The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

Department of Neurological Surgery, University of California, San Francisco, San Francisco, California 94143, USA.
Neurosurgery (Impact Factor: 3.62). 05/2012; 71(3):662-9; discussion 669. DOI: 10.1227/NEU.0b013e31826100c9
Source: PubMed


Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.
To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.
From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.
Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = -0.43, P < .001 and r = -0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.
Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.

Download full-text


Available from: Virginie Lafage, Oct 09, 2015
259 Reads
  • Source
    • "Otani et al. [28] proposed that lateral retraction of paravertebral muscles attached on the cervical spine and removal of lamina and ligamentum flavum in laminectomy, especially the semispinalis attached on the C2 spinous process, increased the flexion mechanical stress, which may be a significant factor in the development of axial symptoms. Tang et al. [29] demonstrated that the severity of neck pain and disability increases with positive sagittal malalignment following surgical reconstruction. The present study showed that axial symptom severity was positively correlated with loss of CI, which meant that the symptoms would get worse if the cervical curvature index was more severely lost. "
    [Show abstract] [Hide abstract]
    ABSTRACT: Purpose To investigate the long-term impacts of different posterior operations on curvature, neurological improvement and axial symptoms for multilevel cervical degenerative myelopathy (CDM), and to study the relationship among loss of cervical lordosis, recovery rate and axial symptom severity. Methods We retrospectively reviewed 98 patients with multilevel CDM who had undergone laminoplasty (Group LP, 36 patients), laminectomy (Group LC, 30 patients), or laminectomy with lateral mass screw fixation (Group LCS, 32 patients) between January 2000 and January 2005. Loss of curvature index (CI) was measured according to the preoperative and final follow-up radiographic parameters. The recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. Axial symptom severity was quantified by Neck Disability Index (NDI). Results Analysis of final follow-up data showed significant differences among the three groups regarding loss of CI (F = 41.46, P < 0.001) between preoperative and final follow-up JOA scores (P < 0.001), final follow-up JOA score (F = 7.81, P < 0.001), recovery rate (F = 12.98, P < 0.001) and axial symptom severity (χ2 = 18.04, P < 0.001). Loss of CI showed negative association with neurological recovery (r = −0.555, P < 0.001) and positive correlation with axial symptom severity (r = 0.696, P < 0.001). Conclusions Excellent neurological improvement was obtained by LP and LCS for patients with multilevel CDM, while loss of CI in groups LP and LC caused a high incidence of axial symptoms. Loss of CI was correlated with poor neurological recovery and axial symptom severity. Lateral mass screw fixation can effectively prevent loss of postoperative cervical curvature and reduce incidence of axial symptoms.
    European Spine Journal 03/2013; 22(7). DOI:10.1007/s00586-013-2741-5 · 2.07 Impact Factor
  • Pain 07/2012; 153(11):2155-6. DOI:10.1016/j.pain.2012.07.017 · 5.21 Impact Factor
  • [Show abstract] [Hide abstract]
    ABSTRACT: Cervical deformity is disruption of normal cervical alignment. This article focuses on the varying etiology of cervical deformity, normative data, and evaluation and examination of deformity, and presents various treatment options for the proper management of these debilitating conditions. Surgical treatment may be indicated in patients with severe mechanical neck pain, neurologic compromise, and progressive deformity causing significant disability, such as dysphagia or loss of horizontal gaze.
    Neurosurgery clinics of North America 04/2013; 24(2):249-74. DOI:10.1016/ · 1.44 Impact Factor
Show more