T1 Slope as a Predictor of Kyphotic Alignment Change After Laminoplasty in Patients With Cervical Myelopathy

Kim, Tae‐Hwan; Lee, Seung Yeop; Kim, Yong Chan; Park, Moon Soo; Kim, Seok Woo

doi:10.1097/brs.0b013e3182972e1b

Cited by 186 publications

(147 citation statements)

References 22 publications

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“…Laminoplasty is a posterior method, and posterior structures, including the lamina, nuchal ligament, and posterior neck muscle, which help to prevent kyphotic alignment changes, are greatly damaged and atrophied after laminoplasty. 16 Posterior damage to the muscles, such as the semispinalis cervicis, trapezius, and rhomboid muscles, or contracture of the cervical spine, are possible causes of postoperative neck pain. Most experienced surgeons recommend preservation of the paraspinal muscles at C-2 or C-7 during cervical spine surgery because these muscles prevent postoperative instability and neck pain.…”

Section: Discussionmentioning

confidence: 99%

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Lee

Shin

et al. 2016

SPI

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OBJECT The goal of this study was to determine the relationship between cervical spine sagittal alignment and clinical outcomes after cervical laminoplasty in patients with ossification of the posterior longitudinal ligament (OPLL). METHODS Fifty consecutive patients who underwent a cervical laminoplasty for OPLL between January 2012 and January 2013 and who were followed up for at least 1 year were analyzed in this study. Standing plain radiographs of the cervical spine, CT (midsagittal view), and MRI (T2-weighted sagittal view) were obtained (anteroposterior, lateral, flexion, and extension) pre- and postoperatively. Cervical spine alignment was assessed with the following 3 parameters: the C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), and T-1 slope minus C2–7 Cobb angle. The change in cervical sagittal alignment was defined as the difference between the post- and preoperative C2–7 Cobb angles, C2–7 SVAs, and T-1 slope minus C2–7 Cobb angles. Outcome assessments (visual analog scale [VAS], Oswestry Neck Disability Index [NDI], 36-Item Short-Form Health Survey [SF-36], and Japanese Orthopaedic Association [JOA] scores) were obtained in all patients pre- and postoperatively. RESULTS The average patient age was 56.3 years (range 38–72 years). There were 34 male patients and 16 female patients. Cervical laminoplasty for OPLL helped alleviate radiculomyelopathy. Compared with the preoperative scores, improvement was seen in postoperative VAS and JOA scores. After laminoplasty, 35 patients had kyphotic changes, and 15 had lordotic changes. However, cervical sagittal alignment after laminoplasty was not significantly associated with clinical outcomes in terms of postoperative improvement of the JOA score (C2–7 Cobb angle: p = 0.633; C2–7 SVA: p = 0.817; T-1 slope minus C2–7 lordosis: p = 0.554), the SF-36 score (C2–7 Cobb angle: p = 0.554; C2–7 SVA: p = 0.793; T-1 slope minus C2–7 lordosis: p = 0.829), the VAS neck score (C2–7 Cobb angle: p = 0.263; C2–7 SVA: p = 0.716; T-1 slope minus C2–7 lordosis: p = 0.497), or the NDI score (C2–7 Cobb angle: p = 0.568; C2–7 SVA: p = 0.279; T-1 slope minus C2–7 lordosis: p = 0.966). Similarly, the change in cervical sagittal alignment was not related to the JOA (p = 0.604), SF-36 (p = 0.308), VAS neck (p = 0.832), or NDI (p = 0.608) scores. CONCLUSIONS Cervical laminoplasty for OPLL improved radiculomyelopathy. Cervical laminoplasty increased the probability of cervical kyphotic alignment. However, cervical sagittal alignment and clinical outcomes were not clearly related.

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Section: Discussionmentioning

confidence: 99%

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Lee

Shin

et al. 2016

SPI

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“…1–3 However, relatively few publications have defined normative values for cervical or thoracic sagittal balance, and even fewer have directly evaluated the influence of cervical segmental and regional balance on outcomes in cervical surgery. 4–7 Scheer et al provided a definition of the cervical sagittal vertical axis (C2-7 SVA) that refers to the distance between a plumb line dropped from the centroid of C2 (or dens) and the posterosuperior aspect of C7. 7 This parameter is expected to provide a measure of cervical regional balance.…”

Section: Introductionmentioning

confidence: 99%

Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy

Kato

Namikawa

Matsumura

et al. 2017

Global Spine Journal

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Study Design:Retrospective clinical study.Objective:We evaluated the relationship between cervical sagittal alignment parameters and clinical status in patients with cervical myelopathy and analyzed the effect of cervical sagittal balance on cervical laminoplasty.Methods:Patients with cervical myelopathy (n = 110) who underwent laminoplasty were included in this study. The relationship between cervical sagittal alignment parameters and clinical status was evaluated. The changes in radiographic cervical sagittal parameters and clinical status 2 years after surgery were compared between patients with preoperative C2-7 SVA ≥35 mm (group A) and those with preoperative C2-7 SVA <35 mm (group B).Results:Preoperatively, C2-7 SVA had no correlation with defined health-related quality of life evaluation scores. At 2-year follow-up, the improvement in SF-36 physical component summary was significantly lower in group A than in group B. The postoperative change of C2-7 SVA did not significantly differ in 2 groups. Patients in group A maintained cervical regional balance after laminoplasty but experienced extensive postoperative neck pain.Conclusions:Our patients with a C2-7 SVA of ≥35 mm maintained cervical regional balance after laminoplasty and their improvement in myelopathy was equivalent to that in patients with a C2-7 SVA of <35 mm. However, the patents with a C2-7 SVA of ≥35 mm experienced severe postoperative neck pain. C2-7 SVA is a parameter worth considering because it can lead to poor QOL and axial neck pain after laminoplasty.

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“…Similar phenomena have been reported with sacral slope, T1 angle, sagittal alignment, and global relationships between spinal and pelvic parameters. 1,5,10,21,24,25,29,38,39,41 Cervical lordosis is derived from the sum of the segmental angles between cervical vertebrae and is important in overall function and quality of life. Of the 42° of cervical lordosis found in healthy patients, approximately 32° comes from C1-2 and 2° comes from the C2-3 level (nearly 81% of overall cervical lordosis).…”

Section: Discussionmentioning

confidence: 99%

“…1,5,25,37,41,44 Previous studies have correlated cervical sagittal imbalance, elevated T1 slope, and kyphosis with adjacent segment disease, disability, and a worse health-related quality of life (HRQOL). 1,5,10,11,15,21,24,25,29,38,39,41 However, there is a lack of data and studies that have evaluated whether there are unique radiographic parameters that are predictive of postoperative instrumentation failure that lead to poor clinical outcomes and the need for reoperation after posterior cervical fusion.…”

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confidence: 99%

The effect of C2–3 disc angle on postoperative adverse events in cervical spondylotic myelopathy

Lee

Walsh

Lubelski

et al. 2019

Journal of Neurosurgery: Spine

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OBJECTIVEComplete radiographic and clinical evaluations are essential in the surgical treatment of cervical spondylotic myelopathy (CSM). Prior studies have correlated cervical sagittal imbalance and kyphosis with disability and worse health-related quality of life. However, little is known about C2–3 disc angle and its correlation with postoperative outcomes. The present study is the first to consider C2–3 disc angle as an additional radiographic predictor of postoperative adverse events.METHODSA retrospective chart review was performed to identify patients with CSM who underwent surgeries from 2010 to 2014. Data collected included demographics, baseline presenting factors, and postoperative outcomes. Cervical sagittal alignment variables were measured using the preoperative and postoperative radiographs. Univariable logistic regression analyses were used to explore the association between dependent and independent variables, and a multivariable logistic regression model was created using stepwise variable selection.RESULTSThe authors identified 171 patients who had complete preoperative and postoperative radiographic and outcomes data. The overall rate of postoperative adverse events was 33% (57/171), and postoperative C2–3 disc angle, C2–7 sagittal vertical axis, and C2–7 Cobb angle were found to be significantly associated with adverse events. Inclusion of postoperative C2–3 disc angle in the analysis led to the best prediction of adverse events. The mean postoperative C2–3 disc angle for patients with any postoperative adverse event was 32.3° ± 17.2°, and the mean for those without any adverse event was 22.4° ± 11.1° (p < 0.0001).CONCLUSIONSIn the present retrospective analysis of postoperative adverse events in patients with CSM, the authors found a significant association between C2–3 disc angle and postoperative adverse events. They propose that C2–3 disc angle be used as an additional parameter of cervical spinal sagittal alignment and predictor for operative outcomes.

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T1 Slope as a Predictor of Kyphotic Alignment Change After Laminoplasty in Patients With Cervical Myelopathy

Cited by 186 publications

References 22 publications

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Correlation between cervical spine sagittal alignment and clinical outcome after cervical laminoplasty for ossification of the posterior longitudinal ligament

Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy

The effect of C2–3 disc angle on postoperative adverse events in cervical spondylotic myelopathy

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