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

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Complete 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.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A 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.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>The 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 &lt; 0.0001).</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>In 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.</jats:p></jats:sec>

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

“…A study by Lee et al [ 24 ] found a relationship between T1 slope and kyphotic alignment change (more than 5° change postoperatively) postlaminoplasty using the receiver operating characteristic curve analysis. As per this study, the cut-off point was found to be 29° using optimal intersection of sensitivity and specificity.…”

“…Lee et al [ 24 ] have shown that increased C2–C3 angle preoperatively is associated with increased adverse events following laminectomy and posterior fixation which includes kyphosis, pseudoarthrosis, reoperation, adjacent segment disease, and adjacent segment degeneration. The region of C2–C3 is considered as a transitional zone in the cervical spine similar to the cervicothoracic region or the lumbosacral region.…”

Which factors predict the loss of cervical lordosis following cervical laminoplasty? A review of various indices and their clinical implications

“…[2,5-7,18] Lee et al . [10] concluded that patients with a T1S of >29° are more likely to exhibit postlaminoplasty kyphosis/loss of lordosis of more than 5° versus those with T1S of <29°.…”

“…Notably, the preoperative cervical lordosis (C2-C7 Cobb's angle) was greater in patients with higher T1S versus those with lower T1S; these patients have a higher risk of kyphosis postlaminoplasty. [2,[5][6][7]18] Lee et al [10] concluded that patients with a T1S of >29° are more likely to exhibit postlaminoplasty kyphosis/loss of lordosis of more than 5° versus those with T1S of <29°.…”

Preoperative Decreased Hounsfield Unit Values of Cervical Vertebrae and the Relative Cross-Sectional Area of Flexion/Extension Paraspinal Muscles Are Novel Risk Factors for the Loss of Cervical Lordosis after Open-Door Laminoplasty

“…It was reported by Zhang [ 9 ] and Kim [ 10 ] that a higher preoperative T1S was an independent risk factor of LCL. Lee et al found that patients with preoperative TIS > 29° faced a higher risk for a decrease in lordosis of more than 5° [ 19 ]. In the present study, patients in the LCL group had a higher preoperative T1S and this was moderately related to a decrease in C2–7 Cobb angle.…”