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Long CC, Dugan JE, Chanbour H, Chen JW, Younus I, Jonzzon S, Khan I, Terry DP, Pennings JS, Lugo-Pico J, Gardocki RJ, Abtahi AM, Stephens BF, Zuckerman SL. Stopping at C2 Versus C3/4 in Elective Posterior Cervical Decompression and Fusion: A 5-Year Follow-up Study. Clin Spine Surg 2024:01933606-990000000-00318. [PMID: 38820083 DOI: 10.1097/bsd.0000000000001646] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/15/2023] [Accepted: 04/29/2024] [Indexed: 06/02/2024]
Abstract
STUDY DESIGN This is a retrospective cohort study. OBJECTIVE In patients undergoing elective posterior cervical laminectomy and fusion (PCLF) with a minimum of 5-year follow-up, we sought to compare reoperation rates between patients with an upper instrumented vertebra (UIV) of C2 versus C3/4. SUMMARY OF BACKGROUND DATA The long-term outcomes of choosing between C2 versus C3/4 as the UIV in PCLF remain unclear. METHODS A single-institution, retrospective cohort study from a prospective registry was conducted of patients undergoing elective, degenerative PCLF from December 2010 to June 2018. The primary exposure was UIV of C2 versus C3/4. The primary outcome was reoperation. Multivariable logistic regression controlled for age, smoking, diabetes, and fusion to the thoracic spine. RESULTS Of the 68 patients who underwent PCLF with 5-year follow-up, 27(39.7%) had a UIV of C2, and 41(60.3%) had a UIV of either C3/4. Groups had similar duration of symptoms (P=0.743), comorbidities (P>0.999), and rates of instrumentation to the thoracic spine (70.4% vs. 53.7%, P=0.210). The C2 group had significantly longer operative time (231.8±65.9 vs. 181.6±44.1 mins, P<0.001) and more fused segments (5.9±1.8 vs. 4.2±0.9, P<0.001). Reoperation rate was lower in the C2 group compared with C3/4 (7.4% vs. 19.5%), though this did not reach statistical significance (P=0.294). Multivariable logistic regression showed increased odds of reoperation for the C3/4 group compared with the C2 group (OR=3.29, 95%CI=0.59-18.11, P=0.170), though statistical significance was not reached. Similarly, the C2 group had a lower rate of instrumentation failure (7.4% vs. 12.2%, P=0.694) and adjacent segment disease/disk herniation (0% vs. 7.3%, P=0.271), though neither trend attained statistical significance. CONCLUSIONS Patients with a UIV of C2 had less than half the number of reoperations and less adjacent segment disease, though neither trend was statistically significant. Despite a lack of statistical significance, whether a clinically meaningful difference exists between UIV of C2 versus C3/4 should be validated in larger samples with long-term follow-up. LEVEL OF EVIDENCE Level-3.
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Affiliation(s)
- Connor C Long
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - John E Dugan
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jeffrey W Chen
- Department of Neurological Surgery, Baylor College of Medicine, Houston, TX
| | - Iyan Younus
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Soren Jonzzon
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | | | - Douglas P Terry
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
| | - Jacqueline S Pennings
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
- Center for Musculoskeletal Research, Vanderbilt University Medical Center
- Department of Biostatistics, Vanderbilt University Medical Center, Nashville, TN
| | - Julian Lugo-Pico
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Raymond J Gardocki
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, TN
- Department of Orthopaedic Surgery, Vanderbilt University Medical Center
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Kim BJ, Cho SM, Hur JW, Cha J, Kim SH. Kinematics after cervical laminoplasty: risk factors for cervical kyphotic deformity after laminoplasty. Spine J 2021; 21:1822-1829. [PMID: 34118416 DOI: 10.1016/j.spinee.2021.06.010] [Citation(s) in RCA: 24] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/13/2021] [Revised: 04/28/2021] [Accepted: 06/07/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laminoplasty of the cervical spine is widely used as an effective surgical method to treat compressive myelopathy of the cervical spine; however, there is an adverse effect of kyphosis after surgery. The risk factors or predictors of kyphosis have not been sufficiently evaluated. PURPOSE To assess the risk factors for kyphosis following laminoplasty. STUDY DESIGN Retrospective study. PATIENT SAMPLE Patients diagnosed with cervical spondylotic myelopathy (CSM) or ossification of the posterior longitudinal ligament (OPLL) who underwent laminoplasty between May 2011 and October 2018 were enrolled. OUTCOME MEASURES Changes in lordosis and range of motion (ROM). METHODS Radiological imaging data were collected from simple neutral and flexion-extension radiographs at baseline and at 2-year follow-up. The ROM from the neutral position to complete flexion was defined as the flexion capacity, and the ROM from the neutral position to complete extension was defined as the extension capacity. RESULTS This study included 53 patients (mean age, 59.3 years). Multivariate linear regression analysis revealed that, the smaller the preoperative extension capacity, the greater was the decrease in lordosis (p=.025), while the larger the T1 slope, the greater was the decrease in lordosis following laminoplasty (p= .008). Correlation analysis revealed that C2-7 lordosis increased with increasing baseline T1 slope before surgery (p< .01). In patients with large preoperative C2-7 lordosis, the postoperative decrease in ROM tended to be greater (p= .028). However, the degree of lordosis and ROM reduction did not demonstrate a clear correlation with the clinical outcomes at 2 years after surgery. CONCLUSIONS Kyphotic changes in the cervical spine following laminoplasty were related to preoperative radiological parameters. The greater the preoperative extension capacity, the lower was the decrease in lordosis, and the greater the T1 slope, the greater was the decrease in lordosis.
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Affiliation(s)
- Bum-Joon Kim
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Sung-Min Cho
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Junseok W Hur
- Department of Neurosurgery, Anam Hospital, Korea University College of Medicine, Seoul, Republic of Korea
| | - Jaehyung Cha
- Medical Science Research Center, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea
| | - Se-Hoon Kim
- Department of Neurosurgery, Ansan Hospital, Korea University College of Medicine, Ansan, Republic of Korea.
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Can prophylactic C4/5 foraminotomy prevent C5 palsy after cervical laminoplasty with and without posterior instrumented fusion with maximal expansion? EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 31:1037-1046. [PMID: 33247324 DOI: 10.1007/s00590-020-02842-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Accepted: 11/22/2020] [Indexed: 10/22/2022]
Abstract
OBJECTIVE To prospectively examine whether laminoplasty with maximal expansion induces C5 palsy, even with prophylactic bilateral C4/5 foraminotomy. METHODS Thirty-five consecutive patients with cervical myelopathy underwent laminoplasty (n = 19: LP group) or posterior decompression and fusion (n = 16: PDF group) with maximal expansion. Prophylactic bilateral C4/5 foraminotomy was performed alternately in consecutive five patients undergoing each type of surgery. In each type of surgery, the first and third consecutive five patients did not undergo foraminotomy (NF subgroup: 20 patients), while the second and fourth consecutive five patients underwent foraminotomy (F subgroup: 15 patients). The widths between the gutters was equivalent to the diameter of the spinal canal, and an inclination angle of the lamina of approximately 90° was created during laminoplasty. The incidence and severity of postoperative C5 palsy were investigated. Patients with a manual muscle testing score for the deltoid muscle and/or biceps brachii muscle of ≤ 2 were diagnosed with severe palsy. RESULTS The respective incidences of C5 palsy in the F and NF subgroups were 33% and 20% in the LP group and 50% and 20% in the PDF group. Severe palsy occurred in 67% and 0% of patients who had developed palsy in F and NF subgroups, respectively, in the LP group, and in 100% of patients in the PDF group. Furthermore, 40% of the patients with severe palsy took more than 6 months to recover. CONCLUSIONS Laminoplasty with maximal expansion induced C5 palsy in both the LP and PDF groups, even with the addition of prophylactic bilateral C4/5 foraminotomy.
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Takeuchi K, Yokoyama T, Wada K, Kumagai G, Kudo H, Tanaka S, Asari T, Sasaki E, Fujita T, Fukutoku T, Koyama K, Ichinohe M, Ishibashi Y. Improvement in the results of the simple-foot-tapping test and cross-sectional area of the dural sac in patients with C5 palsy after posterior cervical spine surgery. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2020; 30:1401-1409. [PMID: 32529569 DOI: 10.1007/s00590-020-02715-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/13/2020] [Accepted: 06/03/2020] [Indexed: 10/24/2022]
Abstract
INTRODUCTION The smaller cross-sectional areas of the dural sacs in patients without C5 palsy after posterior cervical spine surgery may lead to less neurological improvement. OBJECTIVES The aim of this retrospective study was to clarify the differences in the cross-sectional area of the dural sac in the cervical spine and neurological improvement in patients with and without C5 palsy after posterior cervical spinal surgery. METHODS We retrospectively evaluated the postoperative cross-sectional areas of the dural sacs and neurological outcomes in patients with and without C5 palsy after posterior cervical spine surgery. We compared the postoperative cross-sectional areas of the dural sac at C4/5 and C5/6 on magnetic resonance images between the C5 palsy group (n = 19) and the no-C5 palsy group (n = 84) after posterior cervical spinal surgery 1 year postoperatively. Performance tests, namely, the 10-s grip-and-release test and the 10-s single-foot-tapping (FT) test, were compared between the two groups. RESULTS Postoperative cross-sectional areas of the dural sac at C4/5 and C5/6 (233.3 mm2 and 226.6 mm2, respectively) in the C5 palsy group were significantly larger (P = 0.0036 and P = 0.0039, respectively) than those (195.0 mm2 and 193.8 mm2, respectively) in the no-C5 palsy group. Postoperative gain in the grip-and-release test was similar between the two groups. Postoperative gain in the FT test (4.9 times) in the C5 palsy group was significantly larger (P = 0.0060) than that (1.8 times) in the no-C5 palsy group. CONCLUSIONS In the C5 palsy group 1 year after posterior cervical spine surgery, the cross-sectional areas of the dural sac were larger, and the 10-s single FT test improved noticeably.
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan.
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
| | - Kanichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopedic Surgery, Mutsu General Hospital, Mutsu, Aomori, Japan
| | - Sunao Tanaka
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Eiji Sasaki
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
| | - Taku Fujita
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
| | - Tatsuhiro Fukutoku
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
| | - Kazushige Koyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
| | - Masayuki Ichinohe
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Akita, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University Graduate School of Medicine, Hirosaki, Aomori, Japan
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Impact of the Inclusion of C2 in Posterior Cervical Fusions for Cervical Myelopathy on Sagittal Cervical Alignment. Clin Spine Surg 2020; 33:E141-E146. [PMID: 31913172 DOI: 10.1097/bsd.0000000000000931] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To determine the impact of including C2 in posterior fusions on radiographic parameters of cervical alignment in cervical spondylotic myelopathy. SUMMARY OF BACKGROUND DATA Despite the use of posterior instrumentation and arthrodesis after cervical laminectomy, loss of lordosis and the development of kyphosis are prevalent. Inadequate cervical lordosis and other measures of sagittal cervical alignment have been shown to correlate with disability, general health scores, and severity of myelopathy. The role of C2 in the posterior tension band, which maintains sagittal alignment, differs from the subaxial spine, as it is the insertion point for erector spinae muscles that play a critical role in maintaining posture. PATIENTS AND METHODS This study compares the radiographic outcomes of sagittal balance between 2 cohorts of patients who underwent posterior cervical decompression and fusion for cervical myelopathy over a 12-year period at a single institution. Demographic and surgical characteristics were collected using the electronic medical record of patients undergoing posterior cervical fusions (PCF) which included the axis [axial fusion (AF)] and those that were subaxial fusions (SAF). Radiographic measurements included preopertaive and postoperative C2-C7 lordosis (CL), C2-C7 sagittal vertical axis (SVA), and T1 slope (T1S). RESULTS After review of the electronic medical records, 229 patients were identified as having PCF and decompression for treatment of myelopathy. One hundred sixty-seven patients had AF, whereas 62 had SAF. PCF resulted in loss of CL in both cohorts. Although there was no statistical difference in postoperative CL, there was a significant increase in SVA (P<0.001) and T1S (P<0.001) with AF. CONCLUSIONS PCF often result in loss of lordosis. When compared with SAF, inclusion of C2 into the fusion construct may result in worsened sagittal balance, increasing the SVA and T1S.
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Takeuchi K, Yokoyama T, Wada KI, Itabashi T, Kumagai G, Kudo H, Asari T, Sasaki E, Fujita T, Ishibashi Y. Short Monocortical Screws at C4-C6 Lateral Masses as Novel Mid-cervical Anchor in Cervical Laminoplasty with Instrumented Fusion: Surgical Outcomes Compared with C5 Pedicle Screws as Mid-cervical Anchor. Spine Surg Relat Res 2019; 3:295-303. [PMID: 31768448 PMCID: PMC6834462 DOI: 10.22603/ssrr.2019-0027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2019] [Accepted: 05/29/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction Methods Results Conclusions
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Affiliation(s)
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital
| | - Kan-ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine
| | | | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Odate Municipal General Hospital
| | - Taku Fujita
- Department of Orthopedic Surgery, Odate Municipal General Hospital
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine
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Takeuchi K, Yokoyama T. Comparison of Axial Symptoms and Limitations of Activities of Daily Living Accompanying Reduced Neck Mobility After Cervical Laminoplasty Preserving C2 Muscle Attachments With and Without C2 to T1 Instrumented Fusion. Neurospine 2019; 16:608-617. [PMID: 31284341 PMCID: PMC6790720 DOI: 10.14245/ns.1836184.092] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2018] [Revised: 10/25/2018] [Accepted: 11/20/2018] [Indexed: 11/23/2022] Open
Abstract
OBJECTIVE Muscles are usually detached from C2 to facilitate C2 pedicle screw insertion. The aim of this study was to compare 1-year postoperative axial symptoms and limitations in activities of daily livings (ADLs) accompanying reduced neck mobility between 2 procedures in which all C2 muscle attachments are preserved: laminoplasty and C2 to T1 fusion (LPF group: n=15) and laminoplasty alone (LP group: n=26). METHODS We examined axial symptoms and limitations in ADLs using the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire. We also examined related factors, including the occiput (O)-C7 angle in extension and flexion, and the rotational and O-C2 ranges of motion (ROM). RESULTS The postoperative decreases in the O-C7 angle in flexion (27.8° vs. 9.4°) and rotational ROM (40° vs. 15°), as well as the compensating postoperative increase in the O-C2 ROM (11.7° vs. 2.3°), were significantly greater in the LPF group. Most of the axial symptoms were similar between groups. The ability to perform ADLs tended to worsen more frequently in the LPF group, but the difference did not achieve significance. CONCLUSION Postoperative changes in axial symptoms and loss of ROM were not obstacles affecting patients' ability to perform ADLs after laminoplasty with muscle-sparing C2 to T1 fusion.
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopaedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Toru Yokoyama
- Department of Orthopaedic Surgery, Odate Municipal General Hospital, Akita, Japan
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Takeuchi K, Yokoyama T, Wada KI, Kumagai G, Kudo H, Asari T, Sasaki E, Fujita T, Ishibashi Y. A New Grading of Epidural Hematoma or Scar Formation after Posterior Cervical Spine Surgery: Evaluation of Perioperative Related Factors, Distributions, and Clinical Outcomes after Surgery. Spine Surg Relat Res 2019; 3:285-294. [PMID: 31768447 PMCID: PMC6834457 DOI: 10.22603/ssrr.2019-0015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2019] [Accepted: 05/10/2019] [Indexed: 11/05/2022] Open
Abstract
Introduction The purpose of this study was to evaluate surgical outcomes using a new grading of postoperative epidural hematoma (EH) or epidural scar formation after posterior cervical spine surgery. Methods Postoperative EH or epidural scar formation after cervical laminoplasty (LP) or posterior decompression and fusion (PDF) were graded into Grades 1-5 by magnetic resonance imaging at 24 hours, 2 weeks, 6 months, and one year after surgery. The patients were divided into the Mild group (Grades 1-3) and the Severe group (Grades 4, 5). Perioperative factors were compared between the two groups at 24 hours after surgery. Distribution of EH or scar formation was investigated according to two surgeries. The recovery rate of Japanese Orthopedic Association (JOA) scores and the improvements of neck disability index (NDI) were compared between the two groups at one year postoperatively. Results Of the postoperative factors, posterior shift of the cervical spinal cord at C4 and C7 significantly differed between the two groups. Patients in the Severe group at 24 hours after surgery (17%) increased to 41% at 2 weeks and subsequently decreased to 16% at 6 months after LP. After PDF, 3% in the Severe group at 24 hours after surgery increased to 15% at 2 weeks and then decreased to 3% at 6 months postoperatively. Only one (3%) patient remained in the Severe group at 1 year after PDF. The recovery rate of JOA score (47.5%) of the patients in the Mild group showed trend larger than that of the Severe group (34.7%) after LP. Preoperative NDI (15.6 points) significantly improved postoperatively to 12.1 points in only the Mild group after LP. Conclusions The patterns of distribution of EH or scar formation did not differ between the two surgical methods. The severity of postoperative scar formation related to surgical outcomes after LP.
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Kan-Ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
| | - Gentaro Kumagai
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
| | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
| | - Toru Asari
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
| | - Eiji Sasaki
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Taku Fujita
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Akita, Japan
| | - Yasuyuki Ishibashi
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Aomori, Japan
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Takeuchi K, Yokoyama T, Numasawa T, Wada KI, Itabashi T, Yamasaki Y, Kudo H, Ota S. Fixed Neck Position in Multilevel Cervical Posterior Decompression and Fusion to Reduce Postoperative Disturbances of Cervical Spine Function. Spine Surg Relat Res 2018; 2:253-262. [PMID: 31435531 PMCID: PMC6690097 DOI: 10.22603/ssrr.2017-0090] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2017] [Accepted: 03/15/2018] [Indexed: 11/05/2022] Open
Abstract
Introduction Difficulties with neck mobility often interfere with patients' activities of daily living (ADL) after cervical posterior spine surgery. The range of motion of the cervical spine decreases markedly after multilevel cervical posterior decompression and fusion (PDF). However, details regarding the limitations of cervical spine function due to postoperative reduced neck mobility after multilevel PDF are as yet unclarified. The present study aimed to clarify the quality of life and its related factors after PDF, and the optimal fixed neck position in multilevel PDF that minimizes the limitations of ADL accompanying markedly reduced postoperative neck mobility. Methods Limitations of ADL involving neck extension, rotation, and flexion were investigated in 32 consecutive patients who underwent C2-T1 PDF using the responses to the cervical spine function domain of the Japanese Orthopedic Association Cervical Myelopathy Evaluation Questionnaire (JOACMEQ). The EuroQol 5 Dimension, Japanese Orthopedic Association score, and five domains of the JOACMEQ were also investigated. We investigated the risk factors regarding the fixed neck position in PDF for the impossibility to perform ADL involving each of three movements using cut-off values obtained from receiver-operating characteristic curves. Results Postoperative comprehensive quality of life was significantly related to neurological improvements and to poor outcomes of cervical spine function after PDF. The significant risk factors for impossibility to perform ADL involving neck rotation were a C2-C7 lordotic angle ≥ 6° (P = 0.0057) or a proportion coefficient of C2-T1 tilt angle/C2-C7 lordotic angle ≤ 1.8 (P = 0.0024). There were no significant risk factors for impossibility to perform ADL involving neck extension or flexion. Conclusions The optimal fixed neck position in C2-T1 PDF to reduce postoperative limitations of ADL involving neck mobility is a C2-C7 lordotic angle of less than 6°, or a C2-T1 tilt angle (°) of greater than 1.8 × the C2-C7 lordotic angle (°).
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Affiliation(s)
- Kazunari Takeuchi
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Toru Yokoyama
- Department of Orthopedic Surgery, Odate Municipal General Hospital, Odate, Japan
| | - Takuya Numasawa
- Department of Orthopedic Surgery, Hachinohe City Hospital, Hachinohe, Japan
| | - Kan-Ichiro Wada
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Taito Itabashi
- Department of Orthopedic Surgery, Towada City Hospital, Towada, Japan
| | | | - Hitoshi Kudo
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
| | - Seiya Ota
- Department of Orthopaedic Surgery, Hirosaki University School of Medicine, Hirosaki, Japan
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