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Liu C, Wang W, Li X, Shi B, Lu S. Preoperative Cervical Range of Motion in Flexion as a Risk Factor for Postoperative Cervical Sagittal Imbalance After Laminoplasty. Spine (Phila Pa 1976) 2024; 49:492-499. [PMID: 37798845 PMCID: PMC10927305 DOI: 10.1097/brs.0000000000004844] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2023] [Accepted: 09/26/2023] [Indexed: 10/07/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To investigate factors associated with cervical sagittal imbalance (CSI) after cervical laminoplasty (LMP). SUMMARY OF BACKGROUND DATA Preoperative dynamic cervical sagittal alignment is an important predictor for changes in cervical sagittal alignment and clinical outcomes after LMP. However, the impact of preoperative dynamic cervical sagittal alignment on postoperative changes in the cervical sagittal vertical axis (cSVA) after LMP remains unclear. We hypothesized that preoperative cervical flexion and extension function are associated with the changes in cSVA and clinical outcomes and found potential risk factors for post-LMP CSI. PATIENTS AND METHODS Patients undergoing LMP at a single institution between January 2019 and December 2021 were retrospectively reviewed. The average follow-up period was 19 months. The parameters were collected before the surgery and at the final follow-up. We defined the changes in cSVA (△cSVA) ≤ -10 mm as the improvement group, -10 mm < △cSVA ≤ 10 mm as the stable group, and △cSVA > 10 mm as the deterioration group. Multivariate logistic regression was used to evaluate factors associated with postoperative CSI. The χ 2 test was used to compare categorical data between groups. T tests, analysis of variance, Kruskal-Wallis tests, and Mann-Whitney Wilcoxon tests were used to assess the differences between radiographic and clinical parameters among groups. A receiver operating characteristic curve analysis was used to identify optimal cutoff values. RESULTS The study comprised 102 patients with cervical spondylotic myelopathy. The Japanese Orthopedic Association recovery rate was better in the improvement group and a significant aggravation in neck pain was observed in the deterioration group after surgery. Cervical Flex range of motion (ROM; spine range of flexion) was significantly higher in the deterioration group. The multivariate logistic regression model suggested that greater Flex ROM and starting LMP at C3 were significant risk factors for postoperative deterioration of cervical sagittal balance. Receiver operating characteristic curves showed that the cutoff value for preoperative Flex ROM was 34.10°. CONCLUSION Preoperative dynamic cervical sagittal alignment influences postoperative cervical sagittal balance after LMP. Cervical LMP should be carefully considered for patients with a preoperative high Flex ROM, as CSI is likely to occur after surgery. LEVEL OF EVIDENCE Level 3.
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Affiliation(s)
- Chengxin Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xiangyu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Bin Shi
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
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Suzuki H, Funaba M, Fujimoto K, Ichihara Y, Nishida N, Sakai T. Current Concepts of Cervical Spine Alignment, Sagittal Deformity, and Cervical Spine Surgery. J Clin Med 2024; 13:1196. [PMID: 38592040 PMCID: PMC10932435 DOI: 10.3390/jcm13051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
There are not many reports on cervical spine alignment, and only a few analyze ideal surgical approaches and optimal amounts of correction needed for the various types of deformity. We comprehensively reviewed the present literature on cervical spinal deformities (with or without myelopathy) and their surgical management to provide a framework for surgical planning. A general assessment of the parameters actually in use and correlations between cervical and thoracolumbar spine alignment are provided. We also analyzed posterior, anterior, and combined cervical surgical approaches and indications for the associated techniques of laminoplasty, laminectomy and fusion, and anterior cervical discectomy and fusion. Finally, on the basis of the NDI, SF-36, VAS, and mJOA questionnaires, we fully evaluated the outcomes and measures of postoperative health-related quality of life. We found the need for additional prospective studies to further enhance our understanding of the importance of cervical alignment when assessing and treating cervical deformities with or without myelopathy. Future studies need to focus on correlations between cervical alignment parameters, disability scores, and myelopathy outcomes. Through this comprehensive literature review, we offer guidance on practical and important points of surgical technique, cervical alignment, and goals surgeons can meet to improve symptoms in all patients.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan; (M.F.); (K.F.); (Y.I.); (N.N.); (T.S.)
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Ren HL, Shen X, Ding RT, Cai HB, Zhang GL. Preoperative Range of Motion in Extension May Influence Postoperative Cervical Kyphosis After Laminoplasty. Spine (Phila Pa 1976) 2023; 48:1308-1316. [PMID: 36856549 DOI: 10.1097/brs.0000000000004610] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2023] [Accepted: 02/01/2023] [Indexed: 03/02/2023]
Abstract
STUDY DESIGN Retrospective observational study. OBJECTIVE The objective of this study was to investigate factors associated with cervical kyphosis after laminoplasty. SUMMARY OF BACKGROUND DATA Many factors are reportedly associated with the deterioration of cervical curvature after laminoplasty, including cervical lordosis angle, cervical spine range of motion (ROM), T1 slope, and C2-C7 sagittal vertical axis. Postlaminoplasty kyphosis or deterioration of cervical curvature is likely caused by multiple factors. There is currently no consensus on these issues. MATERIALS AND METHODS Data of patients treated with laminoplasty for degenerative cervical myelopathy at our institution during 2008-2018 were reviewed. The following variables were collected for each patient: age and sex; follow-up time; surgery involving C3 (yes or no); surgery involving C7 (yes or no); distribution of segments operated on; number of laminae operated on; flexion, extension, and total ROM; cervical lordotic angle; longitudinal distance index; curvature index; C2-C7 sagittal vertical axis; and T1 slope. Logistic regression analysis was used to assess possible risk factors for postoperative kyphosis. Receiver operating characteristic curves were constructed to determine the cutoff values of risk factors. RESULTS The study cohort comprised 151 patients. Logistic regression analysis indicated that sex, number of laminae operated on, and preoperative extension ROM were significantly associated with postoperative cervical kyphosis ( P <0.05). There was significantly greater postoperative kyphosis in women than in men; the more segments operated on, the greater the risk of postoperative kyphosis, and the larger the preoperative extension ROM, the lower the risk of postlaminoplasty kyphosis. Receiver operating characteristic curve analysis showed that the cutoff value for preoperative extension ROM is 22.1°. CONCLUSIONS Preoperative extension ROM may be associated with the development of postoperative kyphosis. The cutoff value of preoperative extension ROM that suggested the prospect of postoperative kyphosis in our sample was 22.1°.
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Affiliation(s)
- Hai-Long Ren
- Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Xing Shen
- Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Ruo-Ting Ding
- Division of Spinal Surgery, Department of Orthopaedics, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Hai-Bo Cai
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
| | - Gong-Liang Zhang
- Department of Radiology, Nanfang Hospital, Southern Medical University, Guangzhou, Guangdong Province, China
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Jin L, Liang Y, Guo C, Zheng B, Liu H, Xu S. Cervical Sagittal Alignment and Balance Associated With Aging Chinese Adults: A Radiographic Analysis. Global Spine J 2023:21925682231172125. [PMID: 37204859 DOI: 10.1177/21925682231172125] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/20/2023] Open
Abstract
STUDY DESIGN This was a retrospective cohort radiographic study. OBJECTIVE To determine the age- and gender-related normative values and correlation of cervical sagittal parameters in asymptomatic Chinese adults, and to explore the changes and compensating mechanisms across different age groups. METHODS The asymptomatic subjects were divided into 6 groups according to age and then one-way analysis of variance was used to compare the multiple sets of cervical sagittal parameters among the different age groups. Independent t-tests were performed to compare the sagittal parameters among different gender and different cervical spine alignments. Relationships between each parameter were tested by Pearson's correlation. Linear regression analysis based on T1 slope (T1S) and C2 slope (C2S) was used to provide an equation to predict normal cervical alignment. RESULTS Mean values of each cervical sagittal parameter were presented based on age and gender. There were positive correlations between age and cervical lordosis (CL) (r = -.278, P < .001), T1S (r = .271, P < .001), cervical sagittal vertical axis (cSVA) (r = .218, P < .001), C2-C4 Cobb angle (r = -.283, P < .001), horacic inlet angle (TIA) (r = .443, P < .001), and neck tilt (NT) (r = .354, P < .001). Older groups (aged >50 years) had greater T1 Slope, C2S, and TIA. The C2-C4 Cobb angle maintained a steadily increasing trend and significantly increased in the older adult groups (P < .05), while the C5-C7 Cobb angle was relatively constant. Mean values of parameters were larger in males (P > .05). Linear regression analysis indicated a strong association between T1S and CL (R2 = .551, standard error 1.16°), T1S and C5-7 (R2 = .372; P < .001), and C2S and C2-4 (R2 = .309; P < .001). CONCLUSIONS Normative values of cervical sagittal parameters vary by age and sex. The CL, cSVA, and T1S, C2-4 Cobb angle changed with increasing age, and it can influence the recruitment of compensation mechanism. Normative CL of Chinese adults was predicted by the equation CL = T1S-14.7° ± 1.2°, which could serve as a reference when planning for cervical surgery.
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Affiliation(s)
- Linyu Jin
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
- Department of Orthopedics, Shanghai Key Laboratory for Prevention and Treatment of Bone and Joint Diseases, Shanghai Institute of Traumatology and Orthopedics, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China
| | - Yan Liang
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Chen Guo
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Bin Zheng
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Haiying Liu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
| | - Shuai Xu
- Department of Spinal Surgery, Peking University People's Hospital, Peking University, Beijing, China
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Liu C, Shi B, Wang W, Li X, Lu S. Effect of preoperative dynamic cervical sagittal alignment on the loss of cervical lordosis after laminoplasty. BMC Musculoskelet Disord 2023; 24:233. [PMID: 36978058 PMCID: PMC10045627 DOI: 10.1186/s12891-023-06335-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/04/2023] [Accepted: 03/17/2023] [Indexed: 03/30/2023] Open
Abstract
PURPOSE Cervical laminoplasty (CLP) is a developed surgical procedure for the treatment of cervical spondylotic myelopathy (CSM), but only a few of those studies focus on preoperative dynamic cervical sagittal alignment and the study of different degrees of loss of cervical lordosis (LCL) is lacking. This study aimed to analyze patients who underwent CLP to investigate the effect of cervical extension and flexion function on different degrees of LCL. METHODS In this retrospective case-control study, we analyzed 79 patients who underwent CLP for CSM between January 2019 and December 2020. We measured the cervical sagittal alignment parameters on lateral radiographs (neutral, flexion, and extension positions) and used Japanese Orthopedic Association (JOA) score to assess clinical outcomes. We defined the extension ratio (EXR) as 100 × Ext ROM (cervical range of extension)/ROM (cervical range of motion). We observed the relationships between collected variables (demographic and radiological variables) and LCL. Patients were classified into the following three groups according to the LCL: stability group: (LCL ≤ 5°); mild loss group (5° < LCL ≤ 10°); and severe loss group (LCL > 10°). We compared the differences of collected variables (demographic, surgical and radiological variables) among the three groups. RESULTS Seventy-nine patients were enrolled (mean age 62.92 years; 51 men, 28 women) in the study. Among the three groups, cervical Ext ROM was the best in the stability group (p < 0.01). Compared with the stability group, range of flexion (Flex ROM) was significantly higher (p < 0.05) and EXR was significantly lower (p < 0.01) in the severe loss group. Compared with the severe loss group, JOA recovery rates were better (p < 0.01) in the stability group. Receiver-operating characteristic curve (ROC) analysis to predict LCL > 10° (area under the curve = 0.808, p < 0.001). The cutoff value for EXR was 16.80%, with sensitivity and specificity of 72.5% and 82.4%, respectively. CONCLUSION CLP should be carefully considered for patients with a preoperative low Ext ROM and high Flex ROM, as a significant kyphotic change is likely to develop after surgery. EXR is a useful and simple index to predict significant kyphotic changes.
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Affiliation(s)
- Chengxin Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Bin Shi
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xiangyu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China.
- National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Choi DY, Shin MH, Kim JT. Impact of C3 Involvement on Postoperative Kyphosis Following Cervical Laminoplasty: A Comparison Between High and Low T1 Slope. World Neurosurg 2022; 167:e1084-e1089. [PMID: 36087912 DOI: 10.1016/j.wneu.2022.08.146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 08/28/2022] [Accepted: 08/30/2022] [Indexed: 10/31/2022]
Abstract
BACKGROUND The goal of the present study was to investigate the impact of C3 involvement on the postoperative kyphosis following cervical laminoplasty in patients with high and low T1S. METHODS The data from ossification of the posterior longitudinal ligament patients who had undergone laminoplasty between January 2016 and December 2019 were retrospectively reviewed. Patients were divided into low-and high-T1S groups according to preoperative T1S, and the postoperative alignment change was compared between the groups. The relationships between postoperative cervical kyphosis and preoperative variables, including gender, C3 laminoplasty, T1S, cervical lordosis (CL), C2-7 Sagittal Vertical Axis, and T1S minus CL (T1S-CL) were investigated. RESULTS Eighty-six patients were divided into 2 groups above and below median preoperative T1S (23.70). There were thirty-three patients (38.3%) in low-T1S group and fifty-three patients (61.7%) in high-T1S group. Twenty-three patients (26.7%) were performed with C3 involved laminoplasty. C3 laminoplasty (odds ratio [OR], 9.67; 2.82-33.16; P = 0.000), high T1S (OR, 4.89; 1.54-15.49; P = 0.007), and mismatched T1S-CL (OR, 5.96; 1.83-19.43; P = 0.003) were significantly associated with postoperative kyphosis. In high-T1S group, the loss of CL was significant (P = 0.017) when C3 laminoplasty was performed, whereas, in low-T1S group, the C3 laminoplasty did not show the statistically significant difference. (P = 0.194). CONCLUSIONS C3 laminoplasty, mismatched T1S-CL, and high T1S were found to increase the risk of postoperative kyphosis following cervical laminoplasty. Patients with high T1 slope tended to exhibit a greater loss of CL when the laminoplasty was performed extending to C3 segment.
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Affiliation(s)
- Du-Yong Choi
- Departments of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University, Incheon, Republic of Korea
| | - Myung-Hoon Shin
- Departments of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University, Incheon, Republic of Korea.
| | - Jong-Tae Kim
- Departments of Neurosurgery, Incheon St Mary's Hospital, College of Medicine, The Catholic University, Incheon, Republic of Korea
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Characterization of Clinical Symptoms of Cervical Spondylotic Myelopathy Based on DKI Imaging Parameter Ratios. CONTRAST MEDIA & MOLECULAR IMAGING 2022; 2022:7491565. [PMID: 36304776 PMCID: PMC9578830 DOI: 10.1155/2022/7491565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Revised: 09/20/2022] [Accepted: 09/27/2022] [Indexed: 01/26/2023]
Abstract
In recent years, people's living conditions have significantly improved, and their lifestyles have been diversified. However, the incidence of various diseases has also increased with it, including cervical spondylotic myelopathy (CSM). Spinal cord cervical spondylosis is one of the spinal cord compression disorders that can be severely disabling and accounts for 10% to 15% of all cervical spondylosis. In this paper, DKI image processing technology is used to study the symptoms of cervical spondylosis, which is helpful to help them explore the symptoms and causes. The onset of cervical spondylosis has a longer period of time, and the period of conservative treatment will inevitably require a longer period of time. The clinical symptoms of cervical spinal cord compression are mainly pain, and after the cervical spinal cord nerve is compressed, ischemia and hypoxia will occur, the nerve sensitivity will increase, and the patient will have reflex neck muscle pain symptoms. This causes degeneration of the patient's intervertebral disc tissue, degeneration of facet joints, ossification of the posterior longitudinal ligament, and formation of spurs on the posterior edge of the vertebral body. The condition will become more complicated, so it is very important to identify the characteristics of the clinical symptoms of cervical spondylotic myelopathy to help patients with cervical spondylosis recover. This paper identifies the clinical symptoms of cervical spondylosis based on the parameter ratio method of Diffusional Kurtosis Imaging (DKI). The current state of diffusion kurtosis imaging and the treatment of cervical spondylosis and the treatment operation are introduced, and the image enhancement technology in medical imaging is used to analyze the disc herniation of each segment in the overflexion, neutral and hyperextension positions. After comparing the FA, MK, and MD values in the spinal cord between the normal group and the patient group, the results showed that the FA, MD and MK values in the patient group were lower than those in the normal group, and the findings showed that the MD and MK values were positively correlated with the JOA score, reflecting that as the clinical symptoms of spinal cervical spondylosis worsened. The size and number of cervical intervertebral disc bulge on the hyperextension image is obvious and the number increases (especially the C4/5, C5/6, and C6/7 intervertebral discs with greater mobility), and the highest is 0.82 and 27%, respectively.
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Lambrechts MJ, Toci GR, Karamian BA, Kozick Z, Prodoehl J, Reiter D, Muchintala R, Tecce E, Vaccaro A, O'Connor P, Syal A, Lambo D, Canseco JA, Kaye ID, Woods BI, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Sagittal alignment differences on the operating room table compared to preoperative and postoperative imaging in anterior cervical discectomy and fusion. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:415-420. [PMID: 36777914 PMCID: PMC9910136 DOI: 10.4103/jcvjs.jcvjs_100_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2022] [Accepted: 10/14/2022] [Indexed: 12/12/2022] Open
Abstract
Study Design The study design used was a retrospective cohort. Objective The objective of this study is to determine if intraoperative improvements in sagittal alignment on the operating table persisted on postoperative standing radiographs. Summary of Background Data Cervical sagittal alignment may be correlated to postoperative outcomes. Since anterior cervical discectomy and fusions (ACDFs) can restore some cervical lordosis through intervertebral grafts/cages, it is important to understand if intraoperative radiographic measurements correlate with persistent postoperative radiographic changes. Materials and Methods Patients undergoing elective primary ACDF were screened for the presence of lateral cervical radiographs preoperatively, intraoperatively, and postoperatively. Patients were excluded if their first postoperative radiograph was more than 3 months following the procedure or if cervical lordosis was not able to be measured at each time point. Paired t-tests were utilized to compare differences in measurements between time points. Statistical significance was set at P < 0.05. Results Of 46 included patients, 26 (56.5%) were female, and the mean age was 55.2 ± 11.6 years. C0-C2 lordosis significantly increased from the preoperative to intraoperative time point (delta [Δ] = 4.49, P = 0.029) and significantly decreased from the intraoperative to postoperative time period (Δ = -6.57, P < 0.001), but this resulted in no significant preoperative to postoperative change (Δ = -2.08, P = 0.096). C2 slope decreased from the preoperative to the intraoperative time point (Δ = -3.84, P = 0.043) and significantly increased from the intraoperative to the postoperative time point (Δ = 3.68, P = 0.047), which also resulted in no net change in alignment between the preoperative and postoperative periods (Δ = -0.16, P = 0.848). There was no significant difference in the C2-C7 SVA from the preoperative to intraoperative (Δ = 0.85, P = 0.724) or intraoperative to postoperative periods (Δ = 2.04, P = 0.401); however, the C2-C7 SVA significantly increased from the preoperative to postoperative period (Δ = 2.88, P = 0.006). Conclusions Intraoperative positioning predominantly affects the mobile upper cervical spine, particularly C0-C2 lordosis and C2 slope, but these changes do not persist postoperatively.
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Affiliation(s)
- Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory R. Toci
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Zachary Kozick
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - John Prodoehl
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - David Reiter
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Rahul Muchintala
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Patrick O'Connor
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Amit Syal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Dominic Lambo
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - I. David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Barrett I. Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA, USA
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Wang DF, Li XY, Kong C, Liu CX, Shi B, Lu SB. Changes in T1 slope and cervical sagittal vertical axis correlate to improved neurological function recovery after cervical laminoplasty. Front Surg 2022; 9:1002848. [PMID: 36189391 PMCID: PMC9523107 DOI: 10.3389/fsurg.2022.1002848] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 09/02/2022] [Indexed: 12/04/2022] Open
Abstract
Purpose To investigate the influence of changes in T1 slope (T1S) and cervical sagittal vertical axis (CSVA) on cervical laminoplasty outcomes. Methods Eighty-one patients with cervical spondylotic myelopathy (CSM) treated with cervical laminoplasty were enrolled in this study. Demographic parameters included age and follow-up time. Imaging data included occiput-C2 lordosis (OC2), C2–C7 Cobb angle (CL), T1S, CSVA. Outcome assessment indicators included the Japanese Orthopedic Association (JOA) score, JOA recovery rate, and neck disability index (NDI). All patients were grouped based on preoperative T1S and variation in CL after surgery, respectively. Patients with decreased CL postoperatively were further grouped according to whether they were combined with T1S reduction. Results There were no significant differences in the final JOA score, JOA recovery rate, or NDI between patients with different T1S. Patients with loss of CL postoperatively had lower JOA score and JOA recovery rate, but higher NDI than patients with sustained CL. Furthermore, patients with CL loss but compensate for it with reduction in T1S had lower CSVA, higher JOA score and JOA recovery rate than those with CL loss alone. Conclusions Decreased T1S postoperatively prevents the tendency of the cervical spine to tilt forward by regulating CSVA and facilitates recovery of neurological function after cervical laminoplasty.
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Affiliation(s)
- Dong-Fan Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Cheng-Xin Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Bin Shi
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Beijing, China
- National Clinical Research Center for Geriatric Diseases, Xuanwu Hospital, Capital Medical University, Beijing, China
- Correspondence: Shi-Bao Lu
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Sakamoto R, Nakamoto H, Yoshida Y, Ohtomo N, Nagata K, Kato S, Doi T, Matsubayashi Y, Taniguchi Y, Tanaka S, Oshima Y. Does T1 slope minus cervical lordosis mismatch affect surgical outcomes of cervical laminoplasty in the absence of preoperative severe kyphosis? BMC Musculoskelet Disord 2022; 23:810. [PMID: 36008857 PMCID: PMC9404666 DOI: 10.1186/s12891-022-05755-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2022] [Accepted: 08/12/2022] [Indexed: 12/04/2022] Open
Abstract
Background The impact of the T1 slope minus cervical lordosis (T1S-CL) on surgical outcomes in patients with degenerative cervical myelopathy undergoing laminoplasty (LP) remain uncertain. Methods One hundred patients who underwent cervical LP were retrospectively reviewed. Radiographic measurements included C2–C7 lordosis (CL), T1 slope (T1S), and C2–C7 sagittal vertical axis (SVA). Additionally, pain numeric rating scale, neck disability index (NDI), 12-Item Short-Form Health Survey, Euro QOL 5 dimensions (EQ5D), and Japanese Orthopedic Association score were investigated. According to past reports, T1S–CL > 20° was defined as mismatched. Then, based on T1S-CL mismatching, patients were divided into 2 groups. Results This research understudied 67 males and 33 females with a mean age of 67 y. Preoperatively, only eight patients showed a T1S-CL mismatch. While the C2–7 Cobb angles did not change significantly after surgery, the T1 slope (T1S) angle increased, increasing the T1S-CL as a result. As we compared the clinical outcomes based on the preoperative T1S-CL mismatching, there were no significant differences between the two groups. On the other hand, the number of patients in the mismatched group increased to 21 patients postoperatively. As we compared clinical outcomes based on the postoperative T1S-CL mismatching, the postoperative NDI score and preop/postop EQ5D score were significantly worse in the mismatch group. Conclusions Although cervical LP showed inferior outcomes in patients with postoperative T1S-CL mismatch even in the absence of severe preoperative kyphosis (> 10°), preoperative T1S-CL mismatch was not adversely prognostic.
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Affiliation(s)
- Ryuji Sakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.,Department of Orthopaedic Surgery, National Center for Global Health and Medicine, 1-21-1, Toyama, Shinjyuku-Ku, Tokyo, 162-8655, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yuichi Yoshida
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Kosei Nagata
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - So Kato
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Toru Doi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yoshitaka Matsubayashi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, Faculty of Medicine, The University of Tokyo, 7-3-1, Hongo, Bunkyo-Ku, Tokyo, 113-8655, Japan.
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11
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Yuhuan H, Xueting H, Weiyue W. The Influence of Martial Arts on Spine CT Image Morphological Structure Based on Optimized Ant Colony Algorithm. COMPUTATIONAL INTELLIGENCE AND NEUROSCIENCE 2022; 2022:2725819. [PMID: 36052056 PMCID: PMC9427229 DOI: 10.1155/2022/2725819] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/12/2022] [Revised: 06/27/2022] [Accepted: 07/06/2022] [Indexed: 11/17/2022]
Abstract
As the second lifeline of human body, the abnormal development of its morphological structure has a great impact on people's physical and mental health. Due to bad living habits and learning pressure, the morphological and structural development of spine in adolescents and children is abnormal to a certain extent, which can be improved by sports intervention. Therefore, this article puts forward the research on the influence of Wushu on the spinal morphological structure based on the optimization algorithm and integrates the optimization ant colony algorithm on the basis of the traditional spinal CT image segmentation method. The experimental results show that the improved CT image segmentation method based on the optimized ant colony algorithm can solve the sensitive problem of the number of clusters, improve the segmentation efficiency and quality, and provide more accurate data for the subsequent comparative experiments. At the same time, the comparative test results show that Wuqinxi Wushu can better improve the abnormal dry tilt angle, abnormal kyphosis angle, and body balance angle of teenagers, improve the activity of teenagers' spine, and help teenagers enhance the overall health of spine.
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Affiliation(s)
- Hou Yuhuan
- Basic Medicine Department, Hubei College of Chinese Medicine, Jinzhou, Hubei 434000, China
- Dankook University College of Physical Education, Yongin, Gyeonggi Province 330712, Republic of Korea
| | - Hou Xueting
- Basic Medicine Department, Hubei College of Chinese Medicine, Jinzhou, Hubei 434000, China
- College of Life Sciences, Guangxi Normal University, Guilin, Guangxi 541000, China
| | - Wang Weiyue
- College of Life Sciences, Guangxi Normal University, Guilin, Guangxi 541000, China
- Shenyang Sports Universitye, Shenyang, Liaoning 110102, China
- Wuhan Sports University, Wuhan, Hubei 430079, China
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12
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Niu S, Anastasio AT, Rhee JM. Laminoplasty Achieves Improved Outcomes Despite Leading to a More Positive Sagittal Balance: Neither Preoperative Nor Postoperative Sagittal Balance Correlated With Spine-specific Outcome Data. Clin Spine Surg 2022; 35:E150-E154. [PMID: 33769970 DOI: 10.1097/bsd.0000000000001165] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/08/2020] [Accepted: 02/24/2021] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN A retrospective study of prospective data. OBJECTIVE Determine the correlation between cervical sagittal alignment, either preoperative or postoperative, and the outcomes of laminoplasty. SUMMARY OF BACKGROUND DATA Cervical laminoplasty is a common surgical treatment for myelopathy. However, the effect of preoperative or postoperative cervical sagittal alignment on outcomes, such as neurological improvement and patient-reported outcomes, remains unclear. METHODS A total of 144 consecutive patients (2007-2017) with laminoplasty for myelopathy and a minimum of 1-year postoperative follow-up were reviewed. The severity of myelopathy was assessed by modified Japanese Orthopedic Association (mJOA) scores. Total pain was measured by the visual analog scale. Patient-reported outcome included neck disability index (NDI) and 12-item short-form survey (SF-12). Radiographic measures of cervical sagittal alignment on x-ray images consisted of C2-C7 angle, T1 slope, C2-C7 sagittal vertical axis (SVA), and C2-C7 forward pitch (FP). Patients were also divided into 2 groups based on the postoperative C2-C7 SVA (≥40 or <40 mm) for outcome comparison. RESULTS Laminoplasty yielded improvement in functionality as evidenced by significantly increased mJOA scores, decreased total pain scores, and improved NDI scores at final follow-up. There was a change in sagittal balance postoperatively with significantly increased C2-C7 SVA and FP (7-8 mm increase). However, there was no correlation between preoperative sagittal alignment and outcomes. There was also no correlation between postoperative sagittal alignment and most outcomes, except for a significantly negative correlation between FP and short form-physical component summary (Spearman r=-0.328, P=0.011). When those with postoperative C2-C7 SVA ≥40 mm (n=60) were compared with those with <40 mm (n=84), there was no significant difference in outcomes. CONCLUSIONS Cervical laminoplasty yields significant neurological and functional improvement despite a more positive sagittal balance postoperatively, with increased C2-C7 SVA and FP. However, other than a lower short form-physical component summary score, neither preoperative nor postoperative sagittal alignment measures correlated with spine-specific outcomes. LEVEL OF EVIDENCE Level II-a retrospective cohort study.
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Affiliation(s)
- Shuo Niu
- Department of Orthopaedics, Emory University School of Medicine, Emory Orthopaedics and Spine Center, Atlanta, GA
| | - Albert T Anastasio
- Department of Orthopaedic Surgery, Duke University School of Medicine, Durham, NC
| | - John M Rhee
- Department of Orthopaedics, Emory University School of Medicine, Emory Orthopaedics and Spine Center, Atlanta, GA
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13
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Kato S, Mihara H, Niimura T, Watanabe K, Kawai T, Choe H, Inaba Y. Impact of focal apex angle on postoperative decompression status of the spinal cord and neurological recovery after cervical laminoplasty. J Neurosurg Spine 2021; 35:410-418. [PMID: 34298506 DOI: 10.3171/2020.12.spine201831] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 12/15/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Although anterior compression factors and cervical alignment affect neural decompression, cervical laminoplasty may be used to achieve indirect posterior decompression. The focal apex (FA) angle of the anterior compression factor of the spine represents the degree of anterior prominence toward the spinal cord. The authors investigated the mechanism underlying the influence of FA angle and cervical alignment on spinal cord alignment (SCA) after laminoplasty, including how high-intensity signal cord change (HISCC) on preoperative T2-weighted MRI (T2-MRI) may affect neurological improvement. METHODS We performed a retrospective study of patients who underwent laminoplasty for CSM or OPLL at two hospitals (Kanto Rosai Hospital, Kawasaki City, and Yokohama Minami Kyousai Hospital, Yokohama City, Japan) between April 2004 and March 2015. In total, 109 patients (mean age 67.3 years) with cervical compression myelopathy were included. FA angle was defined as the preoperative angle between the lines from the top of the prominence to the upper and lower adjacent vertebrae. Preoperative cervical alignment was measured between the C2 and C7 vertebrae (C2-7 angle). MRI was used to classify SCA as lordosis (type-L SCA), straight (type-S), local kyphosis (type-LK), or kyphosis (type-K). Preoperative HISCC was investigated by using T2-MRI. Neurological status was evaluated by using the Japanese Orthopaedic Association score. RESULTS The mean preoperative FA and C2-7 angles were 32.1° and 12.4°, respectively. Preoperative SCA was type-L or type-S in 53 patients. The neurological recovery rate (NRR) was significantly higher for patients with preoperative type-L and type-S SCA (51.4% for those with type-L and 45.0% for those with type-S) than for patients with other types (35.3% for those with type-LK and 31.7% for those with type-K). Among patients with preoperative type-L or type-S SCA, 87.3% maintained SCA; however, 5/12 (41.7%) patients with a preoperative average C2-7 angle < 12.4° and an average FA angle > 32.1° had postoperative type-LK or type-K SCA. SCA changed to type-L or type-S in 13.0% of patients with preoperative type-LK or type-K SCA. Moreover, in these patients, FA angle was significantly smaller and NRR was significantly higher than in other patients in whom postoperative SCA remained type-LK or type-K. Preoperative T2-MRI showed 73 patients with HISCC (43 with type-L and type-S, and 30 with type-LK and type-K SCA) and 36 without HISCC (20 with type-L and type-S, and 16 with type-LK and type-K SCA); the NRRs of these patients were 42.6% and 41.2%, respectively. No significant differences in SCA or NRR were observed between patients with and without HISCC. CONCLUSIONS NRR depends on preoperative SCA type; however, it is possible to change the type of SCA after laminoplasty. Preoperative FA and C2-7 angles influence change in SCA; therefore, they are important parameters for successful decompression with cervical laminoplasty.
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Affiliation(s)
- Shinya Kato
- 1Department of Orthopedics, Kanto Rosai Hospital, Kawasaki City.,2Department of Orthopedics, Yokohama Minami Kyousai Hospital; and.,3Department of Orthopedics, Yokohama City University School of Medicine, Yokohama City, Japan
| | - Hisanori Mihara
- 2Department of Orthopedics, Yokohama Minami Kyousai Hospital; and
| | - Takanori Niimura
- 2Department of Orthopedics, Yokohama Minami Kyousai Hospital; and
| | | | - Takuya Kawai
- 1Department of Orthopedics, Kanto Rosai Hospital, Kawasaki City
| | - Hyonmin Choe
- 3Department of Orthopedics, Yokohama City University School of Medicine, Yokohama City, Japan
| | - Yutaka Inaba
- 3Department of Orthopedics, Yokohama City University School of Medicine, Yokohama City, Japan
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14
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Chuang HC, Tseng YH, Chen Y, Chou PH, Chang WL, Su PF, Lin CL. Assessment of sagittal spinopelvic parameters in a Taiwanese population with spondylolysis by the EOS imaging system: a retrospective radiological analysis. BMC Musculoskelet Disord 2021; 22:553. [PMID: 34144702 PMCID: PMC8214289 DOI: 10.1186/s12891-021-04440-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/08/2021] [Accepted: 05/28/2021] [Indexed: 11/10/2022] Open
Abstract
Background The impact of sagittal spinopelvic alignment on spondylolysis is well established in Caucasian populations. However, prior studies suggest that people from different ethnological backgrounds showed divergence, and a few studies that focused on Asian populations reported conflicting results. The aim of this study is to use the EOS imaging system to evaluate the spinopelvic parameters of spondylolysis patients, and their relationship with spondylolisthesis, disc degeneration, and age in a Taiwanese population. Methods Radiographic sagittal spinopelvic parameters for 45 spondylolysis patients and 32 healthy people were evaluated, including pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), thoracic kyphosis (TK), and lumbar lordosis (LL). The spinopelvic parameters were compared between spondylolytic and control groups. These parameters were further compared between spondylolytic subjects with and without spondylolisthesis, with and without high-grade disc degeneration, and young (< 30 years old) and middle-aged. Results The PI and LL of the spondylolytic group (52.6°±12.0° and 41.3°±15.2°) were significantly higher than those of the healthy control group (47.16°±7.95° and 28.22°±10.65°). Further analysis of the spondylolytic patients revealed that those with high-grade disc degeneration were more prone to spondylolisthesis (92.3 %) compared to those without (50 %; p = 0.001). The middle-aged group had significantly higher rates of spondylolisthesis (80 %) and high-grade disc degeneration (52.4 %) compared with those for the young group (45 and 16.7 %, respectively; p = 0.017 and 0.047, respectively). No statistically significant difference in the sagittal spinopelvic parameters was found when spondylolytic patients were divided according to the occurrence of spondylolisthesis or high-grade disc degeneration. Conclusions In a Taiwanese population, PI and LL were significantly larger in spondylolytic patients. Disc degeneration and age were associated with the occurrence of spondylolisthesis. Ethnological differences should thus be taken into account when making clinical decisions regarding spondylolysis in a Taiwanese population.
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Affiliation(s)
- Hao-Chun Chuang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan
| | - Yu-Hsiang Tseng
- Department of Plastic Surgery, Kaohsiung Veterans General Hospital, Kaohsiung, Taiwan
| | - Yueh Chen
- Department of Orthopaedic Surgery, Sin Lau Christian Hospital, Tainan, Taiwan
| | - Po-Hsin Chou
- Department of Orthopedics and Traumatology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Wei-Lun Chang
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan.,Division of Orthopaedics, Department of Surgery, National Cheng Kung University Hospital Dou Liou Branch, National Cheng Kung University, Yunlin, Taiwan
| | - Pei-Fang Su
- Department of Statistics, National Cheng Kung University, Tainan, Taiwan
| | - Cheng-Li Lin
- Department of Orthopaedic Surgery, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, No.138, Sheng-Li Road, 70428, Tainan, Taiwan. .,Skeleton Materials and Bio-compatibility Core Lab, Research Center of Clinical Medicine, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan. .,Medical Device Innovation Center (MDIC), National Cheng Kung University, Tainan, Taiwan. .,Musculoskeletal Research Center, Innovation Headquarter, National Cheng Kung University, Tainan, Taiwan.
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15
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Uehara M, Ikegami S, Kuraishi S, Oba H, Takizawa T, Munakata R, Hatakenaka T, Kamanaka T, Miyaoka Y, Takahashi J. Comparison of fusion versus non-fusion surgery for retro-odontoid pseudotumor with atlanto-axial subluxation. NORTH AMERICAN SPINE SOCIETY JOURNAL (NASSJ) 2021; 6:100064. [PMID: 35141629 PMCID: PMC8820057 DOI: 10.1016/j.xnsj.2021.100064] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/03/2020] [Revised: 04/10/2021] [Accepted: 04/12/2021] [Indexed: 11/16/2022]
Abstract
Background Due to the limited number of reports comparing posterior fusion with posterior decompression alone for retro-odontoid pseudotumor, there remains no consensus on treatment preference, especially in older patients. This study compared posterior fusion (with or without additional decompression) with posterior decompression alone for treating spinal cord pressure from non-inflammatory retro-odontoid pseudotumor with atlanto-axial subluxation (AAS). Methods Forty-one patients (27 male and 14 female; mean age, 73.0 ± 11.4 years) who underwent either posterior cervical fusion or decompression alone for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS and were observed for more than 1 year between September 2009 and July 2019 were enrolled. Thirty-two patients (23 male and 9 female; mean age: 71.8 ± 10.9 years) received posterior fusion surgery (fusion group) and 9 patients (4 male and 5 female; mean age: 77.2 ± 12.5 years) underwent decompression alone (non-fusion group). We compared pre- and postoperative Japanese Orthopaedic Association (JOA) scores and preoperative cervical alignment parameters between the groups. Results In the fusion group, the mean preoperative JOA score was significantly improved from 9.0 ± 3.2 points to 11.7 ± 3.2 points at the final follow-up (p = 0.0002). Similarly in the non-fusion group, the mean preoperative and final follow-up JOA scores were 8.2 ± 3.5 points and 11.7 ± 3.8 points, respectively (p = 0.003). The recovery rate at the final follow-up was 22.6% in the fusion group and 43.4% in the non-fusion group, which were statistically comparable (p = 0.23). We observed no remarkable correlations between cervical sagittal spinal alignment parameters and JOA score recovery rate in the cohort, nor was any significant subluxation progression seen. Conclusion Compared with fusion surgery, surgical decompression alone may be a suitable and less invasive option for the treatment of non-inflammatory retro-odontoid pseudotumor with AAS, especially in elderly patients.
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16
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Lee SH, Son DW, Shin JJ, Ha Y, Song GS, Lee JS, Lee SW. Preoperative Radiological Parameters to Predict Clinical and Radiological Outcomes after Laminoplasty. J Korean Neurosurg Soc 2021; 64:677-692. [PMID: 34044492 PMCID: PMC8435653 DOI: 10.3340/jkns.2020.0294] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2020] [Accepted: 12/19/2020] [Indexed: 12/23/2022] Open
Abstract
Many studies have focused on pre-operative sagittal alignment parameters which could predict poor clinical or radiological outcomes after laminoplasty. However, the influx of too many new factors causes confusion. This study reviewed sagittal alignment parameters, predictive of clinical or radiological outcomes, in the literature. Preoperative kyphotic alignment was initially proposed as a predictor of clinical outcomes. The clinical significance of the K-line and K-line variants also has been studied. Sagittal vertical axis, T1 slope (T1s), T1s-cervical lordosis (CL), anterolisthesis, local kyphosis, the longitudinal distance index, and range of motion were proposed to have relationships with clinical outcomes. The relationship between loss of cervical lordosis (LCL) and T1s has been widely studied, but controversy remains. Extension function, the ratio of CL to T1s (CL/T1s), and Sharma classification were recently proposed as LCL predictors. In predicting postoperative kyphosis, T1s cannot predict postoperative kyphosis, but a low CL/T1s ratio was associated with postoperative kyphosis.
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Affiliation(s)
- Su Hun Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Dong Wuk Son
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Jae Shin
- Department of Neurosurgery, Yongin Severance Hospital, Yonsei University College of Medicine, Yongin, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Geun Sung Song
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
| | - Jun Seok Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea
| | - Sang Weon Lee
- Department of Neurosurgery, Research Institute for Convergence of Biomedical Science and Technology, Pusan National University Yangsan Hospital, Yangsan, Korea.,Department of Neurosurgery, School of Medicine, Pusan National University, Busan, Korea
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