1
|
Caffard T, Arzani A, Verna B, Tripathi V, Chiapparelli E, Medina SJ, Schönnagel L, Tani S, Camino-Willhuber G, Amoroso K, Guven AE, Zhu J, Tan ET, Carrino JA, Shue J, Awan Malik H, Zippelius T, Dalton D, Sama AA, Girardi FP, Cammisa FP, Hughes AP. Association Between Cervical Sagittal Alignment and Subaxial Paraspinal Muscle Parameters. Spine (Phila Pa 1976) 2024; 49:621-629. [PMID: 38098290 DOI: 10.1097/brs.0000000000004897] [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: 09/12/2023] [Accepted: 12/04/2023] [Indexed: 04/11/2024]
Abstract
STUDY DESIGN Retrospective review of prospectively collected data. OBJECTIVE The authors aim to investigate the association between muscle functional group characteristics and sagittal alignment parameters in patients undergoing anterior cervical discectomy and fusion. SUMMARY OF BACKGROUND DATA The relationship between the morphology of cervical paraspinal muscles and sagittal alignment is not well understood. MATERIALS AND METHODS Patients with preoperative cervical magnetic resonance imaging and cervical spine lateral radiographs in standing position who underwent anterior cervical discectomy and fusion between 2015 and 2018 were reviewed. Radiographic alignment parameters included C2 to 7 lordosis, C2 to 7 sagittal vertical axis (SVA), C2 slope, neck tilt, T1 slope, and thoracic inlet angle. Muscles from C3 to C7 were categorized into four functional groups: sternocleidomastoid group, anterior group, posteromedial group, and posterolateral group (PL). A custom-written Matlab software was used to assess the functional cross-sectional area (fCSA) and percent fat infiltration (FI) for all groups. Multivariable linear regression analyses were conducted and adjusted for age, sex, and body mass index. RESULTS A total of 172 patients were included. Regression analyses demonstrated that a greater C2 to 7 SVA was significantly associated with a greater FI of the anterior group from C3 to C5 and with a higher fCSA of the PL group at C3 to C4, and C6 to 7. A larger C2 slope was significantly correlated with a greater FI of the anterior group at C3 to C4 and a higher fCSA of the PL group from C3 to C5. CONCLUSION This work proposes new insights into the complex interaction between sagittal alignment and cervical paraspinal muscles by emphasizing the importance of these muscles in sagittal alignment. The authors hypothesize that with cervical degeneration, the stabilizing function of the anterior muscles decreases, which may result in an increase in the compensatory mechanism of the PL muscles. Consequently, there may be a corresponding increase in the C2 to C7 SVA and a larger C2 slope.
Collapse
Affiliation(s)
- Thomas Caffard
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - Artine Arzani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | - Bruno Verna
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | - Vidushi Tripathi
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | | | - Samuel J Medina
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | - Lukas Schönnagel
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
- Center for Musculoskeletal Surgery, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin and Humboldt-Universität zu Berlin, Berlin, Germany
| | - Soji Tani
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
- Department of Orthopaedic Surgery, School of Medicine, Showa University Hospital, Tokyo, Japan
| | | | - Krizia Amoroso
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | - Ali E Guven
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | - Jiaqi Zhu
- Biostatistics Core, Hospital for Special Surgery, New York City, NY
| | - Ek Tsoon Tan
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY
| | - John A Carrino
- Department of Radiology and Imaging, Hospital for Special Surgery, New York City, NY
| | - Jennifer Shue
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | | | - Timo Zippelius
- Department of Orthopedic Surgery, University of Ulm, Ulm, Germany
| | - David Dalton
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
- Department of Orthopedic Surgery, University Hospital Galway, Galway, Ireland
| | - Andrew A Sama
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | | | - Frank P Cammisa
- Spine Care Institute, Hospital for Special Surgery, New York City, NY
| | | |
Collapse
|
2
|
Divi SN, Bronson WH, Canseco JA, Chang M, Goyal DKC, Nicholson KJ, Mujica VE, Kaye ID, Kurd MF, Woods BI, Radcliff KE, Rihn JA, Anderson DG, Hilibrand AS, Kepler CK, Vaccaro AR, Schroeder GD. How do C2 tilt and C2 slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion? Spine J 2021; 21:578-585. [PMID: 33197615 DOI: 10.1016/j.spinee.2020.10.033] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/06/2020] [Revised: 10/28/2020] [Accepted: 10/31/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND/CONTEXT C2 tilt and C2 slope are quick and easy measurements to obtain on lateral radiographs and may be used to determine overall cervical sagittal alignment; however, the influence of these measurements on patient outcomes has not been well established in literature. PURPOSE To determine if C2 tilt and/or C2 slope predict patient outcomes better compared with conventional radiographic measures after an anterior cervical discectomy and fusion (ACDF). STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 249 patients who underwent 1 to 3 level ACDF to address radiculopathy and/or myelopathy at a single academic institution between 2011 and 2015 were identified. Patients with less than 1 year of follow-up were excluded. OUTCOME MEASURES Patient Reported Outcomes: Neck Disability Index (NDI), Physical Component Score-12 (PCS-12), and Mental Component Score (MCS-12), Visual Analog Score (VAS) Neck and Arm scores Cervical radiographic measurements: C2 tilt, C2 slope, C2-C7 lordosis, cervical SVA, T1 slope, T1 slope minus cervical lordosis (TS-CL), and C2-C7 ROM METHODS: Pearson correlation tests were performed to assess for significant associations between radiographic measurements and patient outcomes. Multiple linear regression models were developed adjusting for demographics and radiographic parameters to determine which factors were predictive of patient outcomes. RESULTS C2 tilt and TS-CL correlated with all postoperative physical outcome scores (NDI, PCS-12, VAS Neck and ARM; p<.05), however no association was seen between C2 slope and postoperative outcomes. After accounting for the presence of subaxial deformity, C2 tilt and TS-CL remained strongly correlated to patient outcome scores. With multiple linear regression, C2 tilt was a significant predictor for NDI, whereas TS-CL was a significant predictor for PCS-12, VAS Neck and VAS Arm. CONCLUSIONS C2 tilt significantly correlated with well-described conventional cervical parameters as well as postoperative physical outcomes measures, especially NDI, on multivariate analysis. C2 tilt may provide an easy and practical tool for predicting physical outcomes after ACDF.
Collapse
Affiliation(s)
- Srikanth N Divi
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA.
| | - Wesley H Bronson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Jose A Canseco
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Michael Chang
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Dhruv K C Goyal
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Kristen J Nicholson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Victor E Mujica
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Ian David Kaye
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Mark F Kurd
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Barrett I Woods
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Kristen E Radcliff
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Jeffrey A Rihn
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - David Greg Anderson
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alan S Hilibrand
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Christopher K Kepler
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Alexander R Vaccaro
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| | - Gregory D Schroeder
- Department of Orthopaedic Surgery, Rothman Institute, Thomas Jefferson University, 925 Chestnut St, 5th Floor, Philadelphia, PA 19107, USA
| |
Collapse
|
3
|
Li Q, Han X, Wang R, Zhang Y, Liu P, Dong Q. Clinical recovery after 5 level of posterior decompression spine surgeries in patients with cervical spondylotic myelopathy: A retrospective cohort study. Asian J Surg 2019; 43:613-624. [PMID: 31481282 DOI: 10.1016/j.asjsur.2019.08.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2019] [Revised: 07/14/2019] [Accepted: 08/05/2019] [Indexed: 11/26/2022] Open
Abstract
BACKGROUND/OBJECTIVE The selection of surgical technique in patients with cervical spondylotic myelopathy relies on the surgeon(s) and patients' conditions. The objectives of the study were to test the hypotheses that French-door laminoplasty recovers faster than laminectomy and has good outcome measures. METHODS Data regarding surgical, radiological, and clinical outcome measures of 330 patients with cervical spondylotic myelopathy operated under French-door laminoplasty (fdLP group, n = 110), open-door laminoplasty (odLP group, n = 110), or laminectomy (LC group, n = 110) were collected from the records of institute and analyzed. RESULTS Patients of fdLP group (p < 0.0001, q = 11.65) and odLP group (p < 0.0001, q = 11.27) both had significantly improved modified Rankin scale score than those of LC group. In addition, patients of fdLP group had minimum blood loss during operations and that was maximum for patients of the LC group. Unlike patients of fdLP group (p < 0.0001, q = 80) and LC group (p < 0.0001, q =122), those of odLP group had lost more amount of cervical lordotic after surgery. Open-door laminoplasty had significantly reduced cervical range of motion than laminectomy (p < 0.0001, q = 15.45) and French-door laminoplasty (p < 0.0001, q = 13.45). After 12-months, fdLP group had higher bone union rate than odLP group (p = 0.007, q = 3.395) and LC group (p = 0.007, q = 4.243). French door laminoplasty had a better postoperative quality of life. CONCLUSIONS Among the posterior decompression spine surgeries, French-door laminoplasty is superior surgical procedure than laminectomy and could be superior surgical technique than open-door laminoplasty.
Collapse
Affiliation(s)
- Qiaomei Li
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Xiaoqiang Han
- Department of Orthopedic, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Renqiang Wang
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Yuanyuan Zhang
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Puke Liu
- Department of Operating and Anesthesiology, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| | - Qingqing Dong
- Department of Outpatient, Ankang Hospital of Traditional Chinese Medicine, Ankang, Shaanxi, 725000, China.
| |
Collapse
|