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Divi SN, Karamian BA, Canseco JA, Chang M, Toci GR, Goyal DKC, Nicholson KJ, Mujica VE, Bronson W, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. The Impact of Upper Cervical Spine Alignment on Patient-reported Outcome Measures in Anterior Cervical Decompression and Fusion. Clin Spine Surg 2022; 35:E539-E545. [PMID: 35302961 DOI: 10.1097/bsd.0000000000001310] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2021] [Accepted: 02/02/2022] [Indexed: 11/26/2022]
Abstract
STUDY DESIGN This was a retrospective cohort study. OBJECTIVE To determine the extent to which the upper cervical spine compensates for malalignment in the subaxial cervical spine, and how changes in upper cervical spine sagittal alignment affect patient-reported outcomes. SUMMARY OF BACKGROUND DATA Previous research has investigated the relationship between clinical outcomes and radiographic parameters in the subaxial cervical spine following anterior cervical discectomy and fusion (ACDF). However, limited research exists regarding the upper cervical spine (occiput to C2), which accounts for up to 40% of neck movement and has been hypothesized to compensate for subaxial dysfunction. MATERIALS AND METHODS Patients undergoing ACDF for cervical radiculopathy and/or myelopathy at a single center with minimum 1-year follow-up were included. Radiographic parameters including cervical sagittal vertical axis, C0 angle, C1 inclination angle, C2 slope, Occiput-C1 angle (Oc-C1 degrees), Oc-C2 degrees, Oc-C7 degrees, C1-C2 degrees, C1-C7 degrees, and C2-C7 degrees cervical lordosis (CL) were recorded preoperatively and postoperatively. Delta (Δ) values were calculated by subtracting preoperative values from postoperative values. Correlation analysis as well as multiple linear regression analysis was used to determine relationships between radiographic and clinical outcomes. Alpha was set at 0.05. RESULTS A total of 264 patients were included (mean follow-up 20 mo). C2 slope significantly decreased for patients after surgery (Δ=-0.8, P =0.02), as did parameters of regional cervical lordosis (Oc-C7 degrees, C1-C7 degrees, and C2-C7 degrees; P <0.001, <0.001, and 0.01, respectively). Weak to moderate associations were observed between postoperative CL and C1 inclination ( r =-0.24, P <0.001), Oc-C1 degrees ( r =0.59, P <0.001), and C1-C2 degrees ( r =-0.23, P <0.001). Increased preoperative C1-C2 degrees and Oc-C2 degrees inversely correlated with preoperative SF-12 Mental Composite Score (MCS-12) scores ( r =-0.16, P =0.01 and r =-0.13, P =0.04). Cervical sagittal vertical axis was found to have weak but significant associations with Short Form-12 (SF-12) Physical Composite Score (PCS-12) ( r =-0.13, P =0.03) and MCS-12 ( r =0.12, P =0.05). CONCLUSION No clinically significant relationship between upper cervical and subaxial cervical alignment was detected for patients undergoing ACDF for neurological symptoms. Upper cervical spine alignment was not found to be a significant predictor of patient-reported outcomes after ACDF. LEVEL OF EVIDENCE Level III.
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Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, Philadelphia, PA
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Wang WX, Zhao YB, Lu XD, Zhao XF, Jin YZ, Chen XW, Fan YX, Wang XN, Zhou RT, Zhao B. Influence of extending expansive open-door laminoplasty to C1 and C2 on cervical sagittal parameters. BMC Musculoskelet Disord 2020; 21:75. [PMID: 32024507 PMCID: PMC7003532 DOI: 10.1186/s12891-020-3083-1] [Citation(s) in RCA: 8] [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] [Received: 11/14/2019] [Accepted: 01/20/2020] [Indexed: 12/17/2022] Open
Abstract
Background For patients with spinal canal stenosis in the upper cervical spine who undergo C3–7 laminoplasty alone, it remains impossible to achieve full decompression due to its limited range. This study explores the extension of expansive open-door laminoplasty (EODL) to C1 and C2 for the treatment of cervical spinal stenosis of the upper cervical spine and its effects on cervical sagittal parameters. Methods A retrospective analysis of 33 patients presenting with symptoms of cervical spondylosis myelopathy (CSM) and ossification in the posterior longitudinal ligament (OPLL) of the upper cervical spine from February 2013 to December 2015 was performed. Furthermore, the changes in the C0–2 Cobb angle, C1–2 Cobb angle, C2–7 Cobb angle, C2–7 SVA, and T1-Slope in lateral X-rays of the cervical spine were measured before, immediately after, and 1 year after the operation. JOA and NDI scores were used to evaluate spinal cord function. Results The C0–2 and C1–2 Cobb angles did not significantly increase (P = 0.190 and P = 0.081), but the C2–7 Cobb angle (P = 0.001), C2–7 SVA (P < 0.001), and T1-Slope (P < 0.001) significantly increased from preoperative to 1 year postoperative. In addition, C2–7 SVA was significantly correlated with the T1-Slope (Pearson = 0.376, P < 0.001) and C0–2 Cobb angle (Pearson = 0.287, P = 0.004), and the C2–7 SVA was negatively correlated with the C2–7 Cobb angle (Pearson = − 0.295, P < 0.001). The average preoperative and postoperative JOA scores were 8.3 ± 1.6 and 14.6 ± 1.4 points, respectively, indicating in a postoperative neurological improvement rate of approximately 91.6%. The average preoperative and final follow-up NDI scores were 12.62 ± 2.34 and 7.61 ± 1.23. Conclusions The sagittal parameters of patients who underwent EODL extended to C1 and C2 included loss of cervical curvature, increased cervical anteversion and compensatory posterior extension of the upper cervical spine to maintain visual balance in the field of vision. However, the changes in cervical spine parameters were far less substantial than the alarm thresholds reported in previous studies. We believe that EODL extended to C1 and C2 for the treatment of patients with spinal canal stenosis in the upper cervical spine is a feasible and safe procedure with excellent outcomes.
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Affiliation(s)
- Wen-Xuan Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yi-Bo Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Xiang-Dong Lu
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Xiao-Feng Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yuan-Zhang Jin
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Xian-Wei Chen
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Yan-Xin Fan
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Xiao-Nan Wang
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Run-Tian Zhou
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China
| | - Bin Zhao
- Department of Orthopaedics, The Second Hospital of Shanxi Medical University, NO.382, Wuyi Road, Taiyuan, 030001, Shanxi, China.
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Pan Z, Xi Y, Huang W, Kim KN, Yi S, Shin DA, Huang K, Chen Y, Huang Z, He D, Ha Y. Independent Correlation of the C1-2 Cobb Angle With Patient-Reported Outcomes After Correcting Chronic Atlantoaxial Instability. Neurospine 2019; 16:267-276. [PMID: 31261466 PMCID: PMC6603837 DOI: 10.14245/ns.1836268.134] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/09/2018] [Accepted: 12/29/2018] [Indexed: 11/29/2022] Open
Abstract
Objective To investigate three-planar radiographic results and patient-reported outcomes (PROs) after correcting chronic atlantoaxial instability (AAI) by translaminar screw (TLS) and pedicle screw (PS) fixation, and to explore the potential association of atlantoaxial realignment with PRO improvements.
Methods Twenty-three patients who underwent C1 lateral mass screw (LMS)-C2 TLS and 29 who underwent C1 LMS-C2 PS with ≥ 2 years of follow-up were retrospectively analyzed. Three-planar (sagittal, coronal, and axial) radiographic parameters were measured. PROs including the Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score and the Short Form 36 Physical Component Summary (SF-36 PCS) were documented. Factors potentially associated with PROs were identified.
Results The radiographic parameters significantly changed postoperatively except the C1–2 midlines’ intersection angle in the TLS group (p = 0.073) and posterior atlanto-dens interval in both groups (p = 0.283, p = 0.271, respectively). The difference in bilateral odontoid lateral mass interspaces at last follow-up was better corrected in the TLS group than in the PS group (p = 0.010). Postoperative PROs had significantly improved in both groups (all p < 0.05). Thereinto, NDI at last follow-up was significantly lower in the TLS group compared with PS group (p = 0.013). In addition, blood loss and operative time were obviously lesser in TLS group compared with PS group (p = 0.010, p = 0.004, respectively). Multivariable regression analysis revealed that a change in C1–2 Cobb angle was independently correlated to PROs improvement (NDI: β = -0.435, p = 0.003; JOA score: β = 0.111, p = 0.033; SF-36 PCS: β = 1.013, p = 0.024, respectively), also age ≤ 40 years was independently associated with NDI (β = 5.40, p = 0.002).
Conclusion Three-planar AAI should be reconstructed by C1 LMS-C2 PS fixation, while sagittal or coronal AAI could be corrected by C1 LMS-C2 TLS fixation. PROs may improve after atlantoaxial reconstruction in patients with chronic AAI. The C1–2 Cobb angle is an independent predictor of PROs after correcting chronic AAI, as is age ≤ 40 years for postoperative NDI.
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Affiliation(s)
- Zhimin Pan
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea.,Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China.,Department of Spine Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Yanhai Xi
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Wei Huang
- Department of Clinical Laboratory, Jiangxi Province Children's Hospital, Nanchang, China
| | - Keung Nyun Kim
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Seong Yi
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Dong Ah Shin
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
| | - Kai Huang
- Department of Orthopedics, Zhabei Central Hospital of Jing'an District, Shanghai, China
| | - Yu Chen
- Department of Spine Surgery, Changzheng Hospital, Second Military Medical University, Shanghai, China
| | - Zhongren Huang
- Department of Radiology, the First Affiliated Hospital of Nanchang University, Nanchang, China
| | - Da He
- Department of Spine Surgery, Beijing Jishuitan Hospital, Peking University, Beijing, China
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Yonsei University College of Medicine, Seoul, Korea
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