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Lin T, Yao Z, Xiao Z, Wu R, Zhao Y, Chen D, Zhou L, Wang Z, Liu W. Identifying and exploring the favorable factors that help to slow the progression of disease in patients with mild cervical spondylotic myelopathy. Sci Rep 2024; 14:18986. [PMID: 39152213 PMCID: PMC11329653 DOI: 10.1038/s41598-024-69899-y] [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: 04/15/2024] [Accepted: 08/09/2024] [Indexed: 08/19/2024] Open
Abstract
To explore the favorable factors that help slow the progression of disease in patients with mild Cervical Spondylotic Myelopathy (CSM). A retrospective analysis was conducted, involving the enrollment of 115 CSM patients. The categorization of patients into two groups was based on the duration of symptoms, assessments using the mJOA scale and Health Transition (HT) scores: mild-slow group and severe-rapid group. We found that the patients in both groups had similar degrees of spinal cord compression, but mild-slow group were older and had smaller C2-C7 cobb angle (Flexion) (CL(F)), C2-C7 cobb angle (Range of motion) (CL(ROM)), Transverse area (TA), Normal-TA, Compressive spinal canal area (CSCA), Normal-Spinal canal area (Normal-SCA) and lower Spinal cord increased signal intensity (ISI) Grade than the severe-rapid group. A binary logistic regression analysis showed that CL(ROM) and Normal-TA are favorable factors to help slow the progression of disease patients with mild CSM. Through ROC curves, we found that when CL(ROM) < 39.1° and Normal-TA < 80.5mm2, the progression of disease in CSM patients may be slower. Meanwhile, we obtained a prediction formula by introducing joint prediction factor: L = CL(ROM) + 2.175 * Normal-TA. And found that when L < 213.0, the disease progression of patients may be slower which was superior to calculate CL(ROM) and Normal-TA separately.
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Affiliation(s)
- Taotao Lin
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Zhipeng Yao
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Zhehao Xiao
- Department of Neurosurgery, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Rongcan Wu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Yujie Zhao
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Dehui Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Linquan Zhou
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou, 086-350001, China.
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Qu N, Jin J, Wang X, Deng Y, Zhang B, Qi Q. Quantitatively assessing the effect of cervical sagittal alignment on dynamic intervertebral kinematics by video-fluoroscopy technique. Musculoskelet Sci Pract 2024; 72:102959. [PMID: 38626497 DOI: 10.1016/j.msksp.2024.102959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/10/2023] [Revised: 04/07/2024] [Accepted: 04/10/2024] [Indexed: 04/18/2024]
Abstract
BACKGROUND Cervical sagittal alignment is crucial for distributing the head load to lower cervical segments and maintaining normal cervical spine function, but its biomechanical effect on the cervical spine was not fully elucidated. OBJECTIVE To investigate the effect of cervical sagittal alignment on dynamic intervertebral kinematics. DESIGN Cross-sectional study. METHODS Healthy participants without neck pain were recruited and divided into lordosis, straight and kyphosis groups according to the C2-C7 Cobb angle at the neutral position. The anti-directional and total joint motions were extracted across 10 epochs of dynamic cervical flexion and extension movements. RESULTS /findings: The overall anti-directional joint motion during flexion is larger in the kyphosis group when compared with the lordosis group (p = 0.021), while the range of flexion is smaller in the kyphosis group than that in the lordosis group (p = 0.017). The C2/C3 anti-directional joint motion during extension in the straight group is larger than that in the lordosis group (p = 0016). The range of extension in the kyphosis group (p < 0.001) and the straight group (p = 0.002) are larger than that in the lordosis group. The increased range of extension in the kyphosis and straight groups were mainly from the C3/C4, C4/C5, and C5/C6 joints(p < 0.05). CONCLUSION Changes in cervical sagittal alignment alter both the quality and quantity of the individual joint motions. More adjustments are required by the cervical joints to complete neck movements with the loss of lordosis. The lordotic curvature is a relatively effort-saving mode for the cervical spine from a biomechanical perspective.
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Affiliation(s)
- Ning Qu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - JiaHao Jin
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Xu Wang
- Department of Orthopedic Surgery, The Second Hospital of Jilin University, Changchun, Jilin, China
| | - YanQun Deng
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - Bin Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China
| | - QiHua Qi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Nanchang University, Nanchang, Jiangxi, China.
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He P, Yang Y, Wang M, Li D, Yuan H, Wang J, He Q, Feng D, Liu X. Is the disappearance of the cervical flexion-relaxation phenomenon associated with cervical degeneration in healthy people? 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 2024; 33:2997-3007. [PMID: 38869650 DOI: 10.1007/s00586-024-08355-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/11/2023] [Revised: 05/06/2024] [Accepted: 06/02/2024] [Indexed: 06/14/2024]
Abstract
PURPOSE This study aims to explore the differences in cervical degeneration between healthy people with and without cervical flexion-relaxation phenomenon (FRP) and to identify whether the disappearance of cervical FRP is related to cervical degeneration. METHODS According to the flexion relaxation ratio (FRR), healthy subjects were divided into the normal FRP group and the abnormal FRP group. Besides, MRI was used to evaluate the degeneration of the passive subsystem (vertebral body, intervertebral disc, cervical sagittal balance, etc.) and the active subsystem (deep flexors [DEs], deep extensors [DFs], and superficial extensors [SEs]). In addition, the correlation of the FRR with the cervical degeneration score, C2-7Cobb, Borden method, relative total cross-sectional area (rTCSA), relative functional cross-sectional area (rFCSA), and fatty infiltration ratio (FIR) was analyzed. RESULTS A total of 128 healthy subjects were divided into the normal FRP group (n=52, 40.63%) and the abnormal FRP group (n=76, 59.38%). There were significant differences between the normal FRP group and the abnormal FRP group in the cervical degeneration score (z=-6.819, P<0.001), C2-7Cobb (t=2.994, P=0.004), Borden method (t=2.811, P=0.006), and FIR of DEs (t=-4.322, P<0.001). The FRR was significantly correlated with the cervical degeneration score (r=-0.457, P<0.001), C2-7Cobb (r=0.228, P=0.010), Borden method (r=0.197, P=0.026), and FIR of DEs (r=-0.253, P=0.004). CONCLUSION The disappearance of cervical FRP is related to cervical degeneration. A new hypothesis mechanism for FRP is proposed. The cervical FRP test is an effective and noninvasive examination for the differential diagnosis of healthy people, people with potential NSNP, and patients with NSNP.
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Affiliation(s)
- Peifeng He
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, China
| | - Yunbo Yang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Minglang Wang
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Dan Li
- Department of Rehabilitation, Southwest Medical University, Luzhou City, China
| | - Hao Yuan
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China
| | - Jianxiong Wang
- Department of Rehabilitation, Southwest Medical University, Luzhou City, China
| | - Qiang He
- Department of Orthopaedic Surgery, Bazhong City Traditional Medical Hospital, Bazhong City, China
| | - Daxiong Feng
- Department of Spinal Surgery, Affiliated Hospital of Southwest Medical University, Luzhou City, China.
| | - Xuanwen Liu
- Department of Orthopaedic Surgery, Chengdu 363 Hospital of Southwest Medical University, Chengdu City, China.
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Ma Y, Zhao D, Yu X, Yue X, Meng L, Xu L, Qiu Z, Feng N, Jiang G. Study on the consistency between CT hounsfield units and MRI evaluation of preoperative cervical paraspinal muscular fat infiltration in patients undergoing ACDF. J Orthop Surg Res 2024; 19:435. [PMID: 39061068 PMCID: PMC11282861 DOI: 10.1186/s13018-024-04935-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2024] [Accepted: 07/21/2024] [Indexed: 07/28/2024] Open
Abstract
OBJECTIVE To explore the feasibility of applying CT Hounsfield Units (HUs) for the assessment of preoperative paraspinal muscle fat infiltration (FI) in different segments in patients who underwent anterior cervical discectomy and fusion (ACDF). To compare the consistency of preoperative paraspinal muscle FI evaluations using MRI and those via CT HUs in patients who underwent ACDF surgery. METHODS Ninety-five patients (45 males and 50 females, aged 37‒71 years) who received CT and MRI examinations and underwent ACDF surgery were retrospectively analyzed. In the axial T2-weighted MR images at the median level of the C3/4, C4/5, and C5/6 segments, regions of interests (ROIs) were delineated along the boundaries of the cervical multifidus (MF) and semispinalis cervicis (Scer) muscles. Using the threshold tool in ImageJ software, areas of fat tissue and intermuscular septa within the ROI were quantified. The effective cross-sectional area (ECSA) for each side was obtained by subtracting the areas of fat tissue and intermuscular septa from the total ROI area. The ratio of the fat tissue area to the CSA was then calculated to determine the initial FI value. The depth of subcutaneous fat from the midline spinous process to the epidermis at the median plane of the C4/5 intervertebral disc was measured. The initial FI values were then divided by the depth of fat to determine the post-correction FI value. Using the Picture Archiving and Communication System (PACS), at identical segments and planes, ROIs were delineated using the same method as in MRI under a standard soft tissue window (width of 500 HU, level of 60 HU). The CT HU values were measured within these defined areas. The CT HU values from both sides are summed to obtain the total HU value for the segment. According to whether the measurement results of two sets of data follow a normal distribution, Pearson's test or Sperman's test was used to analyze the correlation. RESULTS On MRI, a statistically significant difference was observed in the post-correction FI only at the C3/4 segment compared to the other two segments (P < 0.05). No significant difference in the post-correction FI between the C4/5 and C5/6 segments was noted (P > 0.05). The CT HU results showed a substantial discrepancy between C3/4 and C4/5 segments and between C3/4 and C5/6 segments (P < 0.05), whereas no statistically significant difference was found in the CT HU value between the C4/5 and C5/6 segments (P > 0.05). The consistency analysis revealed a relatively strong correlation between the post-correction FI and CT HU values of the C3/4 and C4/5 segments. Furthermore, a strong correlation was detected in the variations in the measurement outcomes at the C5/6 segment. CONCLUSION Patients requiring surgical treatment for the cervical spine exhibit varying degrees of FI in paraspinal muscles across different locations and segments. Evaluating the degree of FI in the paraspinal muscles of the cervical spine through CT HU values is feasible. There is considerable consistency between the post-correction FI assessed under MRI and the measurements of CT HU values in evaluating the FI of paraspinal muscles in the cervical spine.
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Affiliation(s)
- Yukun Ma
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Dingyan Zhao
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Xing Yu
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China.
| | - Xinliang Yue
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Letian Meng
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Luchun Xu
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Ziye Qiu
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Ningning Feng
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
| | - Guozheng Jiang
- Department of Orthopedics, Beijing University of Chinese Medicine Dongzhimen Hospital, No. 5, Marine Warehouse, Dongcheng District, Beijing, 100700, China
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Li J, Xing G, Lu P, Ding Y. Paravertebral Muscular Neurophysiological Function as an Independent Outcome Predictor of Recurring Herniation/Low Back Pain after Radiofrequency Ablation: A Prospective Follow-Up and Case-Control Study Based on Surface Electromyography. Orthop Surg 2024; 16:724-732. [PMID: 38183345 PMCID: PMC10925511 DOI: 10.1111/os.13981] [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: 09/04/2023] [Revised: 12/03/2023] [Accepted: 12/04/2023] [Indexed: 01/08/2024] Open
Abstract
OBJECTIVE Spinal endoscopy radiofrequency is a minimally invasive technique for lumbar disc herniation (LDH) and low back pain (LBP). However, recurring LDH/LBP following spinal endoscopy radiofrequency is a significant problem. Paravertebral musculature plays a crucial role in spine stability and motor function, and the purpose of the present study was to identify whether patients' baseline lumbar muscular electrophysiological function could be a predictor of recurring LDH/LBP. METHODS This was a prospective follow-up and case-control study focusing on elderly patients with LDH who were treated in our department between January 1, 2018, and October 31, 2021. The end of follow-up was recurring LBP, recurring LDH, death, missing to follow-up or 2 years postoperation. The surface electromyography test was performed before the endoscopy C-arm radiofrequency (ECRF) operation to detect the flexion-relaxation ratio (FRR) of the lumbar multifidus (FRRLM ) and the longissimus erector spinae (FRRES ), and the other baseline parameters included the general characteristics, the visual analogue scale, the Japanese Orthopaedic Association score, and the Oswestry Disability Index. Intergroup comparisons were performed by independent t-test and χ2 -test, and further binary logistic regression analysis was performed. RESULTS Fifty-four patients completed the 2-year follow-up and were retrospectively divided into a recurring LDH/LBP group (Group R) (n = 21) and a no recurring group (Group N) (n = 33) according to their clinical outcomes. FRRLM and FRRES in Group N were much higher than those in Group R (p < 0.001, p = 0.009). Logistic regression analysis showed that only the FRRLM (odds ratio [OR] = 0.123, p = 0.011) and FRRES (OR = 0.115, p = 0.036) were independent factors associated with the ECRF outcome. CONCLUSIONS Lumbar disc herniation patients' baseline FRRLM and FRRES are independent outcome predictors of recurring LDH/LBP after ECRF. For every unit increase in baseline FRRLM , the risk of recurring LDH/LBP is decreased by 87.7%, and for every unit increase in baseline FRRES , the risk of recurring LDH/LBP is decreased by 88.5%.
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Affiliation(s)
- Jian Li
- Department of OrthopaedicsChina Aerospace Science & Industry Corporation Hospital 731BeijingChina
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
| | - Gengyan Xing
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
| | - Pengfei Lu
- Department of OrthopaedicsThe People's Hospital of Changshou ChongqingChongqingChina
| | - Yi Ding
- Department of OrthopaedicsThe Third Medical Center of PLA General HospitalBeijingChina
- Rehabilitation Hospital Affiliated to National Research Center for Rehabilitation Technical AidsBeijingChina
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Iwamae M, Tamai K, Suzuki A, Terai H, Hoshino M, Kato M, Toyoda H, Takahashi S, Yabu A, Sawada Y, Nakamura H. Degeneration of Cervical Multifidus Muscles Negatively Affects Physical Activity-related Quality of Life After Laminoplasty for Degenerative Cervical Myelopathy. Clin Spine Surg 2024:01933606-990000000-00261. [PMID: 38366328 DOI: 10.1097/bsd.0000000000001585] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Accepted: 01/22/2024] [Indexed: 02/18/2024]
Abstract
STUDY DESIGN A retrospective cohort study. OBJECTIVE The study aimed to investigate the related factors affecting physical activity-related quality of life (QOL) after 2 years of cervical laminoplasty for degenerative cervical myelopathy (DCM), focusing on the degree of preoperative degeneration of the cervical multifidus muscles. SUMMARY OF BACKGROUND DATA The association between paraspinal muscle degeneration and clinical outcomes after spinal surgery is being investigated. The effect of preoperative degeneration of the cervical multifidus muscles in patients undergoing cervical laminoplasty is ambiguous. METHODS Patients who underwent laminoplasty for DCM and followed up for more than 2 years were reviewed. To evaluate physical QOL, the physical component summary (PCS) of the 36-Item Short-Form Health Survey (SF-36) was recorded at 2 years postoperatively. The degree of preoperative degeneration in the multifidus muscles at the C4 and C7 levels on axial T2-weighted magnetic resonance imaging (MRI) was categorized according to the Goutallier grading system. The correlation between 2-year postoperative PCS and each preoperative clinical outcome, radiographic parameter, and MRI finding, including Goutallier classification, was analyzed. Variables with a P value <0.10 in univariate analysis were included in multiple linear regression analysis. RESULTS In total, 106 consecutive patients were included. The 2-year postoperative PCS demonstrated significant correlation with age (R=-0.358, P=0.002), preoperative JOA score (R=0.286, P=0.021), preoperative PCS (R=0.603, P<0.001), C2-C7 lordotic angle (R=-0.284, P=0.017), stenosis severity (R=-0.271, P=0.019), and Goutallier classification at the C7 level (R=-0.268, P=0.021). In multiple linear regression analysis, sex (β=-0.334, P=0.002), age (β=-0.299, P=0.013), preoperative PCS (β=0.356, P=0.009), and Goutallier classification at the C7 level (β=-0.280, P=0.018) were significantly related to 2-year postoperative PCS. CONCLUSIONS Increased degeneration of the multifidus muscle at the C7 level negatively affected physical activity-related QOL postoperatively. These results may guide spine surgeons in predicting physical activity-related QOL in patients with DCM after laminoplasty. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Masayoshi Iwamae
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Koji Tamai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Akinobu Suzuki
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hidetomi Terai
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Masatoshi Hoshino
- Department of Orthopedic Surgery, Osaka City General Hospital, Osaka
| | - Minori Kato
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hiromitsu Toyoda
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Shinji Takahashi
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Akito Yabu
- Department of Orthopedic Surgery, Eniwa Hospital, Hokkaido, Japan
| | - Yuta Sawada
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
| | - Hiroaki Nakamura
- Department of Orthopedic Surgery, Osaka Metropolitan University Graduate School of Medicine
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Abudouaini H, Xu H, Yang J, Yi M, Lin K, Wang S. Comparison of the effectiveness of zero-profile device and plate cage construct in the treatment of one-level cervical disc degenerative disease combined with moderate to severe paraspinal muscle degeneration. Front Endocrinol (Lausanne) 2023; 14:1283795. [PMID: 38125794 PMCID: PMC10731364 DOI: 10.3389/fendo.2023.1283795] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2023] [Accepted: 11/15/2023] [Indexed: 12/23/2023] Open
Abstract
Objective Recent evidence indicates that cervical paraspinal muscle degeneration (PMD) is a prevalent and age-related condition in patients with cervical disc degenerative disease (CDDD). However, the relationship between surgery selection and post-operative outcomes in this population remains unclear. Consequently, this study aims to investigate the disparities in clinical outcomes, radiological findings, and complications between two frequently utilized anterior cervical surgical procedures. The objective is to offer guidance for the management of PMD in conjunction with CDDD. Methods A total of 140 patients who underwent single-level anterior cervical discectomy and fusion (ACDF) at our department were included in this study. The patients were divided into three groups based on the severity of PMD: mild (n=40), moderate (n=54), and severe (n=46), as determined by Goutalier fat infiltration grade. The subjects of interest were those with moderate-severe PMD, and their clinical outcomes, radiological parameters, and complications were compared between those who received a stand-alone zero-profile anchored cage (PREVAIL) and those who received a plate-cage construct (PCC). Results The JOA, NDI, and VAS scores exhibited significant improvement at all postoperative intervals when compared to baseline, and there were no discernible differences in clinical outcomes between the two groups. While the PCC group demonstrated more pronounced enhancements and maintenance of several sagittal alignment parameters, such as the C2-7 angle, FSU angle, C2-7 SVA, and T1 slope, there were no statistically significant differences between the two groups. The incidence of dysphagia in the zero-profile group was 22.41% at one week, which subsequently decreased to 13.79% at three months and 3.45% at the final follow-up. In contrast, the plate cage group exhibited a higher incidence of dysphagia, with rates of 47.62% at one week, 33.33% at three months, and 11.90% at the final follow-up. Notably, there were significant differences in the incidence of dysphagia between the two groups within the first three months. However, the fusion rate, occurrence of implant subsidence, and adjacent segment degeneration (ASD) were comparable at the final follow-up. Conclusion For patients with one-level cervical disc degenerative disease combined with paraspinal muscle degeneration, both the zero-profile technique and PCC have demonstrated efficacy in ameliorating clinical symptoms and maintaining the postoperative sagittal balance. Although no significant disparities were observed between these two technologies in terms of complications such as adjacent segment degeneration and implant subsidence, the zero-profile technique exhibited superior performance over PCC in relation to dysphagia during the early stages of postoperative recovery. To validate these findings, studies with longer follow-up periods and evaluations of multilevel cervical muscles are warranted.
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Affiliation(s)
| | | | | | | | | | - Sibo Wang
- Department of Spine Surgery, Honghui Hospital, Xi’an Jiaotong University, Xi’an, Shanxi, China
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Suo M, Zhang J, Sun T, Wang J, Liu X, Huang H, Li Z. The association between morphological characteristics of paraspinal muscle and spinal disorders. Ann Med 2023; 55:2258922. [PMID: 37722876 PMCID: PMC10512810 DOI: 10.1080/07853890.2023.2258922] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 09/07/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Spinal disorders affect millions of people worldwide, and can cause significant disability and pain. The paraspinal muscles, located on either side of the spinal column, play a crucial role in the movement, support, and stabilization of the spine. Many spinal disorders can affect paraspinal muscles, as evidenced by changes in their morphology, including hypertrophy, atrophy, and degeneration. OBJECTIVES The objectives of this review were to examine the current literature on the relationship between the paraspinal muscles and spinal disorders, summarize the methods used in previous studies, and identify areas for future research. METHODS We reviewed studies on the morphological characteristics of the paravertebral muscle and discussed their relationship with spinal disorders, as well as the current limitations and future research directions. RESULTS The paraspinal muscles play a critical role in spinal disorders and are important targets for the treatment and prevention of spinal disorders. Clinicians should consider the role of the paraspinal muscles in the development and progression of spinal disorders and incorporate assessments of the paraspinal muscle function in clinical practice. CONCLUSION The findings of this review highlight the need for further research to better understand the relationship between the paraspinal muscles and spinal disorders, and to develop effective interventions to improve spinal health and reduce the burden of spinal disorders.
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Affiliation(s)
- Moran Suo
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jing Zhang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Tianze Sun
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Jinzuo Wang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Xin Liu
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Huagui Huang
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
| | - Zhonghai Li
- Department of Orthopedics, First Affiliated Hospital of Dalian Medical University, Dalian, P.R. China
- Key Laboratory of Molecular Mechanism for Repair and Remodeling of Orthopedic Diseases, Liaoning Province, P.R. China
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Virk S, Lafage R, Elysee J, Passias P, Kim HJ, Qureshi S, Lafage V. Cervical Paraspinal Muscle Fatty Infiltration is Directly Related to Extension Reserve in Patients With Cervical Spine Pathology. Clin Spine Surg 2023; 36:E22-E28. [PMID: 35759773 DOI: 10.1097/bsd.0000000000001356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 05/18/2022] [Indexed: 02/07/2023]
Abstract
STUDY DESIGN/SETTING Retrospective review of a prospectively collected database. OBJECTIVE The objective of this study was to determine the relationship between paracervical muscle area, density, and fat infiltration and cervical alignment among patients presenting with cervical spine pathology. BACKGROUND CONTEXT The impact of cervical spine alignment on clinical outcomes has been extensively studied, but little is known about the association between spinal alignment and cervical paraspinal musculature. METHODS We examined computed tomography scans and radiographs for patients presenting with cervical spine pathology. The posterior paracervical muscle area, density, and fat infiltration was calculated on axial slices at C2, C4, C6, and T1. We measured radiographic parameters including cervical sagittal vertical axis, cervical lordosis, T1 slope (T1S), range of motion of the cervical spine. We performed Pearson correlation tests to determine if there were significant relationships between muscle measurements and alignment parameters. RESULTS The study included 51 patients. The paracervical muscle area was higher for males at C2 ( P =0.005), C4 ( P =0.001), and T1 ( P =0.002). There was a positive correlation between age and fat infiltration at C2, C4, C6, and T1 (all P <0.05). The cervical sagittal vertical axis positively correlated with muscle cross-sectional area at C2 ( P =0.013) and C4 ( P =0.013). Overall cervical range of motion directly correlated with muscle density at C2 ( r =0.48, P =0.003), C4 ( r =0.41, P =0.01), and C6 ( r =0.53. P <0.001) and indirectly correlated with fat infiltration at C2 ( r =-0.40, P =0.02), C4 ( r =-0.32, P =0.04), and C6 ( r =-0.35, P =0.02). Muscle density correlated directly with reserve of extension at C2 ( r =0.57, P =0.009), C4 ( r =0.48, P =0.037), and C6 ( r =0.47, P =0.033). Reserve of extension indirectly correlated with fat infiltration at C2 ( r =0.65, P =0.006), C4 ( r =0.47, P =0.037), and C6 ( r =0.48, P =0.029). CONCLUSIONS We have identified specific changes in paracervical muscle that are associated with a patient's ability to extend their cervical spine.
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Affiliation(s)
- Sohrab Virk
- Department of Orthopedic Surgery, Northwell Health, Great Neck
| | - Renaud Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery
| | - Jonathan Elysee
- Department of Orthopedic Surgery, Hospital for Special Surgery
| | - Peter Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY
| | - Han Jo Kim
- Department of Orthopedic Surgery, Hospital for Special Surgery
| | - Sheeraz Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery
| | - Virginie Lafage
- Department of Orthopedic Surgery, Hospital for Special Surgery
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He J, Wu T, Ding C, Wang B, Hong Y, Liu H. The fatty infiltration into cervical paraspinal muscle as a predictor of postoperative outcomes: A controlled study based on hybrid surgery. Front Endocrinol (Lausanne) 2023; 14:1128810. [PMID: 36843584 PMCID: PMC9946973 DOI: 10.3389/fendo.2023.1128810] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Accepted: 01/26/2023] [Indexed: 02/11/2023] Open
Abstract
BACKGROUND The cervical paraspinal muscle (CPM) has an essential role in positioning, stabilizing and directing the cervical spine. However, information is lacking regarding the influence of CPM on outcomes following anterior cervical surgery. This study aims to evaluate the association of fatty infiltration (FI) of CPM with postoperative outcomes in patients undergoing hybrid surgery (HS) and analyze the relationship between FI and cross-sectional area (CSA) of CPM. METHODS A retrospective analysis was performed on 110 consecutive patients undergoing continuous 2-level HS. According to Goutallier classification of multifidus FI, the patients were divided into normal, moderate, and severe groups. Image J software was employed to outline and analyze CPM. Clinical outcomes and radiographic parameters were collected and evaluated for relevant comparisons. RESULTS Visible FI was identified in 69.1% of patients (76/110), with a propensity in elderly patients (p = 0.053). No statistically significant differences were presented among the three groups regarding pre- and postoperative clinical evaluation scores. The cervical lordosis was significantly higher in the normal group before surgery (p = 0.029). Likewise, the sagittal vertical axis (SVA) was significantly higher in the severe group than the normal group at the final follow-up (p = 0.046). The function spine unit angle and disc angle of arthroplasty levels were significantly lower in the severe group than the normal group at follow-ups. Moreover, after correction according to vertebral body area, no statistically significant relationship existed between CSA ratio and FI grade. CONCLUSION CPM degeneration is common and age-related in patients with cervical disc degenerative disease. More importantly, there was a significant positive correlation between severe FI of CPM and postoperative sagittal balance disorder, particularly in C2-7 SVA and segmental alignment of arthroplasty level. Meanwhile, FI of CPM appears to have no impact on clinical outcomes and reveals small correlations to CSA.
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Doi T, Ohtomo N, Oguchi F, Tozawa K, Nakarai H, Nakajima K, Sakamoto R, Okamoto N, Nakamoto H, Kato S, Taniguchi Y, Matsubayashi Y, Oka H, Matsudaira K, Tanaka S, Oshima Y. Association Between Deep Posterior Cervical Paraspinal Muscle Morphology and Clinical Features in Patients With Cervical Ossification of the Posterior Longitudinal Ligament. Global Spine J 2023; 13:8-16. [PMID: 33504203 PMCID: PMC9837499 DOI: 10.1177/2192568221989655] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
STUDY DESIGN A retrospective observational study. OBJECTIVE To clarify the association of the paraspinal muscle area and composition with clinical features in patients with cervical ossification of the posterior longitudinal ligament (OPLL). METHODS Consecutive patients with cervical OPLL who underwent cervical magnetic resonance imaging (MRI) before surgery were reviewed. The cross-sectional area (CSA) and fatty infiltration ratio (FI%) of deep posterior cervical paraspinal muscles (multifidus [MF] and semispinalis cervicis [SCer]) were examined. We assessed the association of paraspinal muscle measurements with the clinical characteristics and clinical outcomes, such as Neck Disability Index (NDI) score. Moreover, we divided the patients into 2 groups according to the extent of the ossified lesion (segmental and localized [OPLL-SL] and continuous and mixed [OPLL-CM] groups) and compared these variables between the 2 groups. RESULTS 49 patients with cervical OPLL were enrolled in this study. The FI% of the paraspinal muscles was significantly associated with the number of vertebrae (ρ = 0.283, p = 0.049) or maximum occupancy ratio of OPLL (ρ = 0.397, p = 0.005). The comparative study results indicated that the NDI score was significantly worse (OPLL-SL, 22.9 ± 13.7 vs. OPLL-CM, 34.4 ± 13.7) and FI% of SCer higher (OPLL-SL, 9.1 ± 1.7% vs. OPLL-CM, 11.1 ± 3.7%) in the OPLL-CM group than those in the OPLL-SL group. CONCLUSIONS Our results suggest that OPLL severity may be associated with fatty infiltration of deep posterior cervical paraspinal muscles, which could affect neck disability in patients with cervical OPLL.
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Affiliation(s)
- Toru Doi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Nozomu Ohtomo
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Fumihiko Oguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Keiichiro Tozawa
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hiroyuki Nakarai
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Koji Nakajima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Ryuji Sakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Naoki Okamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Hideki Nakamoto
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - So Kato
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yuki Taniguchi
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | | | - Hiroyuki Oka
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Ko Matsudaira
- Department of Medical Research and
Management for Musculoskeletal Pain, 22nd Century Medical and Research Center,
Faculty of Medicine, The University of Tokyo, Tokyo, Japan
| | - Sakae Tanaka
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan
| | - Yasushi Oshima
- Department of Orthopaedic Surgery, The University of Tokyo, Tokyo, Japan,Yasushi Oshima, Department of Orthopaedic
Surgery, The University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655, Japan.
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Lin S, Lin T, Wu Z, Chen G, Shangguan Z, Wang Z, Liu W. Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty? Spine J 2022; 22:1953-1963. [PMID: 35878757 DOI: 10.1016/j.spinee.2022.07.099] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/20/2022] [Revised: 07/12/2022] [Accepted: 07/18/2022] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT A previous study found that the cross-sectional area (CSA) of the preoperative cervical paraspinal extensors (CPEs) was associated with loss of cervical lordosis after laminoplasty, while a recent study found that CPE asymmetry was associated with symptoms of degenerative cervical myelopathy. Whether preoperative CPE asymmetry can predict cervical sagittal deformity (CSD) after laminoplasty is unknown. PURPOSE To assess whether asymmetry, degree of degeneration, and extension function of the CPE can be used as predictors of postoperative CSD in patients who undergo laminoplasty. STUDY DESIGN A retrospective study. PATIENT SAMPLE From January 2017 to December 2019, 55 patients with multilevel cord compression and myelopathic symptoms were enrolled. OUTCOME MEASURES The visual analog scale (VAS), neck disability index (NDI), and modified Japanese Orthopedic Association (mJOA) were used to assess cervical spinal function and quality of life. METHODS From January 2017 to December 2019, 55 patients undergoing modified laminoplasty were included. The following parameters were measured preoperatively and 24 months postoperatively on X-ray: (1) C0-C2 Cobb angle; (2) C2-C7 Cobb angle (CL); (3) T1 slope (T1S); (5) C2-C7 sagittal vertical axis (SVA); (6) T1S minus CL; (7) Preoperative extension function: Extension CL minus Neutral CL (EF). Preoperative global alignment parameters: (8) spino cranial angle, (9) C7-S1 sagittal vertical axis (C7 SVA), (10) pelvic incidence, (11) lumbar lordosis, (12) thoracic kyphosis. (13) Preoperative CPE parameters: Summation of bilateral total cross-sectional area (STCSA), summation of bilateral total cross-sectional area ratio (STCSAR), total cross-sectional area asymmetry, summation of bilateral functional cross-sectional area of muscle (SFCSA), summation of bilateral functional cross-sectional area of muscle ratio (FCSAR), and functional cross-sectional area of muscle asymmetry (FCSAA). The VAS, mJOA, and NDI were used to evaluate cervical spine function and quality of life. Patients were divided into the CSD group and the non-deformed group (N-CSD) group postoperatively, and the parameters between the two groups were compared. The Pearson correlation coefficient was used to evaluate the relationship between the parameters, and multiple regression analysis and ROC curve analysis were used to determine the predictors and key values. RESULTS Compared with functional scores, mJOA in the CSD group was significantly lower than that in the N-CSD group, while NDI and VAS were significantly higher. Postoperative CL was significantly correlated with EF, SFCSA/STCSA (C3-C6), SFCSAR (C4 and C6), STCSAR (C6), and FSCAA (C6). T1S minus CL was significantly correlated with EF, SFCSA/STCSA (C3-4 and C6), SFCSAR (C4 and C6), STCSAR (C6) and FSCAA (C6). C2-7 SVA was significantly correlated with EF, SFCSAR (C4 and C6), STCSAR (C6), and FSCAA (C6). Multiple regression analysis showed that FCSAA (C6), SFCSAR (C6), SFCSAR (C4), and EF were significant predictors of postoperative CSD. ROC curve analysis showed that the optimal cutoff points were 18.405, 2.95, 4.47, and 11.96. CONCLUSIONS The present study found that preoperative extension dysfunction of CPEs, asymmetry at the C6 level cervical extensors, and cervical extensor CSAs without fatty infiltration at the C4 and C6 levels were associated with cervical sagittal imbalance after modified laminoplasty. These factors can be considered when future spine surgeons formulate surgical plans.
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Affiliation(s)
- Sibo Lin
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China
| | - Taotao Lin
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China
| | - Zhengru Wu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China
| | - Gang Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China
| | - Zhitao Shangguan
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China.
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Xinquan Road No.29, Gulou, Fuzhou 086-350001, China.
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13
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Wang D, Liu B. Effects of hanger reflex on the cervical muscular activation and function: A surface electromyography assessment. Front Physiol 2022; 13:1006179. [PMID: 36311253 PMCID: PMC9597877 DOI: 10.3389/fphys.2022.1006179] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 09/20/2022] [Indexed: 11/22/2022] Open
Abstract
Introduction: Cervical muscular dysfunction is closely associated with disorders and neuromuscular diseases of the cervical spine, and the hanger reflex (HR) has the potential to become a rehabilitation method. The muscular electrophysiology mechanism of HR is unclear. This study aims to identify the impacts of HR on cervical rotators’ myoelectrical activity and function. Methods: We designed a self-control clinical trial, and asymptomatic volunteers were continuously included from 1 September 2021 to 30 April 2022 in our department. Rotation tasks were performed on both sides under each of the situations: no HR, unilateral HR, and bilateral HR. Surface electromyography (SEMG) was used to detect the myoelectrical activity of agonistic splenius capitis (SPL), upper trapezius (UTr), and sternocleidomastoid (SCM). The co-contraction ratio (CCR) during rotation tasks was calculated. Correlation analyses and multiple linear regression were performed. Results: Finally, 90 subjects were enrolled (power >90%). The adjusted EMG value (aEMG) of SPL UTr, SCM, and rotating CCR under the unilateral HR and bilateral HR were higher than no HR; the aEMG of SPL and rotating CCR under the bilateral HR were higher than the unilateral HR. Multiple linear regression showed that HR pattern and age were the independent affecting factors for the aEMG of SPL (p < 0.001, p < 0.001), UTr (p < 0.001, p < 0.001), and SCM (p < 0.001, p < 0.001); BMI was an independent affecting factor for the aEMG of SPL (p < 0.001) and SCM (p < 0.001); HR pattern was the only affecting factor for CCR (p < 0.001). Conclusion: HR can increase the cervical rotators’ myoelectrical activities and rotating CCR, and the effects of bilateral HR are greater than unilateral HR, suggesting that bilateral HR has a greater clinical potential to become a rehabilitation method for treating cervical neuromuscular disorders.
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14
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Tran KS, Mazmudar A, Paziuk T, Lambrechts MJ, Tecce E, Blaber O, Habbal D, Okroj K, Karamian BA, Canseco JA, Rihn JA, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. Cross-sectional area of the longus colli and cervical degenerative spondylolisthesis: A retrospective review evaluating this anatomic consideration. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2022; 13:421-426. [PMID: 36777905 PMCID: PMC9910131 DOI: 10.4103/jcvjs.jcvjs_104_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: 08/30/2022] [Accepted: 10/19/2022] [Indexed: 12/12/2022] Open
Abstract
Background Limited literature is available to define the impact of the longus colli muscle, a deep flexor of the spine, on cervical spine stability despite its close proximity to the vertebrae. Aims and Objectives The purpose of this study was to determine if longus colli cross-sectional area (CSA) is associated with the severity preoperative cervical degenerative spondylolisthesis. Materials and Methods Patients undergoing elective anterior cervical discectomy and fusion (ACDF) for cervical spondylolisthesis between 2010-2021 were retrospectively identified. Longus colli cross-sectional areas (CSA) were measured from preoperative MRI images at the C5 level. Preoperative spondylolisthesis measurements were recorded with cervical radiographs. Patients were grouped by quartiles respectively according to longus colli CSAs. Statistical tests compared patient demographics, surgical characteristics, and surgical outcomes between groups. Multiple linear regression analysis was utilized to assess if longus colli CSA predicted cervical spondylolisthesis. Results A total of 157 patients met inclusion criteria. Group 1 (first quartile) was the oldest (60.4 ± 12.0 years, P = 0.024) and was predominantly female (59.0%, P = 0.001). Group 1 also had the highest maximum spondylolisthesis (0.19 mm, P = 0.031) and highest proportion of grade 2 spondylolisthesis (23.1%, P = 0.003). On regression analysis, lowest quartile of longus colli CSA was an independent predictor of larger measured maximum spondylolisthesis (β: 0.04, P = 0.012). Conclusion Smaller longus colli CSA is independently associated with a higher grade and degree of preoperative cervical spondylolisthesis, but this finding does not result in adverse postsurgical outcomes.
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Affiliation(s)
- Khoa S. Tran
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Aditya Mazmudar
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Taylor Paziuk
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Mark J. Lambrechts
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Eric Tecce
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Olivia Blaber
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Daniel Habbal
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Kamil Okroj
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Brian A. Karamian
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jose A. Canseco
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Jeffrey A. Rihn
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alan S. Hilibrand
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Christopher K. Kepler
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Alexander R. Vaccaro
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
| | - Gregory D. Schroeder
- Department of Orthopaedic Surgery, Rothman Orthopaedic Institute, Thomas Jefferson University, Philadelphia, Pennsylvania, USA
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Liang W, Han B, Hai Y, Yang J, Yin P. Biomechanical Analysis of the Reasonable Cervical Range of Motion to Prevent Non-Fusion Segmental Degeneration After Single-Level ACDF. Front Bioeng Biotechnol 2022; 10:918032. [PMID: 35782514 PMCID: PMC9243332 DOI: 10.3389/fbioe.2022.918032] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 05/05/2022] [Indexed: 11/13/2022] Open
Abstract
The compensatory increase in intervertebral range of motion (ROM) after cervical fusion can increase facet joint force (FJF) and intradiscal pressure (IDP) in non-fusion segments. Guiding the post-ACDF patient cervical exercise within a specific ROM (defined as reasonable ROM) to offset the increase in FJF and IDP may help prevent segmental degeneration. This study aimed to determine the reasonable total C0–C7 ROM without an increase in FJF and IDP in non-fusion segments after anterior cervical discectomy and fusion (ACDF). A three-dimensional intact finite element model of C0–C7 generated healthy cervical conditions. This was modified to the ACDF model by simulating the actual surgery at C5–C6. A 1.0 Nm moment and 73.6 N follower load were applied to the intact model to determine the ROMs. A displacement load was applied to the ACDF model under the same follower load, resulting in a total C0–C7 ROM similar to that of the intact model. The reasonable ROMs in the ACDF model were calculated using the fitting function. The results indicated that the intervertebral ROM of all non-fusion levels was increased in the ACDF model in all motion directions. The compensatory increase in ROM in adjacent segments (C4/5 and C6/7) was more significant than that in non-adjacent segments, except for C3/4 during lateral bending. The intervertebral FJF and IDP of C0–C7 increased with increasing ROM. The reasonable ROMs in the ACDF model were 42.4°, 52.6°, 28.4°, and 42.25° in flexion, extension, lateral bending, and axial rotation, respectively, with a decreased ROM of 4.4–7.2%. The postoperative increase in FJF and IDP in non-fusion segments can be canceled out by reducing the intervertebral ROM within reasonable ROMs. This study provided a new method to estimate the reasonable ROMs after ACDF from a biomechanical perspective, and further in vitro and clinical studies are needed to confirm this.
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Affiliation(s)
| | | | - Yong Hai
- *Correspondence: Yong Hai, ; Peng Yin,
| | | | - Peng Yin
- *Correspondence: Yong Hai, ; Peng Yin,
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Huang Z, Bai Z, Yan J, Zhang Y, Li S, Yuan L, Huang D, Ye W. Association between muscle morphology changes, cervical spine degeneration and clinical features in patients with chronic nonspecific neck pain: a magnetic resonance imaging analysis. World Neurosurg 2021; 159:e273-e284. [PMID: 34929370 DOI: 10.1016/j.wneu.2021.12.041] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2021] [Revised: 12/10/2021] [Accepted: 12/11/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE The primary objective of the present study was to investigate the correlations among cervical paraspinal muscle morphology changes (fatty infiltration (FI) and muscle atrophy), cervical degeneration and clinical features in patients with chronic nonspecific neck pain (CNSNP). METHODS The magnetic resonance imaging (MRI) data of 55 consecutive patients (average age 35.80) with CNSNP were analyzed in this cross-sectional study. Muscle morphology changes in seven groups of paraspinal muscles, indicated by the adjusted cross-sectional area (aCSA) and FI ratio (FI%), were measured from C3/4 to C6/7. The correlations of these changes with disc degeneration, cervical balance (C2-7 angle and cervical alignment) and clinical features (severity of neck pain and related disability and the frequency of acute neck pain (ANP) recurrence) were evaluated. RESULTS Significant correlations between FI% and aCSA and the grade of disc degeneration were observed in specific muscle groups at each level (p<0.05). Morphological changes in the deep extensors and superficial paraspinal muscles were significantly associated with cervical balance parameters (p<0.05). The FI% showed a significant positive correlation, while aCSA showed a significant negative correlation with the severity of neck pain and related disability (p<0.05). Correlations between morphological changes and the frequency of ANP recurrence were also present for some muscles (p<0.05). CONCLUSION Correlations among muscle morphology changes, cervical degeneration and clinical features were established for patients with CNSNP, and muscle volume changes and FI might affect CNSNP in diverse manners through different paraspinal muscle groups. These results implicated the complex contribution of muscle morphological changes to cervical degeneration and the clinical course of CNSNP.
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Affiliation(s)
- Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhiqiang Bai
- Department of Radiology, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Jiansen Yan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Yangyang Zhang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuangxing Li
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Liang Yuan
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Dongsheng Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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Swanson BT, Creighton D. Cervical disc degeneration: important considerations for the manual therapist. J Man Manip Ther 2021; 30:139-153. [PMID: 34821212 DOI: 10.1080/10669817.2021.2000089] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/19/2022] Open
Abstract
Cervical disc degeneration (CDD) is a progressive, age-related occurrence that is frequently associated with neck pain and radiculopathy. Consistent with the majority of published clinical practice guidelines (CPG) for neck pain, the 2017 American Physical Therapy Association Neck Pain CPG recommends cervical manipulation as an intervention to address acute, subacute, and chronic symptoms in the 'Neck Pain With Mobility Deficits' category as well for individuals with 'Chronic Neck Pain With Radiating Pain'. While CPGs are evidence-informed statements intended to help optimize care while considering the relative risks and benefits, these guidelines generally do not discuss the mechanical consequences of underlying cervical pathology nor do they recommend specific manipulation techniques, with selection left to the practitioner's discretion. From a biomechanical perspective, disc degeneration represents the loss of structural integrity/failure of the intervertebral disc. The sequelae of CDD include posterior neck pain, segmental hypermobility/instability, radicular symptoms, myelopathic disturbance, and potential vascular compromise. In this narrative review, we consider the mechanical, neurological, and vascular consequences of CDD, including information on the anatomy of the cervical disc and the mechanics of discogenic instability, the anatomic and mechanical basis of radiculitis, radiculopathy, changes to the intervertebral foramen, the importance of Modic changes, and the effect of spondylotic hypertrophy on the central spinal canal, spinal cord, and vertebral artery. The pathoanatomical and biomechanical consequences of CDD are discussed, along with suggestions which may enhance patient safety.
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Affiliation(s)
- Brian T Swanson
- Department of Rehabilitation Sciences University of Hartford, West Hartford, CT, USA
| | - Douglas Creighton
- Human Movement Science Department Oakland University, Rochester, MI, USA
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Tao Y, Niemeyer F, Galbusera F, Jonas R, Samartzis D, Vogele D, Kienle A, Wilke HJ. Sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine and their associations with age, sex and cervical lordosis: A large-scale morphological study. Clin Anat 2021; 34:1111-1120. [PMID: 34309067 DOI: 10.1002/ca.23769] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2021] [Revised: 07/05/2021] [Accepted: 07/16/2021] [Indexed: 11/11/2022]
Abstract
Many recent studies have focused on the functional and clinical importance of cervical lordosis. However, there is little accurate knowledge of the anatomical parameters that constitute cervical lordosis (i.e., the sagittal wedging angles of intervertebral discs and vertebral bodies) and their associations with age and sex. Standing lateral cervical radiographs of 1020 subjects (424 males, 596 females) with a mean age of 36.6 ± 17.0 years (range 7-95 years) were evaluated retrospectively. Cervical lordosis, the sum of intervertebral disc wedging angles from C2/C3 to C6/C7 and the sum of vertebral body wedging angles from C3 to C7 were measured. The sum of intervertebral disc wedging and the sum of vertebral body wedging were 20.6° ± 14.7° and -12.8° ± 10.3°, respectively. The sum of intervertebral disc wedging increased significantly with age and was significantly greater in males than females, whereas there was no sex-related difference in the sum of vertebral body wedging. The sum of intervertebral disc wedging was negatively correlated with sum of vertebral body wedging. Wedging of discs contributed to C2-C7 cervical lordosis more significantly than wedging of vertebral bodies. There were moderate positive correlations between cervical lordosis and intervertebral disc wedging angles at C3/C4, C4/C5 and C5/C6; weak correlations were observed at C2/C3 and C6/C7. This study constitutes the largest currently available analysis comprehensively documenting the anatomical characteristics of sagittal wedging of intervertebral discs and vertebral bodies in the cervical spine. The findings could improve understanding of the internal architecture of cervical lordosis among clinicians.
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Affiliation(s)
- Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | | | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center and Rush Graduate College, Chicago, Illinois, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, Illinois, USA
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | | | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University Medical Centre, Ulm, Germany
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19
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The Effect of Cervical Paravertebral Extensor Degeneration on Sagittal Alignment and Functional Status of Cervical Spine in Patients With Cervical Spondylotic Myelopathy. Clin Spine Surg 2021; 34:E382-E389. [PMID: 34397532 DOI: 10.1097/bsd.0000000000001149] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/30/2020] [Accepted: 12/22/2020] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a cross-sectional study. OBJECTIVE The objective of this study was to assess cervical paravertebral extensor degeneration in patients with cervical spondylotic myelopathy (CSM) and its impact on the sagittal parameters and functional status of the cervical spine. SUMMARY OF BACKGROUND DATA Paravertebral extensor degeneration is well-studied in CSM; however, the effect of extensor degeneration on the sagittal balance and functional status of the cervical spine is unclear. MATERIALS AND METHODS We enrolled 52 CSM patients (CSM group) and 52 age-matched and sex-matched healthy adults (control group). The C2-C7 and C0-C2 Cobb angles (CAs), C7 slope, T1 slope, cervical arc cord distance, cervical tilt (CERT), cranial tilt (CRAT), and C2-C7 sagittal vertical axis (SVA) were measured. The cross-sectional areas of the deep extensors (DEA), superficial extensors (SEA), and cervical vertebral body (VBA) of C4-C7 were measured. DEA/VBA and SEA/VBA were used to quantify the extensor volume. We analyzed the fatty infiltration ratio of the deep (DFIR) and superficial extensors (SFIR). The Visual Analog Scale, Neck Disability Index, and modified Japanese Orthopaedic Association Scale scores of the CSM group were calculated. RESULTS The DEA/VBA was significantly lower and the DFIR and SFIR were significantly higher in the CSM group. The C4 DEA/VBA correlated with the C2-C7 SVA, C2-C7 CA, CERT, and the Neck Disability Index and modified Japanese Orthopaedic Association Scale scores (r=-0.608, 0.291, 0.335,-0.649, and 0.409, respectively). The DEA/VBA of C5 correlated with the cervical arc cord distance and CRAT (r=-0.350 and -0.356, respectively). The C4 DFIR correlated with the C2-C7 SVA, C2-C7 CA, and the Visual Analog Scale (r=0.286, -0.297, and 0.429, respectively). The SFIR of C7 correlated with the T1 slope and C7 slope (r=0.368 and 0.319, respectively). CONCLUSIONS Paravertebral extensor degeneration negatively impacts the sagittal sequence and functional status of the cervical spine in CSM patients. Our study provides an insight into understanding the significance of cervical muscular degeneration in CSM patients. LEVEL OF EVIDENCE Level III.
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20
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Wong AYL, Harada G, Lee R, Gandhi SD, Dziedzic A, Espinoza-Orias A, Parnianpour M, Louie PK, Basques B, An HS, Samartzis D. Preoperative paraspinal neck muscle characteristics predict early onset adjacent segment degeneration in anterior cervical fusion patients: A machine-learning modeling analysis. J Orthop Res 2021; 39:1732-1744. [PMID: 32816312 DOI: 10.1002/jor.24829] [Citation(s) in RCA: 17] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2020] [Revised: 07/27/2020] [Accepted: 08/05/2020] [Indexed: 02/04/2023]
Abstract
Early onset adjacent segment degeneration (ASD) can be found within six months after anterior cervical discectomy and fusion (ACDF). Deficits in deep paraspinal neck muscles may be related to early onset ASD. This study aimed to determine whether the morphometry of preoperative deep neck muscles (multifidus and semispinalis cervicis) predicted early onset ASD in patients with ACDF. Thirty-two cases of early onset ASD after a two-level ACDF and 30 matched non-ASD cases were identified from a large-scale cohort. The preoperative total cross-sectional area (CSA) of bilateral deep neck muscles and the lean muscle CSAs from C3 to C7 levels were measured manually on T2-weighted magnetic resonance imaging. Paraspinal muscle CSA asymmetry at each level was calculated. A support vector machine (SVM) algorithm was used to identify demographic, radiographic, and/or muscle parameters that predicted proximal/distal ASD development. No significant between-group differences in demographic or preoperative radiographic data were noted (mean age: 52.4 ± 10.9 years). ACDFs comprised C3 to C5 (n = 9), C4 to C6 (n = 20), and C5 to C7 (n = 32) cases. Eighteen, eight, and six patients had proximal, distal, or both ASD, respectively. The SVM model achieved high accuracy (96.7%) and an area under the curve (AUC = 0.97) for predicting early onset ASD. Asymmetry of fat at C5 (coefficient: 0.06), and standardized measures of C7 lean (coefficient: 0.05) and total CSA measures (coefficient: 0.05) were the strongest predictors of early onset ASD. This is the first study to show that preoperative deep neck muscle CSA, composition, and asymmetry at C5 to C7 independently predicted postoperative early onset ASD in patients with ACDF. Paraspinal muscle assessments are recommended to identify high-risk patients for personalized intervention.
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Affiliation(s)
- Arnold Y L Wong
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois.,Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Garrett Harada
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Remy Lee
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Sapan D Gandhi
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Adam Dziedzic
- Department of Computer Science, University of Chicago, Chicago, Illinois
| | - Alejandro Espinoza-Orias
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Mohamad Parnianpour
- Department of Mechanical Engineering, Sharif University of Technology, Tehran, Iran
| | - Philip K Louie
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Bryce Basques
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Howard S An
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Centre, Chicago, Illinois.,Department of Orthopaedic Surgery, International Spine Research and Innovation Initiative, Rush University Medical Centre, Chicago, Illinois
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21
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Tao Y, Galbusera F, Niemeyer F, Jonas R, Samartzis D, Vogele D, Wilke HJ. The impact of age, sex, disc height loss and T1 slope on the upper and lower cervical lordosis: a large-scale radiologic study. 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; 30:2434-2442. [PMID: 34331122 DOI: 10.1007/s00586-021-06933-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 07/14/2021] [Indexed: 11/27/2022]
Abstract
PURPOSE To clarify the relative influence of age, sex, disc height loss and T1 slope on upper (Occiput-C2) and lower cervical lordosis (C2-C7). METHODS Standing lateral cervical radiographs of 865 adult subjects were evaluated. The presence and severity of disc height loss from C2/C3 to C6/C7 (a total of 4325 discs) were assessed using a validated grading system. The total disc height loss score for each subject was calculated as the sum of the score of each disc space. Sagittal radiographic parameters included: occipital slope, occiput-C2 (Oc-C2) lordosis, C2-C7 lordosis and T1 slope. Multivariable regression analyses were performed to examine the relative influence of the multiple factors on upper and lower cervical lordosis. RESULTS This study included 360 males and 505 females, with a mean age of 40.2 ± 16.0 years (range, 20-95 years). Linear multivariate regression analyses showed that greater age, male sex, greater T1 slope were each found to be significantly and independently associated with greater C2-C7 lordosis, whereas total disc height loss score was negatively associated with C2-C7 lordosis. T1 slope had the most independent influence on C2-C7 lordosis among these factors. Age, sex and disc height loss were not independently associated with Oc-C2 lordosis. CONCLUSIONS Results from our large-scale radiologic analysis may enhance the understanding of the factors that affect cervical lordosis, indicating that age, sex, disc height loss and T1 slope were each independently associated with C2-C7 lordosis. However, age, sex and disc height loss were not independently associated with upper cervical lordosis.
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Affiliation(s)
- Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | | | - Frank Niemeyer
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | - René Jonas
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany
| | - Dino Samartzis
- Department of Orthopaedic Surgery, Rush University Medical Center and Rush Graduate College, Chicago, IL, USA.,International Spine Research and Innovation Initiative, Rush University Medical Center, Chicago, IL, USA
| | - Daniel Vogele
- Department of Diagnostic and Interventional Radiology, University Hospital Ulm, Ulm, Germany
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Trauma Research Center Ulm, Ulm University, Helmholtzstrasse 14, 89081, Ulm, Germany.
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22
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Siasios I, Samara E, Fotiadou A, Tsoleka K, Vadikolias K, Mantatzis M, Birbilis T. The Role of Cervical Muscles Morphology in the Surgical Treatment of Degenerative Disc Disease: Clinical Correlations Based on Magnetic Resonance Imaging Studies. J Clin Med Res 2021; 13:367-376. [PMID: 34394779 PMCID: PMC8336945 DOI: 10.14740/jocmr4551] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2021] [Accepted: 07/16/2021] [Indexed: 12/03/2022] Open
Abstract
Cervical spine musculature still remains a less studied component of the cervical spine anatomical compartments, although it plays a significant role in the mobility of the head and the preservation of cervical spine alignment. The goal of this study was to extract any significant information from the literature regarding the role of cervical spine muscles morphology in the outcome of surgically treated patients for degenerative disc disease (DDD) based on preoperative magnetic resonance imaging (MRI) studies. Eleven clinical case series were found, from which four were prospective and seven were retrospective. Six studies were concentrated on anterior approaches and five studies on posterior approaches in the cervical spine. In posterior approaches aiming at the preservation of muscles attachments and overall less surgical manipulations, results on cervical lordosis, axial pain and patient’s functionality were found superior to traditional laminectomies. The study of cross-sectional areas (CSAs) of deep paraspinal muscles in the cervical spine could add significant information for the spine surgeon such as the prediction of adjacent level disease (ALD), fusion failure, axial pain persistence, postoperative cervical alignment and patient’s postoperative functionality. It seems that MRI studies focusing on muscle layers of the cervical spine could add significant information for the spinal surgeon regarding the final surgical outcome in terms of pain and function expression. Larger multicenter clinical studies are a necessity in defining the role of the muscle component of the cervical spine in the surgical treatment of DDD.
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Affiliation(s)
- Ioannis Siasios
- Department of Neurosurgery, General Hospital of Papageorgiou, Thessaloniki, Greece.,Department of Neurosurgery, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Ethymia Samara
- Department of Neurology, General Hospital of Papageorgiou, Thessaloniki, Greece
| | - Aggeliki Fotiadou
- Department of Neurology, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Kalliopi Tsoleka
- Department of Neurosurgery, General Hospital of Papageorgiou, Thessaloniki, Greece
| | - Konstantinos Vadikolias
- Department of Neurology, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Michael Mantatzis
- Department of Radiology, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
| | - Theodosis Birbilis
- Department of Neurosurgery, General University Hospital of Alexandroupolis, Alexandroupoli, Greece
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23
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Wang X, Meng Y, Liu H, Chen H, Wang B, Hong Y. Association of cervical sagittal alignment with adjacent segment degeneration and heterotopic ossification following cervical disc replacement with Prestige-LP disc. J Orthop Surg (Hong Kong) 2021; 28:2309499020968295. [PMID: 33169634 DOI: 10.1177/2309499020968295] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
PURPOSE Cervical sagittal balance plays important roles in transmitting the load of the head and maintaining global spinal balance. This study aimed to identify the association of cervical sagittal alignment with adjacent segment degeneration (ASD) and heterotopic ossification (HO) after Prestige-LP cervical disc replacement (CDR). METHODS We enrolled 132 patients who underwent one-level Prestige-LP CDR with 2-10 years of follow-up. Cervical sagittal alignment parameters, including the degree of C2-C7 lordosis (CL), functional spinal unit angle (FSUA), sagittal vertical axis (SVA),, and T1 slope (T1s), were measured. ASD and HO were evaluated at the last follow-up. Unpaired t tests and logistic regression analysis were used to identify the associations of cervical sagittal alignment with ASD and HO. RESULTS We found that patients who developed ASD showed significantly lower FSUA (2.1° vs. -1.4°, p < 0.001) and T1s values (28.4° vs. 25.5°, p = 0.029) after surgery. Similarly, the postoperative CL was significantly better in patients without ASD or HO (18.0° vs. 14.4°, p = 0.043). The decrease in the T1s at the last follow-up was significantly larger in the patients with ASD (-11.0° vs. -3.2°, p = 0.003), HO (-6.7° vs. -2.7°, p = 0.050), and ASD or HO (-7.0° vs. -0.8°, p < 0.001) than in those without ASD or HO. Multivariate logistic regression analysis showed that both the FSUA and T1s are associated with ASD and that the degree of CL is associated with postoperative complications. CONCLUSION The results imply that maintaining cervical sagittal alignment after Prestige-LP CDR is important.
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Affiliation(s)
- Xiaofei Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Yang Meng
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Hao Liu
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Hua Chen
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Beiyu Wang
- Department of Orthopaedic Surgery, West China Hospital, Sichuan University, Sichuan, China
| | - Ying Hong
- Department of Operation Room, West China Hospital, Sichuan University, Sichuan, China.,West China School of Nursing, Sichuan University, Sichuan, China
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24
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Lin T, Wang Z, Chen G, Liu W. Predictive effect of cervical spinal cord compression and corresponding segmental paravertebral muscle degeneration on the severity of symptoms in patients with cervical spondylotic myelopathy. Spine J 2021; 21:1099-1109. [PMID: 33785472 DOI: 10.1016/j.spinee.2021.03.030] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/15/2020] [Revised: 03/22/2021] [Accepted: 03/23/2021] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Previous studies have found that cervical sagittal parameters and spinal cord compression are important risk factors for cervical spondylotic myelopathy (CSM). An increasing number of scholars believe that cervical muscle condition is also one of the factors affecting the severity of symptoms in affected patients. PURPOSE To determine whether: the degree of corresponding segmental paravertebral muscle degeneration is related to the severity of symptoms in patients with CSM; the degree of cervical spinal cord compression can predict the severity of symptoms in patients with CSM. STUDY DESIGN A retrospective study. PATIENT SAMPLE From January 2015 to January 2019, 121 patients with CSM were enrolled. OUTCOME MEASURES The visual analog scale (VAS), neck disability index (NDI) and modified Japanese Orthopedic Association (mJOA) were used to assess cervical spinal function and quality of life. METHODS From January 2015 to January 2019, 121 patients with CSM were enrolled. The inclusion criterion was the presence of complete cervical lateral radiography and magnetic resonance imaging (MRI) data. The following radiographic parameters were measured: (1) C0-C2 Cobb angle; (2) C2-C7 Cobb angle (CL); (3) T1 slope (T1S); (4) neck tilt (NT); (5) C2-C7 sagittal vertical axis (SVA); and (6) T1S-CL. The following MRI parameters were measured: (1) up(low)-fat/muscle; (2) up(low)-fat/centrum; (3) up(low)-muscle/centrum; (4) cervical cord compression index (CCI); (5) S-index; and (6) cervical spinal cord compression area ratio (S0/S1). The VAS, NDI and mJOA were used to assess cervical spinal function and quality of life. The patients were divided into 2 groups according to the mJOA score: group A (mild-moderate symptom group, mJOA score≥12 points) and group B (severe symptom group, mJOA score<12 points). The Pearson correlation coefficient was used to assess the correlations between cervical sagittal parameters, MRI parameters and functional scores. Logistic regression analysis and ROC curve analysis were performed to identify independent risk factors and critical values. RESULTS In patients with CSM, the VAS score is positively correlated with NT, up-fat/centrum, S-index and S0/S1. The NDI is positively correlated with NT, up-fat/muscle, up-fat/centrum, S-index, and S0/S1 and negatively correlated with C0-2N and CL. The mJOA score is positively correlated with CL and negatively correlated with C2-7 SVA, CCI, S-index, and S0/S1. Thus, corresponding segmental paravertebral muscle degeneration has relevance to neck pain, but it is not related to limb weakness, neurological dysfunction, gait impairment, sensation or bladder/bowel function dysfunction. Through mJOA score grouping and binary logistic regression analysis, we found that S0/S1 is the only independent risk factor for severe symptoms in patients with CSM. When S0/S1>0.295, the clinical symptoms of patients are more severe. Thus, in clinical practice, when the degree of spinal cord compression exceeds 30%, the clinical symptoms are more severe. CONCLUSIONS In patients with CSM, corresponding segmental paravertebral muscle degeneration has relevance to neck pain, but it does not relate to limb weakness, neurological dysfunction, gait impairment, sensation or bladder/bowel function dysfunction. Cervical spinal cord compression is the only independent risk factor;when the degree of spinal cord compression exceeds 30%, the clinical symptoms are more severe.
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Affiliation(s)
- Taotao Lin
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China
| | - Gang Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, Fujian Medical University, Fuzhou 086-350001, China.
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25
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Elysee JC, Lovecchio F, Lafage R, Ang B, Huang A, Bannwarth M, Kim HJ, Schwab F, Lafage V. The relationship of global sagittal malalignment to fatty infiltration in the aging spine. 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; 30:2480-2485. [PMID: 33609190 DOI: 10.1007/s00586-021-06759-7] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 01/01/2021] [Accepted: 01/30/2021] [Indexed: 01/17/2023]
Abstract
PURPOSE To investigate associations between muscle size, fat infiltration (FI), and global sagittal alignment in patients with adult spinal deformity (ASD). METHODS Retrospective cohort study was conducted on a single-institution database of ASD patients with preoperative radiographs and CTs. Following multiplanar reconstructions of CTs, images in the plane of each vertebra were generated. The posterior vertebral musculature (PVM) was contoured on axial images at three vertebral levels (T2, T10, L3). FI was calculated by comparing Hounsfield units within muscles to the normative values of fat. Correlation analyses were conducted between demographics, alignment, and muscle characteristics. RESULTS 107 patients underwent preoperative spine CT (58yo, 79%F, BMI 27 kg/m2). Muscle data were available for 49 pts at T2, 39 pts at T10, and 81 pts at L3. Mean FI was T2 = 33% ± 18, T10 = 28% ± 19, L3_Erector = 39% ± 19, and L3_Psoas = 19% ± 9. FI correlated across levels (T2 vs. T10 r = 0.698; T10 vs L3_Erector r = 0.506; L3_Erector vs Psoas r = 0.419) and with demographics; older pts had greater fat percentages (r = 0.31-0.45) and BMIs (r = 0.24-0.51). Increased FI at T2, T10, and L3 was associated with increased pelvic retroversion (PT: r = 0.25-0.43), global deformity (TPA: r = 0.27-0.45), and anterior malalignment (SVA: r = 0.23-0.41). The degree of FI in the PVM increased with the severity of SRS-Schwab PT and SVA modifiers. CONCLUSION In ASD patients, global sagittal malalignment is related to FI of the PVM throughout the lumbar and thoracic spine, as identified through CT. Future research should investigate how FI relates to ASD pathogenesis.
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Affiliation(s)
| | - Francis Lovecchio
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Renaud Lafage
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Bryan Ang
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA.
| | - Alex Huang
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Mathieu Bannwarth
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Han Jo Kim
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Frank Schwab
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
| | - Virginie Lafage
- Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA
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Cervical Extensor Muscles Play the Role on Malalignment of Cervical Spine: A Case Control Study With Surface Electromyography Assessment. Spine (Phila Pa 1976) 2021; 46:E73-E79. [PMID: 33038198 DOI: 10.1097/brs.0000000000003742] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN A case control study. OBJECTIVE The aim of this study was to identify the potential impact of cervical spine malalignment on muscle parameters. SUMMARY OF BACKGROUND DATA Muscular factors are associated with cervical alignment. Nevertheless, only muscle dimensions or imaging changes have been evaluated, function of cervical muscles has scarcely been investigated. METHODS Thirty-four patients diagnosed as cervical spine degeneration associated with cervical malalignment and 32 control subjects were included in this case control study. Visual analogue scale (VAS) and the neck disability index (NDI) were used. The sagittal alignment parameters and cervical range of motion (ROM) were measured on cervical spine lateral radiographs, included C2-C7 lordosis, C2-C7 sagittal vertical axis (C2-C7 SVA), cervical gravity-sagittal vertical axis (CG-SVA), T1-Slope, and spinal canal angle (SCA). Surface electromyography (SEMG)-based flexion-relaxation ratio (FRR) was measured. RESULTS The result showed VAS score of the neck significantly lower in controls (P<0.05), C2-C7 lordosis, C2-C7 SVA, CG-SVA, T1-Slope and ROM showed significantly different (P<0.001) between malalignment group and control group, FRR of splenius capitis (FRRSpl) and upper trapezius (FRRUTr) of the malalignment group were lower than in the control group, which correlated well with NDI (rSpl = -0.181 rUTr = -0.275), FRRSpl correlated well with VAS (rSpl = -0.177). FRRSpl correlated strongly with C2-C7 SVA (r = 0.30), CG-SVA (r = 0.32), T1-Slope (r = 0.17), ROM (r = 0.19), FRRUTr correlated with C2-C7 lordosis (r = -0.23), CG-SVA (r = 0.19), T1-Slope (r = 0.28), ROM (r = 0.23). CONCLUSION Cervical malalignment patients had more tensional posterior cervical muscle and poor muscle functions. CG-SVA showed advantages in evaluating cervical malalignment.Level of Evidence: 3.
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Li J, Zhang D, Shen Y. Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis. J Orthop Surg Res 2020; 15:434. [PMID: 32962694 PMCID: PMC7509936 DOI: 10.1186/s13018-020-01909-x] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2020] [Accepted: 08/20/2020] [Indexed: 11/10/2022] Open
Abstract
Background Cervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK. Methods Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analog scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP. Results Patients who complained of ANP were categorized as ANP group (VAS score ≥ 3; n = 92), while those without ANP were categorized as non-ANP group (VAS score < 3; n = 171). There was no significant between-group difference with respect to age (P = 0.196), gender (P = 0.516), TIA (P = 0.139), NT (P = 0.676), CK type (P = 0.533), cranial tilt (P = 0.332), cervical tilt (P = 0.585), or cervical disk degeneration (P = 0.695). The T1 slope and C2-7 SVA in the ANP group were significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [ odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P = 0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P = 0.028) were identified as risk factors for ANP. Conclusions Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.
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Affiliation(s)
- Jia Li
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, P. R. China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, P. R. China
| | - Di Zhang
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, P. R. China.,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, P. R. China
| | - Yong Shen
- Department of Orthopedic Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, P. R. China. .,The Key Laboratory of Orthopedic Biomechanics of Hebei Province, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, P. R. China.
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Is Cervical Traction Effective in Chronic Nonspecific Neck Pain Patients With Unsatisfactory NSAID Control? A Nomogram to Predict Effectiveness. World Neurosurg 2020; 139:e245-e254. [PMID: 32289511 DOI: 10.1016/j.wneu.2020.03.195] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2020] [Revised: 03/26/2020] [Accepted: 03/27/2020] [Indexed: 11/24/2022]
Abstract
OBJECTIVE In this retrospective study, our objective was to establish a nomogram to predict the effectiveness of cervical traction in young and middle-aged chronic nonspecific neck pain (CNNP) patients with unsatisfactory nonsteroidal anti-inflammatory drug (NSAID) control. For CNNP patients with unsatisfactory NSAID control, the effectiveness of cervical traction varies. Neck muscle fat infiltration and clinical features may associate with the effectiveness. METHODS A total of 186 suitable patients were classified into a training data set (from August 2015 to July 2018, n = 118) and a validation data set (from August 2018 to June 2019, n = 68) with time sequence. All patients were included to receive magnetic resonance imaging scan to calculate posterior cervical fat and muscle features, then undergoing unified cervical traction in an outpatient clinic. The least absolute shrinkage and selection operator (LASSO) regression model was used to select potentially relevant features to predict effectiveness possibility of cervical traction. Multivariable logistic regression analysis was used to develop the predicting model, presenting with a nomogram. The performance of the nomogram was assessed based on its calibration, discrimination, and clinical utility. RESULTS Through the LASSO regression model, we identified 4 predictors including sex, good exercise compliance, the ratio of the cross-sectional area (CSA) between fat and muscle on C5 level (C5 fat CSA/muscle CSA), the ratio of CSA between fat and centrum on C5 level (C5 fat CSA/centrum muscle CSA). The nomogram provided good calibration and discrimination in the training cohort, showing an area under the curve (AUC) of 0.704 (95% CI, 0.608-0.799) and good concordance between the predicted and actual probabilities with Spiegelhalter's Z-test (P = 0.835). Discrimination of the model in the validation data set was acceptable, with AUC of 0.691 (95% CI, 0.564-0.817). Decision curve analysis revealed the nomogram to be clinically useful. CONCLUSIONS Male sex, good exercise compliance, lower C5 fat CSA/centrum CSA, and and lower C5 fat CSA/muscle CSA could be favorable features to predict the effectiveness of cervical traction in CNNP patients with unsatisfactory NSAID control.
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Liu T, Qiu S, Xu Z, Gu J, Luo Z, Wu D. [Effect of percutaneous kyphoplasty on lumbar-pelvic correlation in osteoporotic vertebral compressive fractures]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2019; 33:1414-1418. [PMID: 31650758 PMCID: PMC8337459 DOI: 10.7507/1002-1892.201812049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 12/14/2018] [Revised: 09/10/2019] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To explore the effect of percutaneous kyphoplasty (PKP) on lumbar-pelvic correlation in osteoporotic vertebral compressive fracture (OVCF). METHODS According to the inclusion criteria, 63 patients with primary osteoporosis between January 2012 and June 2017 were selected as the control group and 67 patients with single-segment lumbar OVCF receiving PKP and complete clinical data were included as the observation group. There was no significant difference in gender, age, and lumbar spine bone density between the two groups ( P>0.05). The visual analogue scale (VAS) score and Oswestry Disability Index (ODI) score were used to assess lumbar pain and function before operation and at 3 days after operation in the observation group; lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS) were measured in lumbar lateral X-ray films which were taken before PKP and at 1 month after PKP. The same parameters were measured in the lumbar lateral X-ray films which were taken at the time of initial diagnosis in the control group. RESULTS All patients were followed up 3-24 months with an average of 5.8 months in the observation group. The VAS score decreased from 5.6±1.8 before PKP to 2.8±1.3 at 3 days after PKP ( t=14.082, P=0.000); ODI decreased from 50.1%±5.0% before PKP to 18.2%±1.8% ( t=47.011, P=0.000). Compared with the control group, the LL, PI, and SS decreased and the PT increased in the observation group, and only the difference in LL between the two groups was significant ( P<0.05). In the observation group, the LL and SS significantly increased ( P<0.05) and PT significantly decreased ( P<0.05) at 1 month after operation when compared with preoperative ones, and PI decreased, but the difference was not significant ( P>0.05). In the control group, LL was positively correlated with PI and SS ( P<0.05); PI was positively correlated with PT and SS ( P<0.05). In the observation group, PI was positively correlated with SS ( P<0.05) before and after PKP. CONCLUSION OVCF patients lost the specific lumbar-pelvic correlation. PKP can restore lumbar lordosis, but it still can not restore the normal physiological fitting.
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Affiliation(s)
- Tao Liu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Shuiqiang Qiu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Zhigang Xu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Jisheng Gu
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Zhendong Luo
- Department of Orthopaedics, Jiangwan Hospital of Hongkou District of Shanghai, Shanghai, 200434, P. R. China
| | - Desheng Wu
- Department of Spinal Surgery, Shanghai Oriental Hospital Affiliated to Tongji University, Shanghai, 200120, P. R.
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