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Ohashi M, Watanabe K, Hirano T, Hasegawa K, Tashi H, Makino T, Minato K, Sato M, Kawashima H. Neck and shoulder pain in thoracic adolescent idiopathic scoliosis 10 years after posterior spinal fusion. 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 2024:10.1007/s00586-024-08233-6. [PMID: 38573384 DOI: 10.1007/s00586-024-08233-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/22/2023] [Revised: 02/27/2024] [Accepted: 03/16/2024] [Indexed: 04/05/2024]
Abstract
PURPOSE We aimed to determine the clinical significance of neck and shoulder pain (NSP) 10 years after posterior spinal fusion (PSF) for thoracic adolescent idiopathic scoliosis (AIS) and the relationship between radiographic parameters and NSP. METHODS Of 72 patients who underwent PSF for thoracic AIS (Lenke 1 or 2) between 2000 and 2013, we included 52 (46 females; Lenke type 1 in 34 patients and type 2 in 18; mean age, 25.6 years) who underwent NSP evaluation using visual analog scale (VAS, 10 cm) 10 years postoperatively (follow-up rate, 72.2%). Correlation analyses were performed using Spearman's rank correlation coefficient (r). RESULTS The VAS for NSP was 2.6 cm in median and 3.4 cm in mean at 10 years. The VAS had significant negative correlations with several SRS-22 domain scores (rs = - 0.348 for pain, - 0.347 for function, - 0.308 for mental health, and - 0.372 for total) (p < 0.05). In addition, the VAS score was significantly correlated with cervical lordosis (CL) (rs = 0.296), lumbar lordosis (rs = - 0.299), and sacral slope (rs = 0.362) (p < 0.05). Furthermore, at the 10-year follow-up, CL was significantly negatively correlated with T1 slope (rs = - 0.763) and thoracic kyphosis (TK) (- 0.554 for T1-12 and - 0.344 for T5-12) (p < 0.02). CONCLUSION NSP was associated with deterioration in SRS-22 scores, indicating that NSP is a clinically significant long-term issue in PSF for thoracic AIS. Restoring or maintaining the TK and T1 slopes, which are controllable factors during PSF, may improve cervical lordosis and alleviate NSP at 10-year follow-up.
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Affiliation(s)
- Masayuki Ohashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan.
| | - Kei Watanabe
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan
- Niigata Spine Surgery Center, Niigata City, Japan
| | - Toru Hirano
- Department of Orthopedic Surgery, Uonuma Institute of Community Medicine, Niigata University Medical and Dental Hospital, Minamiuonuma City, Japan
| | | | - Hideki Tashi
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Tatsuo Makino
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Keitaro Minato
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Masayuki Sato
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan
| | - Hiroyuki Kawashima
- Division of Orthopedic Surgery, Department of Regenerative and Transplant Medicine, Graduate School of Medical and Dental Sciences, Niigata University, 1-757 Asahimachi Dori, Chuo-ku, Niigata City, 951-8510, Japan
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Park D, Lee SH, Lee S, Park J, Yang HG, Kim C, Park JH. The Efficacy of Cervical Pedicle Screw Is Enhanced When Used With 5.5-mm Rods for Metastatic Cervical Spinal Tumor Surgery. Neurospine 2024; 21:352-360. [PMID: 38291748 PMCID: PMC10992656 DOI: 10.14245/ns.2346778.389] [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: 07/27/2023] [Revised: 11/12/2023] [Accepted: 11/16/2023] [Indexed: 02/01/2024] Open
Abstract
OBJECTIVE The cervical spine presents challenges in treating metastatic cervical spinal tumors (MCSTs). Although the efficacy of cervical pedicle screw placement (CPS) has been well established, its use in combination with 5.5-mm rods for MCST has not been reported. This study aimed to evaluate the efficacy of CPS combined with 5.5-mm rods in treating MCST and compare it with that of CPS combined with traditional 3.5-mm rods. METHODS This retrospective study analyzed 58 patients with MCST who underwent posterior cervical spinal fusion surgery by a single surgeon between March 2012 and December 2022. Data included demographics, surgical details, imaging results, numerical rating scale score for neck pain, Eastern Cooperative Oncology Group performance status, and Spine Oncology Study Group Outcomes Questionnaire responses. RESULTS Preoperative Spinal Instability Neoplastic Scores were significantly higher in the 5.5-mm rod group. Greater kyphotic changes in the index vertebra were observed in the 3.5-mm rod group. Neck pain reduction was significantly better in the 5.5-mm rod group. CONCLUSION CPS with 5.5-mm rods provides superior biomechanical stability and effectively resists forward bending momentum in posterior MCST fusion surgery. These findings support the use of 5.5-mm rods to enhance surgical outcomes.
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Affiliation(s)
- Danbi Park
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
- College of Nursing, Korea University, Seoul, Korea
| | - Sang Hyub Lee
- Department of Neurosurgery, Spine Center, The Leon Wiltse Memorial Hospital, Suwon, Korea
| | - Subum Lee
- Department of Neurosurgery, Korea University Anam Hospital, Korea University College of Medicine, Seoul, Korea
| | - Jemin Park
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
| | - Hyeon Gyu Yang
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
| | - Chongman Kim
- Department of Industrial and Management Engineering, Myongji University, Seoul, Korea
| | - Jin Hoon Park
- Department of Neurological Surgery, Asan Medical Center, Seoul, Korea
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Chanbour H, Waddell WH, Vickery J, LaBarge ME, Croft AJ, Longo M, Roth SG, Hills JM, Abtahi AM, Zuckerman SL, Stephens BF. L1-pelvic angle: a convenient measurement to attain optimal deformity correction. 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 2023; 32:4003-4011. [PMID: 37736775 DOI: 10.1007/s00586-023-07920-0] [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: 02/20/2023] [Revised: 05/14/2023] [Accepted: 08/26/2023] [Indexed: 09/23/2023]
Abstract
PURPOSE (1) Evaluate the associations between L1-pelvic angle (L1PA) and both sagittal vertical axis (SVA) and T1-pelvic angle (T1PA), and (2) assess the clinical impact of L1PA. METHODS A single-institution retrospective cohort study was undertaken for patients undergoing adult spinal deformity (ASD) surgery from 2013 to 2017. Ideal L1PA was defined as (0.5xPelvic Incidence)-21. Pearson correlation was performed to compare L1PA, SVA, and T1PA. Univariate/multivariate regression was performed to assess the effect of L1PA on mechanical complications, controlling for age, BMI, and postoperative pelvic incidence-lumbar lordosis mismatch (PI/LL). Due to the overlapping nature of patients with pseudarthrosis and rod fracture, these patients were analyzed together. RESULTS A total of 145 patients were included. Mean preoperative L1PA, SVA, and T1PA were 15.5 ± 8.9°, 90.7 ± 66.8 mm, and 27.1 ± 13.0°, respectively. Mean postoperative L1PA, SVA, and T1PA were 15.0 ± 8.9°, 66.7 ± 52.8 mm, and 22.3 ± 11.1°, respectively. Thirty-six (24.8%) patients achieved ideal L1PA. Though the correlation was modest, preoperative L1PA was linearly correlated with preoperative SVA (r2 = 0.16, r = 0.40, 95%CI = 0.22-0.60, p < 0.001) and T1PA (r2 = 0.41, r = 0.62, 95%CI = 0.46-0.76, p < 0.001). Postoperative L1PA was linearly correlated with postoperative SVA (r2 = 0.12, r = 0.37, 95%CI = 0.18-0.56, p < 0.001) and T1PA (r2 = 0.40, r = 0.62, 95%CI = 0.45-0.74, p < 0.001). Achieving ideal L1PA ± 5° was associated with a decreased risk of rod fracture/pseudarthrosis on univariate and multivariate regression (OR = 0.33, 95%CI = 0.12-0.86, p = 0.024). No association between achieving ideal L1PA and patient-reported outcomes was observed. CONCLUSION L1PA was modestly correlated with SVA and T1PA, and achieving ideal L1PA was associated with lower rates of rod fracture/pseudarthrosis. Future studies are warranted to better define the clinical implications of achieving a normal L1PA. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Hani Chanbour
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
| | - William Hunter Waddell
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Justin Vickery
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Matthew E LaBarge
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Andrew J Croft
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Michael Longo
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
| | - Steven G Roth
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
| | - Jeffrey M Hills
- Department of Orthopedic Surgery, University of Texas, San Antonio, TX, USA
| | - Amir M Abtahi
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Scott L Zuckerman
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA
| | - Byron F Stephens
- Department of Neurological Surgery, Vanderbilt University Medical Center, South Tower, 1215 21st Ave Suite #4200, Nashville, TN, 37232, USA.
- Department of Orthopedic Surgery, Vanderbilt University Medical Center, Nashville, TN, USA.
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Merrill RK, Clohisy JC, Albert TJ, Qureshi SA. Concepts and Techniques to Prevent Cervical Spine Deformity After Spine Surgery: A Narrative Review. Neurospine 2023; 20:221-230. [PMID: 37016868 PMCID: PMC10080418 DOI: 10.14245/ns.2244780.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 04/03/2023] Open
Abstract
Adult cervical spine deformity is associated with decreased health-related quality of life, disability, and myelopathy. A number of radiographic parameters help to characterize cervical deformity and aid in the diagnosis and treatment. There are several etiologies for cervical spine deformity, the most common being iatrogenic. Additionally, spine surgery can accelerate adjacent segment degeneration which may lead to deformity. It is therefore important for all spine surgeons to be aware of the potential to cause iatrogenic cervical deformity. The aim of this review is to highlight concepts and techniques to prevent cervical deformity after spine surgery.
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Affiliation(s)
- Robert K. Merrill
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John C. Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Corresponding Author Sheeraz A. Qureshi Department of Orthopedic Surgery, Minimally Invasive Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, 4th Floor, New York, NY 10021, USA
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Paik S, Choi Y, Chung CK, Won YI, Park SB, Yang SH, Lee CH, Rhee JM, Kim KT, Kim CH. Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis. PLoS One 2023; 18:e0281926. [PMID: 36809260 PMCID: PMC9942978 DOI: 10.1371/journal.pone.0281926] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2022] [Accepted: 02/04/2023] [Indexed: 02/23/2023] Open
Abstract
OBJECTIVE Posterior full-endoscopic cervical foraminotomy (PECF) is one of minimally invasive surgical techniques for cervical radiculopathy. Because of minimal disruption of posterior cervical structures, such as facet joint, cervical kinematics was minimally changed. However, a larger resection of facet joint is required for cervical foraminal stenosis (FS) than disc herniation (DH). The objective was to compare the cervical kinematics between patients with FS and DH after PECF. METHODS Consecutive 52 patients (DH, 34 vs. FS, 18) who underwent PECF for single-level radiculopathy were retrospectively reviewed. Clinical parameters (neck disability index, neck pain and arm pain), and segmental, cervical and global radiological parameters were compared at postoperative 3, 6, and 12 months, and yearly thereafter. A linear mixed-effect model was used to assess interactions between groups and time. Any occurrence of significant pain during follow-up was recorded during a mean follow-up period of 45.5 months (range 24-113 months). RESULTS Clinical parameters improved after PECF, with no significant differences between groups. Recurrent pain occurred in 6 patients and surgery (PECF, anterior discectomy and fusion) was performed in 2 patients. Pain-free survival rate was 91% for DH and 83% for FS, with no significant difference between the groups (P = 0.29). Radiological changes were not different between groups (P > 0.05). Segmental neutral and extension curvature became more lordotic. Cervical curvature became more lordotic on neutral and extension X-rays, and the range of cervical motion increased. The mismatch between T1-slope and cervical curvature decreased. Disc height did not change, but the index level showed degeneration at postoperative 2 years. CONCLUSION Clinical and radiological outcomes after PECF were not different between DH and FS patients and kinematics were significantly improved. These findings may be informative in a shared decision-making process.
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Affiliation(s)
- Seungyoon Paik
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Yunhee Choi
- Division of Medical Statistics, Medical Research Collaborating Center, Seoul National University Hospital, Seoul, Republic of Korea
| | - Chun Kee Chung
- Department of Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Brain and Cognitive Sciences, Seoul National University, Seoul, Republic of Korea
| | - Young Il Won
- Department of Neurosurgery, Chungnam National University Sejong Hospital, Sejong, Republic of Korea
| | - Sung Bae Park
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Boramae Hospital, Seoul, Republic of Korea
| | - Seung Heon Yang
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seongnam-si, Gyeonggi-do, Republic of Korea
| | - Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
| | - John Min Rhee
- Department of Orthopaedic Surgery, Emory University School of Medicine, Atlanta, Georgia, United States of America
| | - Kyoung-Tae Kim
- Department of Neurosurgery, Kyungpook National University Hospital, Daegu, Republic of Korea
- Department of Neurosurgery, School of Medicine, Kyungpook National University, Daegu, Republic of Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University College of Medicine, Seoul, Republic of Korea
- Department of Neurosurgery, Seoul National University Hospital, Seoul, Republic of Korea
- Department of Medical Device Development, Seoul National University College of Medicine, Seoul, Republic of Korea
- * E-mail:
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Lee JK, Hyun SJ, Kim KJ. Reciprocal Changes in the Whole-Body Following Realignment Surgery in Adult Spinal Deformity. Asian Spine J 2022; 16:958-967. [PMID: 35527534 PMCID: PMC9827204 DOI: 10.31616/asj.2021.0451] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Accepted: 01/03/2022] [Indexed: 01/11/2023] Open
Abstract
The idea of the global balance of spine stems from Jean Dubousset, who first introduced the concept of cone of economy. Through the compensatory mechanisms, the human body maintains an upright posture and horizontal gaze in the setting of the spinal malalignment. Compensation takes place not only in the mobile spine segments, but also in the pelvis and lower extremities. Patients with a malalignment exhibit compensatory changes in the cervical hyper-lordosis, posterior pelvic shift, knee/ankle flexion, hip extension, and the pelvic retroversion. The advent of whole-body stereo radiography has yielded an improved understanding of global changes among the patients. Deformity-induced compensatory changes in the sagittal alignment could be resolved reciprocally after the surgical correction of the malalignment. Thoracolumbar realignment surgery restores the pathologic compensatory changes in the unfused spinal segments, pelvis, and the lower extremities. Similarly, reciprocal changes in the thoracolumbar spine may harmonize global sagittal alignment after the cervical reconstruction. This study reviews the compensatory mechanisms and reciprocal changes in global sagittal alignment caused by the surgical correction and highlights, the factors that should be considered while assessing a patient's compensatory status.
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Affiliation(s)
- Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Passfall L, Williamson TK, Krol O, Lebovic J, Imbo B, Joujon-Roche R, Tretiakov P, Dangas K, Owusu-Sarpong S, Koller H, Schoenfeld AJ, Diebo BG, Vira S, Lafage R, Lafage V, Passias PG. Do the newly proposed realignment targets for C2 and T1 slope bridge the gap between radiographic and clinical success in corrective surgery for adult cervical deformity? J Neurosurg Spine 2022; 37:368-375. [PMID: 35426823 DOI: 10.3171/2022.2.spine211576] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2021] [Accepted: 02/21/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Surgical correction of cervical deformity (CD) has been associated with superior alignment and functional outcomes. It has not yet been determined whether baseline or postoperative T1 slope (T1S) and C2 slope (C2S) correlate with health-related quality-of-life (HRQoL) metrics and radiographic complications, such as distal junctional kyphosis (DJK) and distal junctional failure (DJF). The objective of this study was to determine the impact of T1S and C2S deformity severity on HRQoL metrics and DJF development in patients with CD who underwent a cervical fusion procedure. METHODS All operative CD patients with upper instrumented vertebra above C7 and preoperative (baseline) and up to 2-year postoperative radiographic and HRQoL data were included. CD was defined as meeting at least one of the following radiographic parameters: C2-7 lordosis < -15°, TS1-cervical lordosis mismatch > 35°, segmental cervical kyphosis > 15° across any 3 vertebrae between C2 and T1, C2-7 sagittal vertical axis > 4 cm, McGregor's slope > 20°, or chin-brow vertical angle > 25°. Spearman's rank-order correlation and linear regression analysis assessed the impact of T1S and C2S on HRQoL metrics (Neck Disability Index [NDI], modified Japanese Orthopaedic Association [mJOA] scale, EuroQOL 5-Dimension Questionnaire [EQ-5D] visual analog scale [VAS] score, and numeric rating scale [NRS]-neck) and complications (DJK, DJF, reoperation). Logistic regression and a conditional inference tree (CIT) were used to determine radiographic thresholds for achieving optimal clinical outcome, defined as meeting good clinical outcome criteria (≥ 2 of the following: NDI < 20 or meeting minimal clinically important difference, mild myelopathy [mJOA score ≥ 14], and NRS-neck ≤ 5 or improved by ≥ 2 points), not undergoing reoperation, or developing DJF or mechanical complication by 2 years. RESULTS One hundred five patients with CD met inclusion criteria. By surgical approach, 14.7% underwent an anterior-only approach, 46.1% a posterior-only approach, and 39.2% combined anterior and posterior approaches. The mean baseline radiographic parameters were T1S 28.3° ± 14.5° and C2S 25.9° ± 17.5°. Significant associations were found between 3-month C2S and mJOA score (r = -0.248, p = 0.034), NDI (r = 0.399, p = 0.001), EQ-5D VAS (r = -0.532, p < 0.001), NRS-neck (r = 0.239, p = 0.040), and NRS-back (r = 0.264, p = 0.021), while significant correlation was also found between 3-month T1S and mJOA score (r = -0.314, p = 0.026), NDI (r = 0.445, p = 0.001), EQ-5D VAS (r = -0.347, p = 0.018), and NRS-neck (r = 0.269, p = 0.049). A significant correlation was also found between development of DJF and 3-month C2S (odds ratio [OR] 1.1, 95% confidence interval [CI] 1.01-1.1, p = 0.015) as well as for T1S (OR 1.1, 95% CI 1.01-1.1, p = 0.023). Logistic regression with CIT identified thresholds for optimal outcome by 2 years: optimal 3-month T1S < 26° (OR 5.6) and C2S < 10° (OR 10.4), severe 3-month T1S < 45.5° (OR 0.2) and C2S < 38.0° (no patient above this threshold achieved optimal outcome; all p < 0.05). Patients below both optimal thresholds achieved rates of 0% for DJK and DJF, and 100% met optimal outcome. CONCLUSIONS The severity of CD, defined by T1S and C2S at baseline and especially at 3 months, can be predictive of postoperative functional improvement and occurrence of worrisome complications in patients with CD, necessitating the use of thresholds in surgical planning to achieve optimal outcomes.
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Affiliation(s)
- Lara Passfall
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Tyler K Williamson
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Oscar Krol
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Jordan Lebovic
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Bailey Imbo
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Rachel Joujon-Roche
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Peter Tretiakov
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | | | - Stephane Owusu-Sarpong
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
| | - Heiko Koller
- 4Department of Neurosurgery, Technical University of Munich, Klinikum rechts der Isar, Munich, Germany
| | - Andrew J Schoenfeld
- 5Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts
| | - Bassel G Diebo
- 6Department of Orthopedics, SUNY Downstate, Brooklyn, New York
| | - Shaleen Vira
- 7Department of Orthopaedic Surgery, University of Texas Southwestern Medical Center, Dallas, Texas
| | - Renaud Lafage
- 8Department of Orthopedics, Hospital for Special Surgery, New York, New York; and
| | - Virginie Lafage
- 9Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, New York
| | - Peter G Passias
- 1Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York, New York
- 2New York Spine Institute, New York, New York
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Lee JK, Hyun SJ, Kim KJ. Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom. Neurospine 2022; 19:463-471. [PMID: 35793937 PMCID: PMC9260555 DOI: 10.14245/ns.2244220.110] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/07/2022] [Indexed: 11/29/2022] Open
Abstract
Objective By using angulation of the axis itself, this study aims to define and analyze odontoid incidence (OI) and odontoid tilt (OT) as novel cervical alignment parameters and investigate their correlations with cervical alignment.
Methods Novel and existing parameters were measured with whole-spine lateral plain radiographs and EOS images of 42 adults without cervical symptoms. The correlations of OI, OT, C2 slope (C2S), and T1 slope (T1S) were calculated.
Results The OI, OT, and C2S showed significant correlations with C2–7 angle (r = 0.43, r = -0.42, r = 0.62, respectively) and C0–2 angle (r = -0.33, r = 0.48, r = -0.61, respectively). OI, OT, T1S were independent predictors of the C2–7 angle in univariate regression analysis (adjusted-R2 = 0.17, R2 = 0.15, R2 = 0.28, respectively). OI, OT, and T1S were independent predictors in the multivariable regression analysis with estimated standardized coefficients of 0.36, -0.67, -0.69, respectively (adjusted- R2 = 0.80, p < 0.001). Regarding the C0–2 angle, OI and OT were independent predictors in the univariate regression analysis (adjusted-R2 = 0.08, R2 = 0.21, respectively).
Conclusion OI, OT, and C2S had significant correlations with cervical alignment. As the pelvic incidence, the OI is the only anatomical and constant parameter that could be used as a reference point related to the cervical spine from the rostral end. The study results may serve as baseline data for further studies on the alignment and balance of the cervical spine.
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Affiliation(s)
- Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Corresponding Author Seung-Jae Hyun Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 82 Gumi-ro 173beongil, Bundang-gu, Seongnam 13620, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Yang K, Li XY, Wang Y, Kong C, Lu SB. Relationship between TIA minus C0-7 angle and C2-7 SVA: analysis of 113 symptomatic patients. BMC Musculoskelet Disord 2022; 23:338. [PMID: 35395791 PMCID: PMC8991799 DOI: 10.1186/s12891-022-05301-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 04/04/2022] [Indexed: 11/18/2022] Open
Abstract
Background Measurement of T1 slope (T1S) can be difficult due to the anatomical positioning of the shoulders. And thoracic inlet angle (TIA) was a morphological parameter and not changed by the position. We proposed a new parameter, TIA minus C0-7 angle (TIA-C07), to evaluate C2-7 SVA in order to overcome the T1S imperfection. Methods This was a retrospective radiological analysis of symptomatic subjects. The following cervical parameters were measured: Cervical lordosis angle (CL), C0-7 angle (C0-7), occiput-C2 lordosis angle (O-C2), C2-7 sagittal vertical axis (C2–7 SVA), TIA and TIA-C07. The Pearson correlation test was calculated, and the stepwise multiple regression analysis was conducted to determine the best predictor for C2-7 SVA. A paired sample t test was used to compare the predicted and measured C2-7 SVA. Results The mean age of 113 patients was 60.02 ± 9.67. The average O-C2, CL, C0-7, TIA, TIA-C07 and C2-C7 SVA was 29.24 ± 8.48°, 13.67 ± 11.22°, 42.91 ± 11.44°, 76.07 ± 9.54°, 33.16 ± 13.18° and 21.34 ± 11.42 mm. The predictive formula was founded: C2-7 SVA = 2.80 + 0.56 * (TIA—C07) (R = 0.645, R2 = 0.416). There was no statistical difference between the predicted and the measured C2-7 SVA (t = 0.085, P = 0.933). Conclusions TIA and C0-7 mismatch may significantly impact cervical alignment, and a greater T1A-C07 was related to a greater degree of C2-7 SVA. TIA-C07 may be a more important predictor for C2-7 SVA. Supplementary Information The online version contains supplementary material available at 10.1186/s12891-022-05301-0.
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Affiliation(s)
- Kai Yang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Xiang-Yu Li
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Yu Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China.,National Clinical Research Center for Geriatric Diseases, Beijing, China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, China.
| | - Shi-Bao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, No.45 Changchun Street, Xicheng District, Beijing, China. .,National Clinical Research Center for Geriatric Diseases, Beijing, China.
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Lee JK, Park JH, Hyun SJ, Hodel D, Hausmann ON. Regional Anesthesia for Lumbar Spine Surgery: Can It Be a Standard in the Future? Neurospine 2022; 18:733-740. [PMID: 35000326 PMCID: PMC8752703 DOI: 10.14245/ns.2142584.292] [Citation(s) in RCA: 15] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/30/2021] [Indexed: 12/31/2022] Open
Abstract
This paper is an overview of various features of regional anesthesia (RA) and aims to introduce spine surgeons unfamiliar with RA. RA is commonly used for procedures that involve the lower extremities, perineum, pelvic girdle, or lower abdomen. However, general anesthesia (GA) is preferred and most commonly used for lumbar spine surgery. Spinal anesthesia (SA) and epidural anesthesia (EA) are the most commonly used RA methods, and a combined method of SA and EA (CSE). Compared to GA, RA offers numerous benefits including reduced intraoperative blood loss, arterial and venous thrombosis, pulmonary embolism, perioperative cardiac ischemic incidents, renal failure, hypoxic episodes in the postanesthetic care unit, postoperative morbidity and mortality, and decreased incidence of cognitive dysfunction. In spine surgery, RA is associated with lower pain scores, postoperative nausea and vomiting, positioning injuries, shorter anesthesia time, and higher patient satisfaction. Currently, RA is mostly used in short lumbar spine surgeries. However, recent findings illustrate the possibility of applying RA in spinal tumors and spinal fusion. Various researches reveal that SA is an effective alternative to GA with lower minor complications incidence. Comprehensive insight on RA will promote spine surgery under RA, thereby broadening the horizon of spine surgery under RA.
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Affiliation(s)
- Jae-Koo Lee
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jong Hwa Park
- Department of Neurosurgery, Spine Center, Yuil Hospital, Hwasung, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Daniel Hodel
- Clinic of Anesthesiology, Intensive Care Medicine and Pain Therapy, Hirslanden Klinik St. Anna, Lucerne, Switzerland
| | - Oliver N Hausmann
- Neuro- and Spine Center, Hirslanden Klinik St. Anna, Lucerne, Switzerland.,University of Berne, Berne, Switzerland
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