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Oakley PA, Moustafa IM, Haas JW, Betz JW, Harrison DE. Two Methods of Forward Head Posture Assessment: Radiography vs. Posture and Their Clinical Comparison. J Clin Med 2024; 13:2149. [PMID: 38610914 PMCID: PMC11012400 DOI: 10.3390/jcm13072149] [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: 02/22/2024] [Revised: 03/23/2024] [Accepted: 04/05/2024] [Indexed: 04/14/2024] Open
Abstract
Background: Forward head posture (FHP) and altered cervical lordotic curvatures are common spine displacements often associated with neck pain and disability. Two primary categories for determining FHP exist: radiographic and postural measurements. Methods: This study investigated the correlation between the craniovertebral angle (CVA), the radiographically measured C2-C7 sagittal vertical axis (SVA), and cervical lordosis (absolute rotation angle: ARA C2-C7) in a sample of participants with chronic myofascial pain (CMP). In 120 participants, we performed both a postural measurement of the CVA and a lateral cervical radiograph, where the C2-C7 SVA and ARA C2-C7 were measured. A linear-regression R2 value to assess the correlation between the CVA, C2-C7 SVA, and ARA C2-C7 was sought. Results: A statistically significant weak linear fit was identified (Spearman's r = 0.549; R2 = 0.30, p < 0.001) between the CVA and C2-C7 SVA, having considerable variation between the two measures. A statistically significant linear fit (very weak) was identified for the lordosis ARA C2-C7 and the CVA: Spearman's r = 0.524; R2 = 0.275; p < 0.001. A value of 50° for the CVA corresponded to a value of 20 mm for the C2-C7 SVA on an X-ray. Conclusion: While the CVA and radiographic C2-C7 SVA are weakly correlated in an individual, they seem to represent different aspects of sagittal cervical balance. The CVA cannot replace radiographically measured cervical lordosis. We recommend that more emphasis be given to radiographic measures of sagittal cervical alignment than the CVA when considering patient interventions.
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Affiliation(s)
- Paul A. Oakley
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
- Private Practice, Newmarket, ON L3Y 8Y8, Canada
- Kinesiology and Health Science, York University, Toronto, ON M3J 1P3, Canada
| | - Ibrahim M. Moustafa
- Department of Physiotherapy, College of Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates;
- Neuromusculoskeletal Rehabilitation Research Group, RIMHS–Research Institute of Medical and Health Sciences, University of Sharjah, Sharjah 27272, United Arab Emirates
| | - Jason W. Haas
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
| | - Joseph W. Betz
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
- Private Practice, Boise, ID 83709, USA
| | - Deed E. Harrison
- CBP Nonprofit (A Spine Research Foundation), Eagle, ID 83616, USA; (P.A.O.); (J.W.H.); (J.W.B.)
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Zheng B, Xu S, Lu T, Wu Y, Li H, Guo C, Haiying L. Sagittal sequence and clinical efficacy of cervical disc replacement and hybrid surgery in the treatment of cervical spondylotic myelopathy: a retrospective study. Front Surg 2024; 10:1265349. [PMID: 38249309 PMCID: PMC10797051 DOI: 10.3389/fsurg.2023.1265349] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2023] [Accepted: 11/13/2023] [Indexed: 01/23/2024] Open
Abstract
Background Hybrid surgery (HS) combines anterior cervical discectomy and fusion (ACDF) with cervical disc replacement (CDR) is gradually being more frequently implemented, but there are few studies reporting the safety and effectiveness of hybrid surgery in three levels cervical spondylotic myelopathy. Methods The clinical and radiographic data of patients with three-segment cervical spondylosis, who underwent CDR, ACDF and HS in our hospital from February 2007 to February 2013 were analyzed. The Visual Analog Scale (VAS), Japanese Orthopedic Association (JOA) and Neck Disability Index (NDI) were used to evaluate the clinical efficacy post surgery. Cervical spine x-rays were conducted to assess ROM, CL, T1S and relevant outcomes. Results A total of 94 patients were included in the study: 26 in the CDR group, 13 in the HS1 group, 31 in the HS2 group, and 24 in the ACDF group. Most patients in the CDR group were younger. There was no difference in the follow-up duration, blood loss volume or surgery time (P > 0.05). Four groups reported improvements in JOA and NDI scores compared to baseline. There was no significant difference in the final JOA, final NDI or recovery rate among the 4 groups. The final ROM was smaller in the ACDF group than in the other 3 groups. There was no difference among the four groups in the final UROM, final LROM or their changes. There was no difference in the final T1S, final SVA or their change among the four groups. All groups showed similar changes in CL and T1S-CL. Conclusions There was no difference in the clinical outcomes of ACDF, CDR, or hybrid surgery. CDR can better preserve the mobility of the cervical spine. Neither CDR nor hybrid surgery was significantly advantageous over ACDF in restoring the sagittal sequence in patients with three-level CSM.
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Affiliation(s)
- Bin Zheng
- Spine Surgery Department, Peking University People's Hospital, Beijing, China
| | - Shuai Xu
- Spine Surgery Department, Peking University People's Hospital, Beijing, China
| | - Tianliang Lu
- Orthopedics Department, The Coal Central Hospital of Shanxi Province, Taiyuan, Shanxi, China
| | - Yonghao Wu
- Spine Surgery Department, Peking University People's Hospital, Beijing, China
| | - Haoyuan Li
- Spine Surgery Department, Peking University People's Hospital, Beijing, China
| | - Chen Guo
- Spine Surgery Department, Peking University People's Hospital, Beijing, China
| | - Liu Haiying
- Spine Surgery Department, Peking University People's Hospital, Beijing, China
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Pan W, Jiang J, Zhang W, Mei Z, Sun K, Zheng B, Meng Y, Bai Y, He Z, Shi J, Guo Y. Effects of "fixation-fusion" sequence of lumbar surgery on surgical outcomes for patients with lumbar spinal stenosis: study protocol for a multicenter randomized controlled trial. BMC Musculoskelet Disord 2023; 24:928. [PMID: 38041036 PMCID: PMC10691139 DOI: 10.1186/s12891-023-07052-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Accepted: 11/21/2023] [Indexed: 12/03/2023] Open
Abstract
BACKGROUND New-onset neurological symptoms such as numbness and pain in lower extremities might appear immediately after conventional lumbar interbody fusion (LIF) surgery performed in patients with lumbar spinal stenosis. METHODS AND ANALYSIS This is a multicenter, randomized, open-label, parallel-group, active-controlled trial investigating the clinical outcomes of modified LIF sequence versus conventional LIF sequence in treating patients with lumbar spinal stenosis. A total of 254 eligible patients will be enrolled and randomized in a 1:1 ratio to either modified LIF sequence or conventional LIF sequence group. The primary outcome measure is the perioperative incidence of new-onset lower extremity neurological symptoms, including new adverse events of pain, numbness, and foot drop of any severity. Important secondary endpoints include visual analogue scale (VAS) pain score and lumbar Japanese Orthopaedic Association (JOA) recovery rate. Other safety endpoints will also be evaluated. The safety set used for safety data analysis by the actual surgical treatment received and the full analysis set for baseline and efficacy data analyses according to the intent-to-treat principle will be established as the two analysis populations in the study. CONCLUSION This study is designed to investigate the clinical outcomes of modified LIF sequences in patients with lumbar spinal stenosis. It aims to provide clinical evidence that the modified "fixation-fusion" sequence of LIF surgery is effective in treating lumbar spinal stenosis. TRIAL REGISTRATION http://www.chictr.org.cn/index.aspx ID: ChiCTR2100048507.
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Affiliation(s)
- Weicheng Pan
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Jialin Jiang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Weihang Zhang
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Zijian Mei
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Kaiqiang Sun
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Bing Zheng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yake Meng
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China
| | - Yushu Bai
- Departmentof Orthopedic Surgery, Spine Center, Changhai Hospital, Naval Medical University, No.168 Changhai Road, Shanghai, 200438, People's Republic of China
| | - Zhimin He
- Department of Orthopedic Surgery, Spine Center, Shanghai Tenth People's Hospital, Tongji University, No. 301 Yanchang Middle Road, Shanghai, 200072, People's Republic of China
| | - Jiangang Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
| | - Yongfei Guo
- Department of Orthopedic Surgery, Spine Center, Changzheng Hospital, Naval Medical University, No. 415 Fengyang Road, Shanghai, 200003, People's Republic of China.
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Campion C, Crawford CH, Glassman SD, Berkay F, Mkorombindo T, Carreon LY. Correction and Maintenance of Cervical Alignment: 3-Level ACDF Versus Corpectomy-ACDF "Hybrid" Procedures. Clin Spine Surg 2023; 36:E118-E122. [PMID: 36097344 DOI: 10.1097/bsd.0000000000001392] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2021] [Accepted: 08/17/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN Longitudinal observational comparative cohorts. OBJECTIVE The objective of this study is to compare 3 and 12-month radiographic sagittal parameters and patient-reported outcomes (PROs) in patients who underwent 3-level ACDF or a hybrid procedure. SUMMARY OF BACKGROUND DATA Anterior Cervical Discectomy and Fusion (ACDF), Anterior Cervical Corpectomy and Fusion (ACCF), and hybrids (combination ACCF-ACDF) are common procedures used to treat symptomatic cervical spondylosis. Although there is a relative abundance of literature comparing 1-level ACCF versus 2-level ACDF and 2-level ACCF versus 3-level ACDF, detailed comparisons of 3-level ACDF versus hybrid procedures have not been extensively addressed. METHODS Patients who underwent a 3-Level ACDF (3L-ACDF, N=47) or 1-Level Corpectomy/1-Level ACDF (Hybrid, N=52) with at least a 12-month post-op data available were identified. Standard demographic, surgical and PROs were collected in addition to preoperative and postoperative radiographic data, including C2 plumb line (C2PL), C2-C7 lordosis (CL), segmental lordosis (SL), and T1 slope (T1S). RESULTS The 2 cohorts were similar in terms of demographics. At 3 months post-op, CL (9.04° vs. -2.12°, P =0.00) and SL (6.06° vs. -2.26°, P =0.003) were significantly greater in the 3L-ACDF group versus the HYBRID group. This significant difference was maintained at 12 months postoperative for CL [(6.62° vs. -0.60°, P =0.015) but not for SL (2.36° vs. -1.09°, P =0.199)]. There were no differences in PROs between the 2 groups before surgery, at 3 months postoperative or 12 months postoperative. Seven patients required revision surgery in the 1-year study period (1 in the 3L-ACDF, and 6 in the Hybrid P <0.001). CONCLUSIONS Three level ACDF resulted in greater C2-C7 lordosis and segmental lordosis postoperatively, which was maintained at 1 year for cervical lordosis. While PROs were similar between the groups, patients with hybrid instrumentation required significantly more revision surgeries than those treated with 3-level ACDF.
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Affiliation(s)
| | | | | | - Fehmi Berkay
- University of Louisville School of Medicine, Louisville, KY
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Guo S, Lin T, Wu R, Wang Z, Chen G, Liu W. The Pre-Operative Duration of Symptoms: The Most Important Predictor of Post-Operative Efficacy in Patients with Degenerative Cervical Myelopathy. Brain Sci 2022; 12:brainsci12081088. [PMID: 36009151 PMCID: PMC9405785 DOI: 10.3390/brainsci12081088] [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: 07/04/2022] [Revised: 07/20/2022] [Accepted: 08/01/2022] [Indexed: 11/16/2022] Open
Abstract
Objective. To explore the most important predictors of post-operative efficacy in patients with degenerative cervical myelopathy (DCM). Methods. From January 2013 to January 2019, 284 patients with DCM were enrolled. They were categorized based on the different surgical methods used: single anterior cervical decompression and fusion (ACDF) (n = 80), double ACDF (n = 56), three ACDF (n = 13), anterior cervical corpectomy and fusion (ACCF) (n = 63), anterior cervical hybrid decompression and fusion (ACHDF) (n = 25), laminoplasty (n = 38) and laminectomy and fusion (n = 9). The follow-up time was 2 years. The patients were divided into two groups based on the mJOA recovery rate at the last follow-up: Group A (the excellent improvement group, mJOA recovery rate >50%, n = 213) and Group B (the poor improvement group, mJOA recovery rate ≤50%, n = 71). The evaluated data included age, gender, BMI, duration of symptoms (months), smoking, drinking, number of lesion segments, surgical methods, surgical time, blood loss, the Charlson Comorbidity Index (CCI), CCI classification, imaging parameters (CL, T1S, C2-7SVA, CL (F), T1S (F), C2-7SVA (F), CL (E), T1S (E), C2-7SVA (E), CL (ROM), T1S (ROM) and C2-7SVA (ROM)), maximum spinal cord compression (MSCC), maximum canal compromise (MCC), Transverse area (TA), Transverse area ratio (TAR), compression ratio (CR) and the Coefficient compression ratio (CCR). The visual analog score (VAS), neck disability index (NDI), modified Japanese Orthopedic Association (mJOA) and mJOA recovery rate were used to assess cervical spinal function and quality of life. Results. We found that there was no significant difference in the baseline data among the different surgical groups and that there were only significant differences in the number of lesion segments, C2−7SVA, T1S (F), T1S (ROM), TA, CR, surgical time and blood loss. Therefore, there was comparability of the post-operative recovery among the different surgical groups, and we found that there were significant differences in age, the duration of symptoms, CL and pre-mJOA between Group A and Group B. A binary logistic regression analysis showed that the duration of the symptoms was an independent risk factor for post-operative efficacy in patients with DCM. Meanwhile, when the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196). Conclusion. For patients with DCM (regardless of the number of lesion segments and the proposed surgical methods), the duration of symptoms was an independent risk factor for the post-operative efficacy. When the duration of symptoms was ≥6.5 months, the prognosis of patients was more likely to be poor, and the probability of a poor prognosis increased by 0.196 times for each additional month of symptom duration (p < 0.001, OR = 1.196).
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Affiliation(s)
| | | | | | | | | | - Wenge Liu
- Correspondence: ; Tel.: +86-0591-833-578-96
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Sagittal balance of the cervical spine: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1411-1439. [PMID: 33772659 DOI: 10.1007/s00586-021-06825-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 09/26/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls. METHODS Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively. RESULTS A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001). CONCLUSION The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.
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Correlations and Age-Related Changes of Cervical Sagittal Parameters in Adults Without Symptoms of Cervical Spinal Disease. Spine (Phila Pa 1976) 2020; 45:E1542-E1548. [PMID: 32890305 DOI: 10.1097/brs.0000000000003680] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective study. OBJECTIVE To determine the correlations and age-related changes of cervical sagittal parameters in adults without obvious cervical spinal disease. SUMMARY OF BACKGROUND DATA Cervical sagittal parameters play essential roles in the pathogenesis and therapy of cervical spinal diseases. However, few studies have investigated the correlations and age-related changes of cervical sagittal parameters. METHODS The enrolled participants were divided into three age groups and their cervical sagittal parameters were collected. Correlations and age-related changes of these parameters were analyzed. RESULTS Significant differences in the C2-C7 angle, center of gravity of the head-C7 sagittal vertical axis (CGH-C7 SVA), C2-C7 SVA, neck tilt (NT), and thoracic inlet angle (TIA) were found among the three age groups. Pearson correlation analysis showed positive correlations between the C0-C2 angle and CGH-C7 SVA, C0-C2 angle and C2-C7 SVA, C2-C7 angle and T1 slope, C2-C7 angle and TIA, CGH-C7 SVA and C2-C7 SVA, C2-C7 SVA and T1 slope, T1 slope and TIA, and NT and TIA as well as negative correlations between the C0-C2 angle and C2-C7 angle, C2-C7 angle and CGH-C7 SVA, and C2-C7 angle and C2-C7 SVA. Paired t tests showed significant changes in the C2-C7 angle in groups I and II, and in the CGH-C7 SVA and C2-C7 SVA in all age groups with increasing age. CONCLUSION The results indicate that cross correlations exist between different cervical sagittal parameters in adults without symptoms of cervical spinal disease, and the lower cervical curvature and SVA change obviously with increasing age. LEVEL OF EVIDENCE 3.
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Ryu WHA, Platt A, Deutsch H. Hybrid decompression and reconstruction technique for cervical spondylotic myelopathy: case series and review of the literature. JOURNAL OF SPINE SURGERY 2020; 6:181-195. [PMID: 32309656 DOI: 10.21037/jss.2019.12.08] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The primary treatment of choice for patients with cervical spondylotic myelopathy (CSM) is surgical decompression. The benefit of operative intervention has been well established but, the surgeons' decision of operative approach remains nuanced based on patient-specific variables and surgeon preference. Decompression can involve a cervical corpectomy or a discectomy. A hybrid construct is when both a cervical corpectomy and a discectomy are done in the same patient. The purpose of this study was to review the evidence on the clinical and biomechanical outcomes of hybrid decompression and reconstruction techniques in patients with multilevel CSM. A retrospective study was performed on consecutive patients who received hybrid anterior decompression and reconstruction at Rush University between 2013-2018. Preoperative clinical and radiographic variables were analyzed to characterize specific factors leading to the decision of the surgical approach. In addition, we performed a systematic review and meta-analysis to assess superiority in terms of operative time, blood loss, cervical lordosis, patient-reported outcomes (PRO), fusion rates, and complications. Hybrid surgery (HS) was utilized in cases where multilevel CSM was present in conjunction with stenosis posterior to the vertebral body or acute kyphotic deformity. Our meta-analysis highlighted comparable PRO, complications, and rate of success fusion between 3-level anterior cervical discectomy and fusion (ACDF) and hybrid technique. Furthermore, hybrid fusion led to increased postoperative cervical lordosis, higher fusion rate, lower total complication rate, lower implant failure/mesh subsidence rate, and lower blood loss than 2-level corpectomy. The cervical hybrid technique that combines cervical corpectomy and discectomy represents a balanced option with the benefits of two commonly utilized cervical spine procedures in patients with multilevel CSM. The literature on hybrid technique suggests in cases where multilevel ACDF is not feasible, combining discectomy and corpectomy is superior to two-level corpectomy with lower complication rates, improved clinical outcome, spinal alignment correction, and stronger biomechanical properties.
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Affiliation(s)
- Won Hyung A Ryu
- Department of Neurological Surgery, Rush University, Chicago, IL, USA
| | - Andrew Platt
- Section of Neurosurgery, University of Chicago, Chicago, IL, USA
| | - Harel Deutsch
- Department of Neurological Surgery, Rush University, Chicago, IL, USA
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