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Shen YW, Yang Y, Hong Y, Ding C, Rong X, Meng Y, Wang BY, Wu TK, Liu H. Association of Craniocervical Sagittal Alignment With the Outcomes of Cervical Disc Replacement. Global Spine J 2024; 14:846-855. [PMID: 36044545 PMCID: PMC11192106 DOI: 10.1177/21925682221124531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To explore the association between craniocervical sagittal balance and clinical and radiological outcomes of cervical disc replacement (CDR). METHODS Patients who underwent 1-level and 2-level CDR were retrospectively analyzed. Clinical outcomes were evaluated using scores on the Japanese Orthopaedic Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). The craniocervical sagittal alignment parameters, including the C0-C2 Cobb angle, C2-C7 Cobb angle, C2 slope, T1 slope, C2-C7 sagittal vertical axis (SVA), C1-C7 SVA, the center of gravity of the head (CGH)-C7 SVA, and range of motion (ROM) at the surgical segments were measured. RESULTS A total of 169 patients were involved. Significantly lower pre- and postoperative C2 slope and CGH-C7 SVA were found in arthroplasty levels with better ROMs. Patients with a higher preoperative C2 slope and CGH-C7 SVA had lower cervical lordosis and ROM after surgery. There were no significant differences in the clinical outcomes between patients with different sagittal balance statuses. C2-C7 SVA and CGH-C7 SVA were significantly associated with radiographic adjacent segment pathology (rASP). CONCLUSION Craniocervical sagittal balance is associated with cervical lordosis and ROM at the index level after CDR. A higher preoperative SVA is related to the presence and progression of rASP. A relationship between sagittal alignment and clinical outcomes was not observed.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ting-Kui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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Tomezzoli A, Agouram A, Chalamet B, Pialat JB, Duprey S, Cunin V, Fréchède B. Predicting cervico-thoraco-lumbar vertebra positions from cutaneous markers: Combining local frame and postural predictors improves robustness to posture. J Biomech 2024; 164:111961. [PMID: 38310767 DOI: 10.1016/j.jbiomech.2024.111961] [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: 05/12/2023] [Revised: 11/21/2023] [Accepted: 01/19/2024] [Indexed: 02/06/2024]
Abstract
Predictions of vertebra positions from external data are required in many fields like motion analysis or for clinical applications. Existing predictions mainly cover the thoraco-lumbar spine, in one posture. The objective of this study was to develop a method offering robust vertebra position predictions in different postures for the whole spine, in the sagittal plane. EOS radiographs were taken in three postures: slouched, erect, and subject's usual sitting posture, using 21 healthy participants pre-equipped with opaque cutaneous markers. Local curvilinear Frenet frames were built on a spline fitted to spinous processes' cutaneous markers. Vertebra positions were expressed as polar coordinates in these frames, defining an angle (α) and distance (d). Multilinear regressions were fitted to explain α and d from anthropometric predictors and predictors presumed to be linked to spinal posture, the predictors' effects being considered both locally and remotely. Anthropometric predictors were the main predictors for d distances, and postural predictors for α angles, with postural predictors still showing a marked influence on d distances for the cervical spine. Vertebra positions were then predicted by cross-validation. The average RMSE on vertebra positions was 11.0 ± 3.7 mm across the entire spine, 13.4 ± 4.1 mm across the cervical spine and 10.1 ± 3.1 mm across the thoraco-lumbar spine for all participants and postures, performances similar to previous models designed for a single posture. Our simple geometrical and statistical model thus appears promising for predicting vertebra positions from external data in several spinal postures and for the whole spine.
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Affiliation(s)
- A Tomezzoli
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F-69622 Lyon, France
| | - A Agouram
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F-69622 Lyon, France
| | - B Chalamet
- Radiology Department, Hôpital Lyon-Sud, HCL, 69310 Pierre-Bénite, France
| | - J-B Pialat
- Radiology Department, Hôpital Lyon-Sud, HCL, 69310 Pierre-Bénite, France; CREATIS laboratory, CNRS, UMR 5220 - INSERM U1294, Univ Lyon 1 - INSA Lyon - Univ Jean Monnet Saint-Etienne, 69100 Villeurbanne, France
| | - S Duprey
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F-69622 Lyon, France
| | - V Cunin
- Paediatric Orthopaedic Surgery Unit, Hôpital Femme Mère Enfant, Lyon, France
| | - B Fréchède
- Univ Lyon, Univ Gustave Eiffel, Univ Claude Bernard Lyon 1, LBMC UMR_T9406, F-69622 Lyon, France.
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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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Divi SN, Karamian BA, Canseco JA, Chang M, Toci GR, Goyal DKC, Nicholson KJ, Mujica VE, Bronson W, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion. Clin Spine Surg 2022; 35:E539-E545. [PMID: 35302961 DOI: 10.1097/bsd.0000000000001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To determine the extent to which the upper cervical spine compensates for malalignment in the subaxial cervical spine, and how changes in upper cervical spine sagittal alignment affect patient-reported outcomes. SUMMARY OF BACKGROUND DATA Previous research has investigated the relationship between clinical outcomes and radiographic parameters in the subaxial cervical spine following anterior cervical discectomy and fusion (ACDF). However, limited research exists regarding the upper cervical spine (occiput to C2), which accounts for up to 40% of neck movement and has been hypothesized to compensate for subaxial dysfunction. MATERIALS AND METHODS Patients undergoing ACDF for cervical radiculopathy and/or myelopathy at a single center with minimum 1-year follow-up were included. Radiographic parameters including cervical sagittal vertical axis, C0 angle, C1 inclination angle, C2 slope, Occiput-C1 angle (Oc-C1 degrees), Oc-C2 degrees, Oc-C7 degrees, C1-C2 degrees, C1-C7 degrees, and C2-C7 degrees cervical lordosis (CL) were recorded preoperatively and postoperatively. Delta (Δ) values were calculated by subtracting preoperative values from postoperative values. Correlation analysis as well as multiple linear regression analysis was used to determine relationships between radiographic and clinical outcomes. Alpha was set at 0.05. RESULTS A total of 264 patients were included (mean follow-up 20 mo). C2 slope significantly decreased for patients after surgery (Δ=-0.8, P =0.02), as did parameters of regional cervical lordosis (Oc-C7 degrees, C1-C7 degrees, and C2-C7 degrees; P <0.001, <0.001, and 0.01, respectively). Weak to moderate associations were observed between postoperative CL and C1 inclination ( r =-0.24, P <0.001), Oc-C1 degrees ( r =0.59, P <0.001), and C1-C2 degrees ( r =-0.23, P <0.001). Increased preoperative C1-C2 degrees and Oc-C2 degrees inversely correlated with preoperative SF-12 Mental Composite Score (MCS-12) scores ( r =-0.16, P =0.01 and r =-0.13, P =0.04). Cervical sagittal vertical axis was found to have weak but significant associations with Short Form-12 (SF-12) Physical Composite Score (PCS-12) ( r =-0.13, P =0.03) and MCS-12 ( r =0.12, P =0.05). CONCLUSION No clinically significant relationship between upper cervical and subaxial cervical alignment was detected for patients undergoing ACDF for neurological symptoms. Upper cervical spine alignment was not found to be a significant predictor of patient-reported outcomes after ACDF. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Liang Z, Mo F, Zheng Z, Li Y, Tian Y, Jiang X, Liu T. Quantitative cervical spine injury responses in whiplash loading with a numerical method of natural neural reflex consideration. COMPUTER METHODS AND PROGRAMS IN BIOMEDICINE 2022; 219:106761. [PMID: 35344767 DOI: 10.1016/j.cmpb.2022.106761] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/12/2021] [Revised: 03/07/2022] [Accepted: 03/15/2022] [Indexed: 06/14/2023]
Abstract
BACKGROUND AND OBJECTIVE Neural reflex is hypothesized as a regulating step in spine stabilizing system. However, neural reflex control is still in its infancy to consider in the previous finite element analysis of head-neck system for various applications. The purpose of this study is to investigate the influences of neural reflex control on neck biomechanical responses, then provide a new way to achieve an accurate biomechanical analysis for head-neck system with a finite element model. METHODS A new FE head-neck model with detailed active muscles and spinal cord modeling was established and globally validated at multi-levels. Then, it was coupled with our previously developed neuromuscular head-neck model to analyze the effects of vestibular and proprioceptive reflexes on biomechanical responses of head-neck system in a typical spinal injury loading condition (whiplash). The obtained effects were further analyzed by comparing a review of epidemiologic data on cervical spine injury situations. RESULT The results showed that the active model (AM) with neural reflex control obviously presented both rational head-neck kinematics and tissue injury risk referring to the previous experimental and epidemiologic studies, when compared with the passive model (PM) without it. Tissue load concentration locations as well as stress/strain levels were both changed due to the muscle activation forces caused by neural reflex control during the whole loading process. For the bony structures, the AM showed a peak stress level accounting for only about 25% of the PM. For the discs, the stress concentrated location was transferred from C2-C6 in the PM to C4-C6 in the AM. For the spinal cord, the strain concentrated locations were transferred from C1 segment to around C4 segment when the effects of neural reflex control were implemented, while the gray matter and white matter peak strains were reduced to 1/3 and 1/2 of the PM, respectively. All these were well correlated with epidemiological studies on clinical cervical spine injuries. CONCLUSION In summary, the present work demonstrated necessity of considering neural reflex in FE analysis of a head-neck system as well as our model biofidelity. Overall results also verified the previous hypothesis and further quantitatively indicated that the muscle activation caused by neural reflex is providing a protection for the neck in impact loading by decreasing the strain level and changing the possible injury to lower spinal cord level to reduce injury severity.
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Affiliation(s)
- Ziyang Liang
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China; Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
| | - Fuhao Mo
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China.
| | - Zhefen Zheng
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Yuandong Li
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Ye Tian
- College of Mechanical and Vehicle Engineering, Hunan University, Changsha, Hunan 410082, China
| | - Xiaobing Jiang
- Department of Spine Surgery, Guangzhou University of Chinese medicine, Guangzhou, Guangdong 510405, China
| | - Tang Liu
- Department of Orthopedics, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
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Vaishnav AS, Qureshi SA. Reply to Commentary on "Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement". Neurospine 2021; 18:415-416. [PMID: 34218624 PMCID: PMC8255759 DOI: 10.14245/ns.2142446.223] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Accepted: 05/16/2021] [Indexed: 11/19/2022] Open
Affiliation(s)
| | - Sheeraz A Qureshi
- Hospital for Special Surgery, New York, NY, USA.,Weill Cornell Medical College, New York, NY, USA
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Zhang K, Liu H, Wu T. Commentary on "Impact of Nonlordotic Sagittal Alignment on Short-term Outcomes of Cervical Disc Replacement". Neurospine 2021; 18:413-414. [PMID: 34218625 PMCID: PMC8255763 DOI: 10.14245/ns.2142442.221] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/01/2021] [Accepted: 06/02/2021] [Indexed: 02/05/2023] Open
Affiliation(s)
- Kerui Zhang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Hao Liu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Tingkui Wu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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Özer AF, Ateş Ö, Çerezci Ö, Hekimoğlu M, Aydın AL, Öktenoğlu T, Sasani M. Changes in cervical sagittal alignment and the effects on cervical parameters in patients with cervical spondylotic myelopathy after laminoplasty. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:183-190. [PMID: 34194166 PMCID: PMC8214234 DOI: 10.4103/jcvjs.jcvjs_213_20] [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] [Subscribe] [Scholar Register] [Received: 12/25/2020] [Accepted: 04/05/2021] [Indexed: 11/26/2022] Open
Abstract
Objective: To monitor changes in cervical parameters before and after laminoplasty surgery. Cervical parameters and health-related quality-of-life (HRQOL) values that may be affected after laminoplasty were examined before and after surgery. The clinical and radiological course of these values was monitored, and their interaction with all spinal radiological parameters was revealed. Materials and Methods: Nineteen patients who underwent clinical and radiological evaluation for 2 years were followed in this study. Neck disability index, visual analog scale, and short form 36 scores were determined to evaluate HRQOL. For radiological parameters, the C0-C2 angle, C2-C7 angle, cervical sagittal vertical axis, T1 slope angle, neck tilt (NT) and thoracic inlet angle were used. The results of the 4-month, 1 year and 2-year follow-ups were statistically evaluated. Results: Both the HRQOL and cervical radiological parameters deteriorated in the first 4 months and returned to normal in the 2nd year. Statistically, all parameters were meaningful (P < 0.05), except for NT. Conclusion: Cervical parameters and HRQOL values, which deteriorated in the early period, recovered in the late period in the long-term follow-up of patients undergoing laminoplasty. The important point is that preoperative cervical parameters suitable for laminoplasty should be present, and spinopelvic parameters should be normal.
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Affiliation(s)
- Ali Fahir Özer
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Özkan Ateş
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Önder Çerezci
- Department of Physical Treatment and Rehabilitation, American Hospital, Istanbul, Turkey
| | - Mehdi Hekimoğlu
- Department of Neurosurgery, American Hospital, Istanbul, Turkey
| | - Ahmet Levent Aydın
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Tunç Öktenoğlu
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
| | - Mehdi Sasani
- Department of Neurosurgery, Spine Center, Koc University School of Medicine, American Hospital, Istanbul, Turkey
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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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Tu J, Vargas Castillo J, Das A, Diwan AD. Degenerative Cervical Myelopathy: Insights into Its Pathobiology and Molecular Mechanisms. J Clin Med 2021; 10:jcm10061214. [PMID: 33804008 PMCID: PMC8001572 DOI: 10.3390/jcm10061214] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2021] [Revised: 03/07/2021] [Accepted: 03/09/2021] [Indexed: 12/12/2022] Open
Abstract
Degenerative cervical myelopathy (DCM), earlier referred to as cervical spondylotic myelopathy (CSM), is the most common and serious neurological disorder in the elderly population caused by chronic progressive compression or irritation of the spinal cord in the neck. The clinical features of DCM include localised neck pain and functional impairment of motor function in the arms, fingers and hands. If left untreated, this can lead to significant and permanent nerve damage including paralysis and death. Despite recent advancements in understanding the DCM pathology, prognosis remains poor and little is known about the molecular mechanisms underlying its pathogenesis. Moreover, there is scant evidence for the best treatment suitable for DCM patients. Decompressive surgery remains the most effective long-term treatment for this pathology, although the decision of when to perform such a procedure remains challenging. Given the fact that the aged population in the world is continuously increasing, DCM is posing a formidable challenge that needs urgent attention. Here, in this comprehensive review, we discuss the current knowledge of DCM pathology, including epidemiology, diagnosis, natural history, pathophysiology, risk factors, molecular features and treatment options. In addition to describing different scoring and classification systems used by clinicians in diagnosing DCM, we also highlight how advanced imaging techniques are being used to study the disease process. Last but not the least, we discuss several molecular underpinnings of DCM aetiology, including the cells involved and the pathways and molecules that are hallmarks of this disease.
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Affiliation(s)
- Ji Tu
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
| | | | - Abhirup Das
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
- Correspondence:
| | - Ashish D. Diwan
- Spine Labs, St. George and Sutherland Clinical School, University of New South Wales, Kogarah, NSW 2217, Australia; (J.T.); (A.D.D.)
- Spine Service, St. George Hospital, Kogarah, NSW 2217, Australia;
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Ravindra VM, Iyer RR, Awad AW, Bollo RJ, Zhu H, Brockmeyer DL. Defining the role of the condylar-C2 sagittal vertical alignment in Chiari malformation type I. J Neurosurg Pediatr 2020; 26:439-444. [PMID: 32679561 DOI: 10.3171/2020.4.peds20113] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Accepted: 04/23/2020] [Indexed: 11/06/2022]
Abstract
OBJECTIVE The authors' objective was to better understand the anatomical load-bearing relationship between the atlantooccipital joint and the upper cervical spine and its influence on the clinical behavior of patients with Chiari malformation type I (CM-I) and craniocervical pathology. METHODS In a single-center prospective study of patients younger than 18 years with CM-I from 2015 through 2017 (mean age 9.91 years), the authors measured the occipital condyle-C2 sagittal vertebral alignment (C-C2SVA; defined as the position of a plumb line from the midpoint of the occiput (C0)-C1 joint relative to the posterior aspect of the C2-3 disc space), the pB-C2 (a line perpendicular to a line from the basion to the posteroinferior aspect of the C2 body on sagittal MRI), and the CXA (clivoaxial angle). Control data from 30 patients without CM-I (mean age 8.97 years) were used for comparison. The primary outcome was the need for anterior odontoid resection and/or occipitocervical fusion with or without odontoid reduction. The secondary outcome was the need for two or more Chiari-related operations. RESULTS Of the 60 consecutive patients with CM-I identified, 7 underwent anterior odontoid resection or occipitocervical fusion and 10 underwent ≥ 2 decompressive procedures. The mean C-C2SVA was greater in the overall CM-I group versus controls (3.68 vs 0.13 mm, p < 0.0001), as was the pB-C2 (7.7 vs 6.4 mm, p = 0.0092); the CXA was smaller (136° vs 148°, p < 0.0001). A C-C2SVA ≥ 5 mm was found in 35% of CM-I children and 3.3% of controls (p = 0.0006). The sensitivities and specificities for requiring ventral decompression/occipitocervical fusion were 100% and 74%, respectively, for C-C2SVA ≥ 5 mm; 71% and 94%, respectively, for CXA < 125°; and 71% and 75%, respectively, for pB-C2 ≥ 9 mm. The sensitivities and specificities for the need for ≥ 2 decompressive procedures were 60% and 70%, respectively, for C-C2SVA ≥ 5 mm; 50% and 94%, respectively, for CXA < 125°; and 60% and 76%, respectively, for pB-C2 ≥ 9 mm. The log-rank test demonstrated significant differences between C-C2SVA groups (p = 0.0007) for the primary outcome. A kappa value of 0.73 for C-C2SVA between raters indicated substantial agreement. CONCLUSIONS A novel screening measurement for craniocervical bony relationships, the C-C2SVA, is described. A significant difference in C-C2SVA between CM-I patients and controls was found. A C-C2SVA ≥ 5 mm is highly predictive of the need for occipitocervical fusion/ventral decompression in patients with CM-I. Further validation of this screening measurement is needed.
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Affiliation(s)
- Vijay M Ravindra
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | - Rajiv R Iyer
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | - Al-Wala Awad
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | - Robert J Bollo
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
| | - Huirong Zhu
- 2Department of Surgery, Texas Children's Hospital, Houston, Texas
| | - Douglas L Brockmeyer
- 1Division of Pediatric Neurosurgery, Department of Neurosurgery, University of Utah, Salt Lake City, Utah; and
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