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.

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    • "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. "
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