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Xu H, Gong Z, Yang Y, Zhang F, Zou F, Xia X, Ma X, Lyu F, Jiang J, Wang H. C4 constant vertebra: a novel benchmark of physiological cervical sagittal alignment. 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; 33:1195-1204. [PMID: 38200269 DOI: 10.1007/s00586-023-08100-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Revised: 11/19/2023] [Accepted: 12/09/2023] [Indexed: 01/12/2024]
Abstract
BACKGROUND Cervical sagittal alignment is essential, and there is considerable debate as to what constitutes physiological sagittal alignment. The purpose of this study was to identify constant parameters for characterizing cervical sagittal alignment under physiological conditions. METHODS A cross-sectional study was conducted in which asymptomatic subjects were recruited to undergo lateral cervical spine radiographs. Each subject was classified according to three authoritative cervical sagittal morphology classifications, followed by the evaluation of variations in radiological parameters across morphotypes. Moreover, the correlations among cervical sagittal parameters, age, and cervicothoracic junction parameters were also investigated. RESULTS A total of 183 asymptomatic Chinese subjects were enrolled with a mean age of 48.4 years. Subjects with various cervical sagittal morphologies had comparable C4 endplate slope angles under all three different typing systems. Among patients of different ages, C2-C4 endplate slope angles remained constant. Regarding the cervicothoracic junction parameters, T1 slope and thoracic inlet angle affected cervical sagittal parameters, including cervical lordosis and C2-7 sagittal vertical axis, and were correlated with the endplate slope angles of C5 and below and did not affect the endplate slope angles of C4 and above. In general, the slope of the C4 inferior endplate ranges between 13° and 15° under different physiological conditions. CONCLUSIONS In the asymptomatic population, the C4 vertebral body maintains a constant slope angle under physiological conditions. The novel concept of C4 as a constant vertebra would provide a vital benchmark for diagnosing pathological sagittal alignment abnormalities and planning the surgical reconstruction of cervical lordosis.
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Affiliation(s)
- Haocheng Xu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Zhaoyang Gong
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Yong Yang
- Department of Orthopedics, Lanzhou University Second Hospital, Lanzhou University, Lanzhou, China
| | - Fan Zhang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Fei Zou
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xinlei Xia
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Xiaosheng Ma
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Feizhou Lyu
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China.
- Department of Orthopedics, Shanghai Fifth People's Hospital, Fudan University, Shanghai, China.
| | - Jianyuan Jiang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China
| | - Hongli Wang
- Department of Orthopedics, Huashan Hospital, Fudan University, 12 Middle Wulumuqi Road, Shanghai, China.
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Costa F, Anania CD, Agrillo U, Roberto A, Claudio B, Simona B, Daniele B, Carlo B, Barbara C, Ardico C, Battista CG, Raffaele DF, Andrea DR, Carlo DV, Mauro D, Vito F, Diego G, Giancarlo G, Corrado I, Claudio I, Michele I, Innocenzi G, Alessandro L, Giancarlo L, Giuseppe M, Ciro M, Rosario M, Vincenzo M, Nicola M, Pierpaolo N, Andrea P, Giovanni P, Federico PP, Armando R, Alessandro R, Rossella R, Stefano R, Sbaffi PF, Teresa S, Enrico T, Matteo V, Zerbi A, Gianluigi Z, Barbanera A. Cervical Spondylotic Myelopathy: From the World Federation of Neurosurgical Societies (WFNS) to the Italian Neurosurgical Society (SINch) Recommendations. Neurospine 2023; 20:415-429. [PMID: 37401060 PMCID: PMC10323338 DOI: 10.14245/ns.2244996.498] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 01/13/2023] [Accepted: 02/05/2023] [Indexed: 07/05/2023] Open
Abstract
Cervical spondylotic myelopathy (CSM) is a progressively growing pathology to afford by a spinal surgeon due to the aging of the population, associated with better treatment management and the best diagnosis and treatment solutions are greatly discussed. Nowadays that scientific literature is progressively increasing to identify the gold standard in diagnosis and treatment can be very challenging. This is particularly evident in spinal surgery with many different indications not only in different countries but also in the same local reality. In this scenario, many neurosurgical societies works to identify some guideline or recommendations to help spinal surgeons in daily practice. Furthermore, in an era in which legal issues are increasingly present in clinical practice to have some indications globally accepted can be very useful. World Federation of Neurosurgical Societies (WFNS) few years ago starts this process creating a list of recommendations originating from a worldwide steering committee to respect all the local reality. The spinal section of Italian Neurosurgical Society decides to adopt the WFNS recommendations with some revision basing on Italian scenario. The steering committee of the Spinal Section of Italian Neurosurgical Society identify 7 groups to review the literature of the last 10 years about different topics on CSM and to analyses the WFNS recommendations to adapt it to the Italian daily practice. The statements were discussed and voted in 2 sessions to obtain the final version. A list of recommendations on natural course and clinical presentation; diagnostic tests; conservative and surgical treatment; anterior, posterior and combined surgical treatment; role of neurophysiological monitoring and follow-up and outcome was created with only few new or revised statements respect the ones of WFNS. The Spine Section of Italian Neurosurgical Society create a list of recommendations that represent the more contemporary treatment concepts for CSM as presented in the highest quality clinical literature and best clinical practices available on this subject.
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Affiliation(s)
- Francesco Costa
- Spine Surgery Unit, Department of Neurosurgery, Fondazione IRCCS Istituto Nazionale Neurologico C. Besta, Milan, Italy
| | | | | | - Assietti Roberto
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Bernucci Claudio
- Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | | | - Bongetta Daniele
- Unit of Neurosurgery, Azienda Socio Sanitaria Territoriale Fatebenefratelli Sacco, Fatebenefratelli Hospital, Milan, Italy
| | - Brembilla Carlo
- Department of Neurosurgery, ASST Papa Giovanni XXIII Hospital, Bergamo, Italy
| | - Cappelletto Barbara
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, ASUFC University Hospital of Udine, Udine, Italy
| | - Cocciaro Ardico
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AUOP), University of Pisa, Pisa, Italy
| | | | - De Falco Raffaele
- Department of Neurosurgery, P.O. Santa Maria delle Grazie, Pozzuoli (NA), Italy
| | - De Rosa Andrea
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | | | - Dobran Mauro
- Department of Neurosurgery, Università Politecnica delle Marche, Azienda Ospedali Riuniti, Ancona, Italy
| | - Fiorenza Vito
- Department of Neurosurgery, A.R.N.A.S. “Civico Di Cristina Benfratelli” Hospital, Palermo, Italy
| | - Garbossa Diego
- Department of Neuroscience “Rita Levi Montalcini”, Neurosurgery Unit, University of Turin, Turin, Italy
| | | | - Iaccarino Corrado
- Division of Neurosurgery, Department of Biomedical, Metabolic and Neural Sciences, University of Modena and Reggio Emilia, Modena University Hospital, Modena, Italy
| | - Irace Claudio
- Department of Neurosurgery, Hospital Igea, Milan, Italy
| | | | | | | | | | - Maida Giuseppe
- Department of Spine Surgery, Multidisciplinary Spine Center, Santa Maria Maddalena Hospital, Occhiobello (RO), Italy
| | - Mastrantuoni Ciro
- Department of Neurosurgery, P.O. Santa Maria delle Grazie, Pozzuoli (NA), Italy
| | - Maugeri Rosario
- Department of Experimental Biomedicine and Clinical Neurosciences, School of Medicine, Unit of Neurosurgery, AOUP “Paolo Giaccone”, Palermo, Italy
| | - Meglio Vincenzo
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Montemurro Nicola
- Department of Neurosurgery, Azienda Ospedaliera Universitaria Pisana (AUOP), University of Pisa, Pisa, Italy
| | - Nina Pierpaolo
- Neurosurgical Unit of San Giovanni Bosco Hospital, Naples, Italy
| | | | | | | | - Rapanà Armando
- Neurosurgery Unit, Lorenzo Bonomo Hospital, Andria, Italy
| | - Ricci Alessandro
- Unit of Neurosurgery, Ospedale Civile San Salvatore, L'Aquila, Italy
| | - Rispoli Rossella
- Section of Spine and Spinal Cord Surgery, Department of Neurological Sciences, ASUFC University Hospital of Udine, Udine, Italy
| | - Romoli Stefano
- Unit of Spine Surgery, Careggi University Hospital, Florence, Italy
| | | | - Somma Teresa
- Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, Università degli Studi di Napoli Federico II, Naples, Italy
| | - Tessitore Enrico
- Neurosurgical Unit, Faculty of Medicine, Geneva University Hospitals, Geneva, Switzerland
| | - Vitali Matteo
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
| | - Alberto Zerbi
- Fondazione Iseni Y Nervi, Istititi Clinici Iseni, Lonate Pozzolo, Italy
| | - Zona Gianluigi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics and Maternal and Child Health (DINOGMI), University of Genoa, Genoa, Italy
- Department of Neurosurgery, IRCCS San Martino University Hospital, Genoa, Italy
| | - Andrea Barbanera
- Department of Neurosurgery, SS Antonio e Biagio e Cesare Arrigo Alessandria Hospital, Alessandria, Italy
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Lin J, Bao M, Lin S, Liu J, Liu Q, Li R, Huang Z, Zhu Q, Zhang Z, Ji W. Cervical Alignment of Patients with Basilar Invagination: A Radiological Study. Orthop Surg 2022; 14:566-576. [PMID: 35156312 PMCID: PMC8926990 DOI: 10.1111/os.13212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/26/2021] [Revised: 12/08/2021] [Accepted: 12/20/2021] [Indexed: 11/30/2022] Open
Affiliation(s)
- Jun‐yu Lin
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
- Department of Orthopaedics and Traumatology, LKS Faculty of Medicine The University of Hong Kong Hong Kong City Hong Kong
| | - Ming‐gui Bao
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Shao‐yi Lin
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Jun‐hao Liu
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Qi Liu
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Ruo‐yao Li
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Zu‐cheng Huang
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Qing‐an Zhu
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Zhong‐min Zhang
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
| | - Wei Ji
- Division of Spinal Surgery, Department of Orthopaedics Nanfang Hospital, Southern Medical University Guangzhou China
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Sagittal balance of the cervical spine: a systematic review and meta-analysis. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2021; 30:1411-1439. [PMID: 33772659 DOI: 10.1007/s00586-021-06825-0] [Citation(s) in RCA: 12] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/26/2020] [Revised: 09/26/2020] [Accepted: 03/20/2021] [Indexed: 10/21/2022]
Abstract
PURPOSE The purpose of this systematic review and meta-analysis was to compare the cervical sagittal parameters between patients with cervical spine disorder and asymptomatic controls. METHODS Two independent authors systematically searched online databases including Pubmed, Scopus, Cochrane library, and Web of Science up to June 2020. Cervical sagittal balance parameters, such as T1 slope, cervical SVA (cSVA), and spine cranial angle (SCA), were compared between the cervical spine in healthy, symptomatic, and pre-operative participants. Where possible, we pooled data using random-effects meta-analysis, by CMA software. Heterogeneity and publication bias were assessed using the I-squared statistic and funnel plots, respectively. RESULTS A total of 102 studies, comprising 13,802 cases (52.7% female), were included in this meta-analysis. We used the Newcastle-Ottawa Scale (NOS) to evaluate the quality of studies included in this review. Funnel plot and Begg's test did not indicate obvious publication bias. The pooled analysis reveals that the mean (SD) values were: T1 slope (degree), 24.5 (0.98), 25.7 (0.99), 25.4 (0.34); cSVA (mm), 18.7 (1.76), 22.7 (0.66), 22.4 (0.68) for healthy population, symptomatic, and pre-operative assessment, respectively. The mean value of the SCA (degree) was 79.5 (3.55) and 75.6 (10.3) for healthy and symptomatic groups, respectively. Statistical differences were observed between the groups (all P values < 0.001). CONCLUSION The findings showed that the T1 slope and the cSVA were significantly lower among patients with cervical spine disorder compared to controls and higher for the SCA. Further well-conducted studies are needed to complement our findings.
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Analysis of the impact of spinopelvic radiographic parameters on the severity of cervical spondylotic myelopathy. J Orthop Sci 2020; 25:966-974. [PMID: 32063467 DOI: 10.1016/j.jos.2020.01.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/14/2019] [Revised: 12/14/2019] [Accepted: 01/06/2020] [Indexed: 11/21/2022]
Abstract
BACKGROUND The correlation between spinal radiographic parameters and severity of cervical spondylotic myelopathy (CSM) is controversial. This study aimed to investigate the associations between spinal radiographic parameters and CSM severity, as well as between cervical and other spinopelvic radiographic parameters. METHODS Patients diagnosed with CSM (N = 118; 77 men) at our hospital from March 2013 to February 2017 were included. The patients' demographic data and the following radiographic parameters were investigated: cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), T1 slope, thoracic kyphosis, lumbar lordosis, pelvic incidence, sacral slope, pelvic tilt, and sagittal vertical axis (SVA). Cervical cord compression ratio (CCCR) was evaluated on sagittal magnetic resonance imaging. The Japanese Orthopaedic Association (JOA) scoring system was used for clinical evaluation. Correlation analyses were performed among the clinical and radiographic parameters. RESULTS The JOA score had the strongest correlation with SVA (r = -0.46, p < 0.01), followed by CCCR (r = -0.33, p < 0.01), CL (r = -0.29, p < 0.01), T1 slope (r = -0.29, p = 0.01), and C2-C7 SVA (r = -0.20, p = 0.03). Multivariate linear regression analysis revealed a model predicting the JOA score; JOA = 13.6 - 0.24 × SVA - 4.2 × CCCR (r = 0.51, p < 0.01). Although there was no significant correlation between the cervical and lumbopelvic radiographic parameters, the sequential correlation among the investigated spinopelvic parameters was identified. CONCLUSIONS CSM severity worsened with spinal malalignment, such as a larger SVA. Though lumbopelvic radiographic parameters did not significantly impact cervical alignment and CSM severity, the sequential correlations among cervical-thoracic-lumbopelvic radiographic parameters were observed. Therefore, SVA is the most relevant radiographic parameter for CSM, but we cannot preclude the possibility that lumbopelvic alignment also affects cervical alignment and CSM severity.
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Huang Z, Zhu Y, Yuan W. Correlation Between Parameters of Intervertebral Disc and Cervical Lordosis in Cervical Spondylotic Myelopathy. Med Sci Monit 2020; 26:e924857. [PMID: 32865521 PMCID: PMC7450784 DOI: 10.12659/msm.924857] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background In cervical disc degeneration, cervical disc height (CDH) and cervical disc angle (CDA)have a certain but unidentified relationship with cervical lordosis (CL). This study aimed to reveal the relationship among CDH, CDA, and CL in patients diagnosed with cervical spondylotic myelopathy (CSM). Material/Methods A retrospective analysis was conducted using the data of 212 CSM patients (136 males and 76 females). According to CL angle, patients were classified into 2 groups: patients with CL ≤10° constituted Group 1 (n=102); patients with CL >10° constituted Group 2 (n=110). The CDH, CDA, and CL were measured using X-ray imaging. Pearson correlation analysis measured the correlation between CDH, CDA, and CL. Multiple linear regression was utilized to analyze the effects of CDH and CDA on CL. Results The CDAs in every level were higher in Group 2 than those in Group 1 (P<0.05).CDH and CDA gradually increased with the increase in vertebral level and dropped at C5–C6 level in both groups. We found statistically significant correlations between C3/4H, C4/5H, C3/4A,C4/5A, C5/6A, and C6/7Aand CL in Group 1 (P<0.05), and between C4/5H, C3/4A, and C4/5Aand CL in Group 2 (P<0.05). C3/4A and C4/5A predicted CL in Group 1 (adjusted R2=0.176, P<0.001), while C4/5A predicted CL with high sensitivity in Group 2 (adjusted R2=0.198, P<0.001). Conclusions CDA contributes more than CDH to CL in CSM. Further studies are necessary to reveal the relationship between CL and cervical disc degeneration.
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Affiliation(s)
- Zhuxi Huang
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, Liaoning, China (mainland).,Department of Orthopedics, Shenyang Orthopedics Hospital, Shenyang, Liaoning, China (mainland)
| | - Yue Zhu
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
| | - Wei Yuan
- Department of Orthopedics, First Hospital of China Medical University, Shenyang, Liaoning, China (mainland)
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Letter to the Editor Regarding “Is Cervical Sagittal Balance Related to the Progression of Patients with Cervical Spondylotic Myelopathy?”. World Neurosurg 2020; 139:672. [DOI: 10.1016/j.wneu.2020.04.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/30/2020] [Accepted: 04/01/2020] [Indexed: 11/23/2022]
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8
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In Reply to the Letter to the Editor Regarding “Is Cervical Sagittal Balance Related to the Progression of Patients with Cervical Spondylotic Myelopathy?”. World Neurosurg 2020; 139:673. [DOI: 10.1016/j.wneu.2020.04.143] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Accepted: 04/17/2020] [Indexed: 11/22/2022]
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Jannelli G, Nouri A, Molliqaj G, Grasso G, Tessitore E. Degenerative Cervical Myelopathy: Review of Surgical Outcome Predictors and Need for Multimodal Approach. World Neurosurg 2020; 140:541-547. [PMID: 32389875 DOI: 10.1016/j.wneu.2020.04.233] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2020] [Revised: 04/28/2020] [Accepted: 04/29/2020] [Indexed: 12/12/2022]
Abstract
Degenerative cervical myelopathy is the most common cause of spinal cord injury in the elderly population in the developed world, and it significantly affects the quality of life of patients and their caregivers. Surgery remains the only treatment option able to halt disease progression and provide neurological recovery for most patients. Although it has remained challenging to predict exactly who will experience improvement after surgery, increasingly it has been shown that clinical, imaging, and electrophysiological factors can predict, with relatively good capacity, those more likely to benefit. Clinically, the baseline neurological impairment appears to be strongly related to the outcome, and the magnetic resonance imaging findings of T1-weighted hypointensity and the length of T2-weighted hyperintensity appear to be the most prognostic. In this context, electrophysiology findings (both motor and sensory evoked potentials) have shown some predictive capacity. However, large studies are lacking. Although multivariate models have been conducted using clinical and magnetic resonance imaging data, no multimodal prediction models are available that encompass the predictive capacity of clinical, imaging, and electrophysiological data. In the present review, we examined the rationale for clinical, imaging, and electrophysiological usage in clinical practice and discussed a model of multimodal assessment for the management of degenerative cervical myelopathy.
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Affiliation(s)
- Gianpaolo Jannelli
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland.
| | - Aria Nouri
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Granit Molliqaj
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
| | - Giovanni Grasso
- Section of Neurosurgery, Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, Palermo, Italy
| | - Enrico Tessitore
- Neurosurgical Unit, Geneva University Hospitals, University of Geneva, Faculty of Medicine, Geneva, Switzerland
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Fan XW, Wang ZW, Gao XD, Ding WY, Yang DL. The change of cervical sagittal parameters plays an important role in clinical outcomes of cervical spondylotic myelopathy after multi-level anterior cervical discectomy and fusion. J Orthop Surg Res 2019; 14:429. [PMID: 31829200 PMCID: PMC6907178 DOI: 10.1186/s13018-019-1504-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 11/28/2019] [Indexed: 02/08/2023] Open
Abstract
BACKGROUND Cervical sagittal parameters were closely related with clinical outcomes after multi-level ACDF. Our purpose was to evaluate the clinical outcomes and cervical sagittal parameters in patients with MCSM after ACDF and to identify the risk factors of poor clinical outcomes. MATERIAL AND METHODS ACDF was performed in 89 patients with MCSM. Based on average JOA recovery rate, patients were divided good-outcome group (group GO) and poor-outcome group (group PO). The cervical sagittal parameters including Cobb angle, SVA, T1S, cranial tilt and cervical tilt were measured. Multivariate logistic regression was used to identify risk factors. RESULTS Fifty-four patients (60.67%) were divided into group GO, while 35 patients (39.33%) were divided into group PO. Cobb angle, SVA and T1S was corrected from preoperative average 11.80° ± 9.63°, 23.69 mm ± 11.69 mm and 24.43° ± 11.78° to postoperative average 15.08° ± 9.05°, 18.79 mm ± 10.78 mm and 26.92° ± 11.94° respectively (p < 0.001). △Cobb angle (p = 0.008) and △SVA (p = 0.009) showed significantly statistical differences between two groups. Longer symptom duration, lower preoperative JOA score, smaller △Cobb angle and larger △SVA were identified as risk factors of poor clinical outcomes. CONCLUSION Multi-level ACDF is an effective surgical method to treat patients with MCSM. However, long duration of preoperative symptoms, lower preoperative JOA score, smaller △Cobb angle and larger △SVA are risk factors for poor outcomes in patients with MCSM after ACDF. Sagittal parameters should be paid attention to in surgery.
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Affiliation(s)
- Xi-Wen Fan
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Zhi-Wei Wang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Xian-Da Gao
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Wen-Yuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China
| | - Da-Long Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, 139 Ziqiang Road, Shijiazhuang, 050051, People's Republic of China.
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Zhang Y, Liu H, Yang H, Pi B. Relationship Between Sagittal Balance and Axial Symptoms in Patients with Cervical Spondylotic Myelopathy Treated with Anterior Cervical Discectomy and Fusion. J INVEST SURG 2019; 33:404-411. [PMID: 30905209 DOI: 10.1080/08941939.2018.1524948] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
Purpose: The purpose of this study was to investigate the sagittal balance of the cervical spine and the clinical outcomes of anterior cervical discectomy and fusion (ACDF) for the treatment of cervical spondylotic myelopathy and to explore whether sagittal balance is related to the incidence of postoperative axial symptoms. Methods: Sixty-seven consecutive patients who underwent ACDF for the treatment of cervical spondylotic myelopathy from January 2014 to December 2016 were enrolled in our study. Sagittal balance parameters (global lordotic angle, segmented lordotic angle, T1 slope, and C2-7 sagittal vertical axis [C2-7 SVA] were recorded in the preoperative period and at 1 month, 3 months, and 1 year postoperatively. Clinical outcomes (JOA and NDI scores) and incidence of axial symptoms were also evaluated before and after surgery. Subgroup analysis included 20 patients with preoperative abnormal sagittal balance group (C2-7 SVA larger than 20 mm), and these patients were divided into two groups, namely axial symptom group and nonaxial symptom group. Result: The sagittal balance parameters (global lordotic angle, segmented lordotic angle, and TI slope) and the clinical outcomes after surgery significantly improved. The subgroup analysis within the preoperative abnormal sagittal balance group showed significant differences in postoperative and change in C2-7 SVA between patients with and without postoperative axial symptoms. Conclusion: ACDF can be applied to restore the sagittal alignment of the cervical spine and effectively improve clinical outcomes for the treatment of cervical spondylotic myelopathy. Sagittal balance improvement may be associated with the low incidence of postoperative axial symptoms for patients with abnormal cervical sagittal balance before surgery.
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Affiliation(s)
- Yijian Zhang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Hao Liu
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Huilin Yang
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
| | - Bin Pi
- Department of Orthopedic Surgery, The First Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China
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