…”

Factors Affecting Postoperative Complications and Outcomes of Cervical Spondylotic Myelopathy with Cerebral Palsy : A Retrospective Analysis

“…This result was likely because among patients with CP, surgical invasiveness, need for surgical release, and utilization of osteotomies significantly increased in those with fixed cervical kyphosis than in those with semi-rigid or flexible kyphosis. In patients with CP, fixed cervical kyphosis is often accompanied by severe degenerative changes; thus, surgical treatment of such patients is challenging and requires invasive surgery to correct and stabilize the deformity while decompressing neural elements and restoring sagittal alignment [ 11 , 13 , 15 ]. Hence, patients with CSM and CP tend to undergo staged operations or combined approaches.…”

“…Typically, conservative treatments are ineffective; patients often require surgical treatment [ 2 ]. The most important surgical objectives for such patients are adequate decompression of the spinal cord and nerve roots, stabilization of the cervical spine, and alignment correction [ 11 , 12 , 15 ]. Recent advances in medical technology have led to the development of improved internal fixation methods, which promote stronger initial mechanical stability resulting from anterior plating or posterior screw fixation [ 7 ].…”

Cervical Sagittal Imbalance after Cervical Laminoplasty in Elderly Patients

“…Laminoplasty is a better procedure than cervical laminectomy because it maintains cervical alignment and postoperative kyphosis [14,18]. Nevertheless, there have been several studies reporting that cervical laminoplasty reduced the range of motion and caused cervical malalignment, though these issues remain matters of debate.…”