1
|
Wu J, Pan P, Chang Y, Chen F, Yang J, Wu L, Ni B, Guo Q. The Impact of Cervical Degeneration and Sagittal Balance on Retro-Odontoid Soft-Tissue Thickness. World Neurosurg 2024; 182:e231-e235. [PMID: 38008169 DOI: 10.1016/j.wneu.2023.11.088] [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: 11/15/2023] [Accepted: 11/19/2023] [Indexed: 11/28/2023]
Abstract
OBJECTIVE To investigate whether retro-odontoid soft-tissue thickness (ROSTT) is associated with cervical degeneration, cervical spine mobility, and sagittal balance of cervical spine. METHODS The data of 151 patients who presented at our hospital with cervical spondylosis were reviewed. The ROSTT was measured using T1-weighted sagittal cervical magnetic resonance imaging findings. The assessment of the degree of cervical intervertebral disc degeneration (IVDD) was conducted using sagittal T2-weighted imaging. The T1 slope (T1S), C0-C2 angle, C1-C2 angle, C2-C7 angle, C1-C7 sagittal vertical axis and C2-C7 sagittal vertical axis were measured. The range of motion was assessed by measuring the flexion-extension radiographs. According to the ROSTT, those measuring less than 3 mm were classified as normal group and those measuring larger than 3 mm were classified as thickened group. RESULTS The thickened group had larger cervical IVDD grade, age, C2-C7 angle, and T1S compared to the normal group (all P < 0.05). Additionally, the C0-C2 angle was significantly smaller in the thickened group than in the normal group (P < 0.05). ROSTT showed a negative correlation with C0-C2 angle (r = -0.181, P < 0.05), but positive correlations with both C2-C7 angle (r = 0.255, P < 0.05) and T1S (r = 0.240, P < 0.05). Furthermore, ROSTT was positively correlated with age (r = 0277, P < 0.05) and cervical IVDD grade (Spearman, r = 0.299, P < 0.05). CONCLUSIONS Cervical sagittal balance and cervical degeneration have a significant impact on ROSTT. Patients with a higher T1S and severe cervical degeneration are more likely to result in greater ROSTT.
Collapse
Affiliation(s)
- Ji Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Pan Pan
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Yunyun Chang
- Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Fei Chen
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Jun Yang
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Lecheng Wu
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Bin Ni
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China
| | - Qunfeng Guo
- Department of Orthopedics, Shanghai Changzheng Hospital, Naval Medical University, Shanghai, People's Republic of China.
| |
Collapse
|
2
|
Fang Q, Chen J, Jiang A, Chen Y, Meng Q. Correlation between C0–C2 height, occipital-C2 angle and clivus-axial angle: CT-based anatomical study. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
3
|
Tzeng SW, Kuo YH, Kuo CH, Chang HK, Ko CC, Tu TH, Chang CC, Cheng H, Huang WC, Wu JC. Nature or nurture: a latent ossification of the posterior longitudinal ligament after atlantoaxial fusion. Illustrative case. JOURNAL OF NEUROSURGERY. CASE LESSONS 2022; 4:CASE22241. [PMID: 36088554 PMCID: PMC9706324 DOI: 10.3171/case22241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/29/2022] [Accepted: 07/08/2022] [Indexed: 06/15/2023]
Abstract
BACKGROUND The natural history of ossification of the posterior longitudinal ligament (OPLL) remains poorly understood and multiple etiologies have been reported. However, most have focused on the characteristics of the patient rather than alternation of mechanical stress after spinal fusion. OBSERVATIONS This report describes, for the first time, a de novo OPLL found at the subaxial cervical spine 7 years after an atlantoaxial fusion surgery. A 57-year-old female initially required atlantoaxial arthrodesis for os odontoideum and stenosis that caused myelopathy. The posterior fusion surgery went smoothly without complications and the patient had good recovery of neurological functions. There was no associated instability, trauma, or reoperations during the follow-up. Seven years later, the patient presented with slight neck pain and a newly developed OPLL at C3-4 caudal to the C1-2 fusion construct. LESSONS Conflicting with the conventional concept that OPLL is common in elderly men with genetic or hormonal factors, or associated spondyloarthropathies, OPLL could develop in women even after solid C1-2 fusion. The adjacent subaxial cervical spine is not free of risks for subsequent development of OPLL and cervical spondylotic myelopathy. This case illustration extends the scope of etiologies of OPLL within the present literature.
Collapse
Affiliation(s)
- Shih-Wei Tzeng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Biomedical Informatics, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Imaging and Radiological Sciences, National Yang Ming Chiao Tung University, Taipei, Taiwan; and
| | - Chin-Chu Ko
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
- Institute of Pharmacology, National Yang Ming Chiao Tung University, Taipei, Taiwan
| |
Collapse
|
4
|
Shi L, Xue D, Wang Y, Chou D, Zhao Y, Zhang S, Zhang M, Wang L, Li P, Liu Y. Efficacy of a Lateral Mass Fusion Device Combined with a Three-Dimensional-Printed Model in the Treatment of Craniovertebral Junction Abnormalities. World Neurosurg 2021; 159:e120-e129. [PMID: 34896663 DOI: 10.1016/j.wneu.2021.12.012] [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: 10/16/2021] [Revised: 12/02/2021] [Accepted: 12/03/2021] [Indexed: 10/19/2022]
Abstract
OBJECTIVE To investigate the efficacy of a lateral mass fusion device combined with a three-dimensional-printed model in treatment of craniovertebral junction abnormalities. METHODS This retrospective study comprised 56 patients with irreducible atlantoaxial dislocation who underwent posterior fixation between January 2016 and December 2019. Patients were divided into 2 groups according to whether or not cages were used-cage group and autograft group. Visual analog scale score, Japanese Orthopaedic Association score, health-related quality of life, American Spinal Injury Association spinal cord injury grade, atlas-dens interval, space available for the cord, cervicomedullary angle, and fusion rate were compared between groups. RESULTS Medical follow-up was >1 year. There was no statistical difference between groups in preoperative visual analog scale score, Japanese Orthopaedic Association score, 12-Item Short Form Health Survey score, American Spinal Injury Association grade, atlas-dens interval, space available for the cord, and cervicomedullary angle, and these indexes significantly improved after surgery (P < 0.05). Visual analog scale score and atlas-dens interval were lower in the cage group than in the autograft group (P < 0.05). Japanese Orthopaedic Association score, 12-Item Short Form Health Survey score, space available for the cord, and cervicomedullary angle were significantly higher in the cage group than in the autograft group (P < 0.05). Fusion rate of the cage group 4-6 months after surgery was higher than that of the autograft group (P = 0.068). American Spinal Injury Association grade was significantly higher in the cage group than in the autograft group (P < 0.05). CONCLUSIONS During 1-year follow-up, neurological function improvement and atlantoaxial joint reduction were satisfactory. The lateral mass fusion device combined with a three-dimensional printed model may be a clinically useful technique.
Collapse
Affiliation(s)
- Landa Shi
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Deng Xue
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yuqiang Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Dean Chou
- Department of Neurosurgery, University of California San Francisco, San Francisco, California, USA
| | - Yao Zhao
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Shuhao Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Min Zhang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Limin Wang
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Pengfei Li
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
| | - Yilin Liu
- Department of Orthopaedic Surgery, The First Affiliated Hospital of Zhengzhou University, Zhengzhou, China.
| |
Collapse
|
5
|
Kalidindi KKV, Sharma JK, Bansal K, Vishwakarma G, Chhabra HS. Radiological changes in sagittal parameters after C1-C2 arthrodesis and their clinical correlation: Is there a difference between traumatic and non-traumatic causes? Int J Neurosci 2021; 133:505-511. [PMID: 33980113 DOI: 10.1080/00207454.2021.1929213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
Background: Compensatory changes in cervical sagittal alignment after C1-C2 arthrodesis have been reported in a few studies. No studies have explored the differences in these compensatory changes between traumatic and non-traumatic pathologies. Conflicting reports exist on the correlation between cervical sagittal parameters and neck pain or function.Methodology: Medical records of 81 consecutive patients [Jan 2010 - Dec 2018] who underwent Harms arthrodesis were retrospectively reviewed. 53 patients were included in the final analysis. Radiological parameters [C0-C1, C1-C2, C2-C7 angles and T1 slope] and clinical parameters [VAS (Visual analogue scale) and NDI (Neck disability index)] were compared between the two groups, Group A (traumatic) and Group B (non-traumatic).Results: The 53 patients [Group A (n = 24,) and Group B (n = 29)] had a mean age of 49.98 ± 21.82 years (42 males, 11 females). Mean follow up duration was 48.9 months. Δ C1-C2 angle is significantly correlated with ΔC2-C7 angle (Group A, p = 0.004; Group B, p = 0.015) but not with ΔC0-C1 angle (Group A, p = 0.315; Group B, p = 0.938). Though significant improvement in the clinical parameters (VAS/NDI) has been noted in both groups, Group A showed a greater improvement in VAS scores [Group A, (p < 0.001); Group B, (p < 0.023)].Conclusions: The sub-axial sagittal profile was strongly correlated with the ΔC1-C2 angle in both groups. Group B showed greater changes in sagittal parameters after Harms fixation and Group A showed greater improvement in long-term functional outcomes. The final functional outcomes were not related to the initial or final radiological sagittal profile in both groups.
Collapse
Affiliation(s)
| | - Jeevan Kumar Sharma
- Department of Spine Service, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Kuldeep Bansal
- Department of Spine Service, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | - Gayatri Vishwakarma
- Department of Biostatistics, Indian Spinal Injuries Centre, Vasant Kunj, New Delhi, India
| | | |
Collapse
|
6
|
Age-related Changes in T1 and C7 Slope and the Correlation Between Them in More Than 300 Asymptomatic Subjects. Spine (Phila Pa 1976) 2021; 46:E474-E481. [PMID: 33181776 DOI: 10.1097/brs.0000000000003813] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A cross-sectional analysis using T1 slope (T1S) and C7 slope (C7S) in asymptomatic individuals. OBJECTIVE The aim of this study was to identify normative values, ranges of motion (ROMs), age-related changes in T1S and C7S, and correlation between the two slopes. SUMMARY OF BACKGROUND DATA Few studies have reported age-related changes in the T1S and C7S angles. Additionally, studies investigating the effects of cervical position on these slopes are limited. METHODS A total of 388 asymptomatic subjects (162 males and 226 females) for whom T1S measurement was performed on radiographs were enrolled in the study. The T1S and C7S angles were measured using neutral radiography of the cervical spine. ROMs were assessed by measuring the difference in alignment in the neutral position, flexion, and extension. RESULTS The mean C7S and T1S angles were 19.6° (22.2° in males, 17.9° in females) and 24.0° (26.7° in men and 22.1° in women), respectively. The T1S angle was significantly greater than the C7S angle. Both the C7S and T1S angles significantly increased with age. The flexion ROM of C7S was higher than that of T1S, whereas no significant difference was detected between the extension ROMs of the two slopes. The flexion ROMs of the two slopes did not change, whereas the extension ROMs significantly increased with age. A significant positive correlation was observed between the C7S and T1S angles (r2 = 0.75). CONCLUSION The normative values and age-related changes in C7S and T1S were analyzed. Both the C7S and T1S angles increased with age. The C7S angle was strongly correlated with the T1S angle, suggesting that C7S can substitute T1S on radiographic images.Level of Evidence: 3.
Collapse
|
7
|
A Technique for the In Vivo Study of Three-dimensional Cervical Segmental Motion Characteristics After Anterior Screw Fixation for Odontoid Process Fractures. Spine (Phila Pa 1976) 2021; 46:E433-E442. [PMID: 33186275 DOI: 10.1097/brs.0000000000003818] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Kinematics of the cervical spine was investigated using cone beam computed tomography (CBCT) images combined with three dimensions to three dimensions (3D-3D) registration technology in patients after anterior odontoid screw fixation (AOSF) surgery. OBJECTIVE The aim of this study was to investigate in vivo 3D cervical motion characteristics of patients who had undergone AOSF surgeries. SUMMARY OF BACKGROUND DATA AOSF surgery is a classic surgical method for the treatment of odontoid fracture, but there are few studies that investigated its effect on in vivo biomechanics of the cervical spine. Postoperative biomechanical characters of the atlantoaxial joint (C1-C2) and the caudal adjacent segment (C2-C3) have yet to be clarified. METHODS The study involved 14 patients subjected to a procedure of AOSF with lag screw. Subjects were matched with 14 healthy controls. All subjects underwent CBCT scanning of the cervical spine under seven functional positions. A 3D-3D registration was performed for each vertebra at each functional position to calculate the segmental motion characteristics. The ranges of motion (ROMs) of the C1-C2, C2-C3, and the overall cervical spine (C1-C7) for each of the functional positions were determined. RESULTS The ROMs of the AOSF group were significantly (P < 0.05) smaller than the control group in flexion-extension positions for the C1-C2 (7.0°vs.11.0°), C2-C3 (3.7°vs.6.7°) and C1-C7 (43.3°vs.54.4°). The twisting ROM of the C1-C2 was 39.3° in the AOSF group and 65.7° in the control (P < 0.05), the bending ROM of the C2-C3 was 2.8° in the AOSF group and 8.9° in the control (P < 0.05). The twisting ROM of C1-C7 segment was 63.2° for the AOSF and 98.1° for the healthy control groups (P < 0.05). CONCLUSION Although AOSF surgery reduced the flexion-extension ROMs of all investigated spinal segments, additionally, it reduced twisting ROMs of C1-C2 and C1-C7, but only lateral bending ROM of C2-C3, when compared with the control group. The data implied that the AOSF surgery would result in different biomechanics changes in the atlantoaxial segment and caudal adjacent segment. Longer-term follow-up studies of larger patient cohorts are necessary to evaluate the clinical outcomes of patients after the AOSF surgery.Level of Evidence: 3.
Collapse
|
8
|
Kuo YH, Kuo CH, Chang HK, Fay LY, Tu TH, Chang CC, Cheng H, Wu CL, Lirng JF, Wu JC, Huang WC. The Effect of T1-Slope in Spinal Parameters After Cervical Disc Arthroplasty. Neurosurgery 2020; 87:1231-1239. [PMID: 32649746 DOI: 10.1093/neuros/nyaa271] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2019] [Accepted: 04/15/2020] [Indexed: 12/18/2022] Open
Abstract
BACKGROUND Although patients with cervical kyphosis are not ideal candidates for cervical disc arthroplasty (CDA), there is a paucity of data on patients with a straight or slightly lordotic neck. OBJECTIVE To correlate cervical lordosis, T1-slope, and clinical outcomes of CDA. METHODS The study retrospectively analyzed 95 patients who underwent 1-level CDA and had 2-yr follow-up. They were divided into a high T1-slope (≥28°) group (HTSG, n = 45) and a low T1-slope (<28°) group (LTSG, n = 50). Cervical spinal alignment parameters, including T1-slope, cervical lordosis (C2-7 Cobb angle), and segmental mobility (range of motion [ROM]) at the indexed level, were compared. The clinical outcomes were also assessed. RESULTS The mean T1-slope was 28.1 ± 7.0°. After CDA, the pre- and postoperative segmental motility remained similar and cervical lordosis was preserved. All the clinical outcomes improved after CDA. The HTSG were similar to the LTSG in age, sex, segmental mobility, and clinical outcomes. However, the HTSG had higher cervical lordosis than the LTSG. Furthermore, the LTSG had increased cervical lordosis (ΔC2-7 Cobb angle), whereas the HTSG had decreased lordosis after CDA. Patients of the LTSG, who had more improvement in cervical lordosis, had a trend toward increasing segmental mobility at the index level (ΔROM) than the HTSG. CONCLUSION In this series, T1-slope correlated well with global cervical lordosis but did not affect the segmental mobility. After CDA, the changes in cervical lordosis correlated with changes in segmental mobility. Therefore, segmental lordosis should be cautiously preserved during CDA as it could determine the mobility of the disc.
Collapse
Affiliation(s)
- Yi-Hsuan Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Chao-Hung Kuo
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Engineering, School of Biomedical Science and Engineering, National Yang-Ming University, Taipei, Taiwan
| | - Hsuan-Kan Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Biomedical Imaging and Radiological Sciences, National Yang-Ming University, Taipei, Taiwan
| | - Li-Yu Fay
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Tsung-Hsi Tu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Taiwan International Graduate Program in Molecular Medicine, National Yang-Ming University and Academia Sinica, Taipei, Taiwan
| | - Chih-Chang Chang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Henrich Cheng
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Institute of Pharmacology, National Yang-Ming University, Taipei, Taiwan
| | - Ching-Lan Wu
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jiing-Feng Lirng
- School of Medicine, National Yang-Ming University, Taipei, Taiwan.,Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Jau-Ching Wu
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| | - Wen-Cheng Huang
- Department of Neurosurgery, Neurological Institute, Taipei Veterans General Hospital, Taipei, Taiwan.,School of Medicine, National Yang-Ming University, Taipei, Taiwan
| |
Collapse
|
9
|
Sun J, Zhao HW, Wang JJ, Xun L, Fu NX, Huang H. Diagnostic Value of T1 Slope in Degenerative Cervical Spondylotic Myelopathy. Med Sci Monit 2018; 24:791-796. [PMID: 29414927 PMCID: PMC5812428 DOI: 10.12659/msm.906417] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background To explore the diagnostic value of sagittal measurement of thoracic inlet parameters for degenerative cervical spondylotic myelopathy (DCSM). Material/Methods Sixty patients with DCSM (study group) and the same number of normal subjects (control group) were initially enrolled in the study. All data from X-ray in the standing position and computed tomography (CT) in the supine position were collected and carefully analyzed. Cervical sagittal parameters, including C2–C7 angle, C2–C7 sagittal vertical axis (C2–C7 SVA), T1 slope, thoracic inlet angle (TIA), and neck tilt (NT), were measured at the lateral radiographs by using standard X-rays and CT. Univariate analysis and multivariate logistic regression analysis were carried out to explore the diagnostic value of cervical sagittal parameters for the DCSM. Results All the enrolled patients in the study and control groups completed the follow-up, and the mean follow-up periods were 35.8 months in the study group and 36.3 months in the control group. The DCSM group had smaller T1 slope and TIA when compared with that of the control group (18.14±2.67° vs. 24.16±3.7°, p=0.00; 66.42±12.36° vs. 70.42±10.21°, p=0.01). Logistic regression analysis and receiver operating characteristic (ROC) curve revealed that preoperative T1 slope of less than 18.5° had significant diagnostic value for the incidence of DCSM (p<0.05). Conclusions Patients with sagittal imbalance of thoracic inlet parameters have higher risk of DCSM, while T1 slope of less than 18.5° showed significant diagnostic value for the incidence of DCSM.
Collapse
Affiliation(s)
- Jin Sun
- Department of Orthopedics, The Third College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China (mainland).,Department of Orthopedics, Gezhouba Central Hospital, Yichang, Hubei, China (mainland)
| | - Hong-Wei Zhao
- Department of Radiology, The Third College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China (mainland).,Department of Radiology, Gezhouba Central Hospital, Yichang, Hubei, China (mainland)
| | - Jun-Jie Wang
- Department of Radiology, The Third College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China (mainland).,Department of Radiology, Gezhouba Central Hospital, Yichang, Hubei, China (mainland)
| | - Liang Xun
- School of Medicine and Life Sciences, University of Jining Academy of Medical Sciences, Jining, Shandong, China (mainland)
| | - Na-Xin Fu
- Department of Orthopedics, The Third College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China (mainland).,Department of Orthopedics, Gezhouba Central Hospital, Yichang, Hubei, China (mainland)
| | - Hui Huang
- Department of Orthopedics, The Third College of Clinical Medical Sciences, China Three Gorges University, Yichang, Hubei, China (mainland)
| |
Collapse
|
10
|
Zhao J, Jiang R, Yang Y, Gu R, Gao Z, Xiao J, Chen S, Yang M. Preoperative T1 Slope as a Predictor of Change in Cervical Alignment and Range of Motion After Cervical Disc Arthroplasty. Med Sci Monit 2017; 23:5844-5850. [PMID: 29222937 PMCID: PMC5732433 DOI: 10.12659/msm.906944] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND This study analyzed the effect of preoperative T1 slope on cervical alignment and range of motion (ROM) after cervical disc arthroplasty (CDA) in patients with cervical degenerative disease. MATERIAL AND METHODS This retrospective study included 32 patients with single-level symptomatic cervical disc disease who underwent CDA with the Mobi-C cervical disc prosthesis and had a mean follow-up of 26.8±6.4 months. Standing lateral, flexion, and extension X-rays of the cervical spine were obtained preoperatively and postoperatively at 24-month follow-up. Simple linear regression analysis was used to assess the impact of preoperative T1 slope on changes from preoperative values in radiologic parameters. RESULTS Compared to preoperative values, at 24-month follow-up, there was a significant increase in mean functional spinal unit (FSU) angle (+7.4°), upper adjacent segment (UAS) angle (+3.1°), and overall cervical alignment (C2-C7 angle) (+6.3°), and a significant decrease in mean lower adjacent segment (LAS) angle (-2.4°). Mean ROM of the FSU (-3.6°), LAS (-3.0°), and overall cervical spine (-11.5°) significantly decreased, and mean ROM of the UAS (+1.6°) significantly increased. There were significant correlations between preoperative T1 slope and mean change from preoperative value in FSU angle, C2-C7 angle, and ROM of the overall cervical spine (C2-C7). CONCLUSIONS T1 slope is useful for evaluating changes in the FSU angle, C2-C7 angle, and ROM of the overall cervical spine following CDA with the Mobi-C disc. Patients with a large preoperative T1 slope may be good candidates for CDA with the Mobi-C prosthesis due its motion maintenance and the fact that it has little adverse impact on sagittal alignment. It also could be a good option in terms of sagittal alignment improvement or motion maintenance for patients with kyphosis.
Collapse
Affiliation(s)
- Jianhui Zhao
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Rui Jiang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Yuhui Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Rui Gu
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Zhongli Gao
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Jianlin Xiao
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| | - Shangjun Chen
- Norman Bethune Medical School, Jilin University, Changchun, Jilin, China (mainland)
| | - Modi Yang
- Department of Orthopaedics, China-Japan Union Hospital of Jilin University, Changchun, Jilin, China (mainland)
| |
Collapse
|
11
|
Surgical overreduction and hyperlordotic fusion of C1-C2 joint are associated with cervical sagittal malalignment. Arch Orthop Trauma Surg 2017; 137:1631-1639. [PMID: 28986674 DOI: 10.1007/s00402-017-2814-8] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2017] [Indexed: 12/17/2022]
Abstract
INTRODUCTION Previous studies have shown that hyperlordotic C1-C2 fusion was related to postoperative subaxial kyphosis. However, most of the patients in these studies were complicated with rheumatoid arthritis (RA). Moreover, no studies have specifically evaluated the relationship between C1-C2 fusion angle and cervical sagittal vertical axis (cSVA), T1 slope or cranial tilt (CRT) after posterior C1-C2 fusion. This study aimed to investigate the cervical sagittal alignment in non-RA patients following posterior C1-C2 fusion and the correlation between C1-C2 fusion angle and postoperative cervical sagittal alignment. MATERIALS AND METHODS From August 2004 to December 2015, twenty-eight consecutive patients with an average age of 39.2 years (range 6-70 years) who underwent posterior C1-C2 fusion from a single institution were enrolled. The mean follow-up period was 30.7 months (range 12-77 months). Angles of Oc-C1, C1-C2, C2-C3 and C2-C7, cSVA, T1 slope and CRT were measured in lateral cervical radiographs in neutral position before surgery and at the final follow-up. RESULTS C1-C2 angle significantly increased from 13.6° ± 12.4° to 22.0° ± 8.1° at the final follow-up (P < 0.001). A significant decrease was found both in Oc-C1 and C2-C7 angles from pre-operation to the final follow-up (P < 0.001 and P = 0.011, respectively). Moreover, cSVA and CRT dramatically increased from pre-operation to the final follow-up (P < 0.001). C1-C2 fusion angle was significantly associated with Oc-C1, C2-C7 angle, cSVA and CRT at the final follow-up. A significant correlation was also observed between postoperative change of C1-C2 angle and that of Oc-C1, C2-C7 angle, cSVA and CRT. CONCLUSIONS Apart from decreased subaxial lordosis, posterior C1-C2 fusion in hyperextension may also lead to kyphotic change of atlanto-occipital alignment and increased tilting forward of the cervical spine. Therefore, intraoperative overreduction of C1-C2 angle and hyperlordotic C1-C2 fusion should be avoided to maintain the physiologic cervical sagittal alignment.
Collapse
|