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Shi L, Ding T, Wang F, Wu C. Comparison of Anterior Cervical Decompression and Fusion and Posterior Laminoplasty for Four-Segment Cervical Spondylotic Myelopathy: Clinical and Radiographic Outcomes. J Neurol Surg A Cent Eur Neurosurg 2024; 85:331-339. [PMID: 36584878 DOI: 10.1055/a-2005-0552] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
BACKGROUND Although anterior or posterior surgery for cervical spondylotic myelopathy (CSM) has been extensively studied, the choice of anterior or posterior approach in four-segment CSM remains poorly studied and controversial. We compared the clinical and radiographic outcomes of four-segment CSM by posterior laminoplasty (LAMP) and anterior cervical decompression fusion (ACDF) to further explore the merits and demerits of ACDF and LAMP for four-segment CSM in this study. METHODS Patients with four-segment CSM who underwent ACDF or LAMP between January 2016 and June 2019 were retrospectively analyzed. We compared the preoperative and postoperative cervical Japanese Orthopaedic Association (JOA) scores, neck disability index (NDI), neck pain visual analog scale (VAS) score, sagittal vertical axis, cervical lordosis (CL), and range of motion. RESULTS There were 47 and 79 patients in the ACDF and LAMP groups, respectively. Patients in the ACDF group had a significantly longer surgical time and lower estimated blood loss and length of stay than those in the LAMP group. There was no significant difference in the JOA, NDI, or neck pain VAS scores between the two groups preoperatively, but the NDI and neck pain VAS scores in the ACDF group were significantly lower than those in the LAMP group at the final follow-up. The preoperative C2-C7 Cobb angle of the ACDF group was significantly lower than that of the LAMP group but there was no significant difference between the two groups postoperatively. The improvement of C2-C7 Cobb angle (∆C2-C7 Cobb angle) in the ACDF group was significantly higher than that in the LAMP group. This indicated that ACDF can improve CL better than LAMP. The linear regression analysis revealed the ∆C2-C7 Cobb angle was negatively correlated with the final follow-up neck pain VAS scores and NDI. This indicated that patients with better improvement of CL may have a better prognosis. CONCLUSIONS Although both ACDF and LAMP surgeries are effective for four-segment CSM, ACDF can better improve CL and neck pain. For patients with poor CL, we suggest ACDF when both approaches are feasible.
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Affiliation(s)
- Liang Shi
- Department of Orthopedics, Xiangyang No.1 People's Hospital, Hubei University of Medicine, Xiangyang, China
| | - Tao Ding
- Department of Spine Surgery, Shengli Oilfield Central Hospital, Dongying, Shandong, China
| | - Fang Wang
- Department of Pathology, Qujing Second People's Hospital of Yunnan Province, Qujing, China
| | - Chengcong Wu
- Department of Spine Surgery, Qujing First People's Hospital: Kunming Medical University Affiliated Qujing Hospital, Qujing, Yunnan, China
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Romani MD, Zhang HQ, Gao QL, Liu SH, Deng A. Cervical Sagittal Alignment and Related Factor Analysis and Prediction Model in Patients Undergoing Revision Surgery After Anterior Cervical Fusion. J Am Acad Orthop Surg 2024; 32:e585-e595. [PMID: 38595101 PMCID: PMC11111316 DOI: 10.5435/jaaos-d-23-00565] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2023] [Revised: 02/03/2024] [Accepted: 02/17/2024] [Indexed: 04/11/2024] Open
Abstract
INTRODUCTION Patients with myelopathy or radiculopathy commonly undergo anterior cervical fusion surgery (ACFS), which has a notable failure rate on occasion. The goal of this study was to compare revision and nonrevision surgery patients in cervical sagittal alignment (CSA) subsequent to ACFS; additionally, to identify the best CSA parameters for predicting clinical outcome after ACFS; and furthermore, to create an equation model to assist surgeons in making decisions on patients undergoing ACFS. METHODS The data of 99 patients with symptomatic cervical myelopathy/radiculopathy who underwent ACFS were analyzed. Patients were divided into group A (underwent revision surgery after the first surgery failed) and group B (underwent only the first surgery). We measured and analyzed both preoperative and postoperative CSA parameters, including C2 slope, T1 slope, cervical lordosis C2-C7 (CL), C2-C7 sagittal vertical axis (C2C7 SVA), occiput-C2 lordosis angle (C0-C2), and chin brow vertical angle, and we further computed the correlation between the CSA parameters and created a prediction model. RESULTS The (T1S-CL)-C2S mismatch differed significantly between groups A and B ([9.95 ± 9.95] 0 , [3.79 ± 6.58] 0 , P < 0.05, respectively). A significant correlation was observed between C2 slope and T1CL in group B relative to group A postoperatively (R 2 = 0.42 versus R 2 = 0.09, respectively). Compared with group B, patients in group A had significantly higher C2C7SVA values, more levels of fusion, and more smokers. The sensitivity, specificity, accuracy, and discrimination of the model were, respectively, 73.5%, 84%, 78.8%, and 85.65%. CONCLUSION The causes of revision surgery in cervical myelopathic patients after anterior cervical corpectomy and fusion/anterior cervical diskectomy and fusion are multifactorial. (T1S-CL)-C2S mismatch and high C2C7SVA are the best cervical sagittal parameters that increase the odds of revision surgery, and the effect is more enhanced when comorbidities such as smoking, low bone-mineral density, and increased levels of fusion are taken into account.
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Affiliation(s)
- Manini Daudi Romani
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Hong-Qi Zhang
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Qi-Le Gao
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Shao-Hua Liu
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
| | - Ang Deng
- From the Department of spine surgery and Orthopedics, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, Deng), and the National Clinical Research Center for Geriatric Disorders, Xiangya Hospital, Central South University, Changsha, China (Romani, Zhang, Qi-Le Gao, Liu, and Deng)
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Dai L, Du K, Guo P, Gong H, Wang W, Hou X, Qin C, Zhang C. Comparison of Laminectomy with Fusion and Laminoplasty Treating Multilevel Cervical Spondylotic Myelopathy: A Single-Center Retrospective Study. World Neurosurg 2024; 186:e487-e494. [PMID: 38583558 DOI: 10.1016/j.wneu.2024.03.163] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2024] [Revised: 03/27/2024] [Accepted: 03/28/2024] [Indexed: 04/09/2024]
Abstract
OBJECTIVE Comparing laminectomy with fusion (LF) and laminoplasty (LP) for treating multilevel cervical spondylotic myelopathy (MCSM) and comparative analysis of neck pain and sagittal cervical parameters. METHODS This single-center study retrospectively analyzed MCSM patients treated with LF or LP in our department between June 2018 and January 2023, with at least a 12-month follow-up. T-tests were used to identify operation time, hemoglobin, hospital stay, modified Japanese Orthopaedic Association (mJOA) score, C2-C7 Cobb angle, C2-C7 sagittal vertical axis, T1 slope, cervical range of motion (cROM), and C4/5 anterior and posterior spinal canal diameter (A-P diameter) and area. Nonparametric tests were used to identify visual analog scale (VAS) score (assessing neck pain). Pearson correlation analyses were used to identify the neck pain. RESULTS Of all 67 patients (LF: 24, LP: 43), both groups' mJOA scores significantly improved (P < 0.001). The VAS scores had both significantly decreased, with the LF group exhibiting a more marked reduction (LF: P < 0.001, LP: P = 0.037). Both groups' C4/5 A-P diameters and areas increased significantly (P < 0.001). The cROM had both significantly decreased, with the LF group exhibiting a greater reduction. At the last follow-up, the LF group's T1 slope and C2-C7 Cobb angle considerably increased, and pain VAS scores substantially correlated with the C2-C7 Cobb angle (R = -0.451, P < 0.001). CONCLUSIONS LF and LP were efficacious for MCSM. LF relieved neck pain better but caused greater reduction in cervical mobility. Cervical lordosis improvement was significantly correlated with neck pain alleviation.
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Affiliation(s)
- Liping Dai
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Kaili Du
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Peiyu Guo
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Hongda Gong
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Weizhou Wang
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Xiaodong Hou
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China
| | - Chao Qin
- Department of orthopaedics, Fujian Medical University Union Hospital, Fuzhou, Fujian, China
| | - Chunqiang Zhang
- Department of orthopaedics, First Affiliated Hospital of Kunming Medical University, Kunming, Yunnan, China.
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Liu J, Tan J, Wang H, Tan Y, Qi J, Chen R, Huang J, Zhu C, Tan J, Yuan W, Shi C, Xu G. Does Focal Kyphotic Deformity at Non-responsible Levels Affect the Outcomes of Anterior Cervical Decompression and Fusion? Orthop Surg 2024; 16:1407-1417. [PMID: 38715422 PMCID: PMC11144497 DOI: 10.1111/os.14048] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/31/2023] [Revised: 03/08/2024] [Accepted: 03/13/2024] [Indexed: 06/04/2024] Open
Abstract
OBJECTIVE Focal cervical kyphotic deformity (FCK) without neurologic compression is not uncommon in patients with cervical spondylotic myelopathy (CSM) who underwent anterior cervical decompression and fusion (ACDF) surgery. It remains unclear whether FCK at non-responsible levels needs to be treated simultaneously. This study aims to investigate whether FCK at non-responsible levels is the prognostic factor for CSM and elucidate the surgical indication for FCK. METHODS Patients with CSM who underwent ACDF between January 2016 and April 2021 were included. Patients were divided into two groups according to the presence of FCK and two classifications according to global cervical sagittal alignment. Clinical outcomes were compared using Japanese Orthopaedic Association (JOA) scores and recovery rate (RR) of neurologic function. Univariate and multivariate analysis based on RR assessed the relationship between various possible prognostic factors and clinical outcomes. The receiver operating characteristic curve (ROC) was used to determine the optimal cutoff value of the focal Cobb angle to predict poor clinical outcomes. RESULTS A total of 94 patients were included, 41 with FCK and 53 without. Overall, the RR of neurologic function was significantly lower in the FCK than in the non-FCK group. Further analysis showed that the RR difference between the two groups was only observed in hypo-lordosis classification (kyphotic and sigmoid alignment), but not in the lordosis classification. Multivariate analysis showed that the preoperative focal Cobb angle in the FCK level (OR = 0.42; 95% CI = 0.18-0.97) was independently associated with clinical outcomes in the hypo-lordosis classification. The optimal cutoff point of the preoperative focal kyphotic Cobb angle was calculated at 4.05°. CONCLUSION For CSM with hypo-lordosis, FCK was a risk factor for poor postoperative outcomes. Surgeons may consider treating the FCK simultaneously if the focal kyphotic Cobb angle of FCK is greater than 4.05° and is accompanied by cervical global kyphotic or sigmoid deformity.
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Affiliation(s)
- Jia Liu
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
- Department of OrthopedicsThe 72nd Army Hospital of the People's Liberation ArmyHuzhouPeople's Republic of China
| | - Jian Tan
- Department of Medical GeneticsNaval Medical UniversityShanghaiPeople's Republic of China
| | - Haotian Wang
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
| | - Yixuan Tan
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
| | - Junqiang Qi
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
| | - Rukun Chen
- Faculty of MedicineUniversity of SouthamptonSouthamptonUK
| | - Jian Huang
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
| | - Chao Zhu
- Department of Nephrology and RheumatologyThe Third Affiliated Hospital of Naval Medical UniversityShanghaiPeople's Republic of China
| | - Junming Tan
- Department of OrthopedicsThe 72nd Army Hospital of the People's Liberation ArmyHuzhouPeople's Republic of China
| | - Wen Yuan
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
| | - Changgui Shi
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
| | - Guohua Xu
- Department of Orthopedic Surgery, Spine Center, Changzheng HospitalNaval Military Medical University (Second Military Medical University)ShanghaiPeople's Republic of China
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Qi H, Zhao Z, Gao X, Wang C, Zhang Z, Su D, Zu F, Xue R, Hou Z, Chen W, Zhang D. Normal spinopelvic parameters and correlation analysis in 217 asymptomatic children. 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/s00586-024-08311-9. [PMID: 38764090 DOI: 10.1007/s00586-024-08311-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/26/2024] [Revised: 04/22/2024] [Accepted: 05/11/2024] [Indexed: 05/21/2024]
Abstract
BACKGROUND Understanding spinal sagittal balance is crucial for assessing and treating spinal deformities in pediatric populations. OBJECTIVE The aim of the present observational study is to examine the parameters of sagittal alignment of the regional spine and spinopelvic region in asymptomatic pediatric populations and the characteristics of these parameters with age and sex. METHODS We enrolled 217 participants, consisting of 112 males (51.6%) and 105 females (48.4%), aged between 4 and 15 years, with an average age of 12.19 years. Pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, thoracic kyphosis, T1 slope, C7 slope, cervical sagittal vertical axis, and C2-7 Cobb angle were measured. Three spine surgeons conducted radiographic measurements utilizing the PACS software. The measurement reliability was assessed through ICCs. RESULTS Our results show significant age-related changes in pelvic tilt and cervical sagittal vertical axis, with notable gender differences in pelvic tilt, lumbar lordosis, and thoracic kyphosis. Girls have larger PT, boys have larger cSVA. PI, PT, and cSVA also differ among different age groups. Correlation analysis shows that a series of relationships that align with adult population patterns between pelvic incidence, pelvic tilt, sacral slope, lumbar lordosis, and thoracic kyphosis. CONCLUSION Significant variations in PT and cSVA across diverse age cohorts highlights notable disparities in the distribution of PT and cSVA values within the pediatric population. Gender-based differences in PT, LL, and TK and correlation in spinopelvic parameter could enhances our understanding of compensatory mechanisms.
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Affiliation(s)
- Hao Qi
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - ZengHui Zhao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - XianDa Gao
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Chenchen Wang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Zuzhuo Zhang
- Department of Radiology, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Dan Su
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Feiyu Zu
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Rui Xue
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Zhiyong Hou
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Wei Chen
- Key Laboratory of Biomechanics of Hebei Province, Shijiazhuang, 050051, China
- Department of Orthopaedic Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China
| | - Di Zhang
- Department of Spine Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, 050051, China.
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Henao Romero S, Sierra Peña JA, Diaz Orduz RC, Berbeo-Calderon ME. Horizontal Gaze Assessment: An Extensive Narrative Review. World Neurosurg 2024:S1878-8750(24)00788-5. [PMID: 38750886 DOI: 10.1016/j.wneu.2024.05.035] [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: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Bipedalism was a significant milestone in the evolutionary development of Homo sapiens sapiens, influencing neocortical evolution and subsequent behavioral changes. Coordinated visual and sensory inputs are crucial for posture, environmental interaction, and surgical planning, with horizontal gaze being a pivotal parameter. This narrative review aims to explore various geometric measures used to assess horizontal gaze in patients, highlighting their applications in surgical planning. METHODS A literature review was conducted in indexed databases using Mesh terms like "Cervical Vertebrae" and "Visual Fields" along with keywords such as "horizontal gaze" and "sagittal spine parameters." Among 477 initially identified articles, 41 were selected for inclusion after rigorous filtering. RESULTS The most recognized method for assessing horizontal gaze is the Chin Brow Vertical Angle (CBVA), initially described in patients with ankylosing spondylitis. Clinical photography is employed as a tool for CBVA calculation, while other measures like McGregor slope and Slope of the Line of Sight have been considered as alternatives to CBVA. Each method presents its unique advantages and limitations. CONCLUSIONS This review highlights the need for further research into horizontal gaze measurement methods. Developing novel approaches to determine horizontal gaze can significantly enhance surgical planning and, consequently, improve patient outcomes. The ongoing exploration of these geometric measures offers promising prospects for advancing the field and optimizing patient care.
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Affiliation(s)
- Sara Henao Romero
- Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia; Neurosurgery research seedbed, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | | | - Roberto Carlos Diaz Orduz
- Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Wu Y, Sun B, Huang Z, Han W, Zheng W, Zhang C, Han S, Li S, Gao B, Ye W. Novel Risk Factors for Cervical Facet Joint Degeneration in the Subaxial Cervical Spine: Correlation with Cervical Sagittal Alignment and Bone Mineral Density. World Neurosurg 2024; 185:e850-e859. [PMID: 38432510 DOI: 10.1016/j.wneu.2024.02.138] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2024] [Accepted: 02/24/2024] [Indexed: 03/05/2024]
Abstract
OBJECTIVE The impact of cervical sagittal alignment on cervical facet joint degeneration (CFD) and the risk factors for CFD in patients with degenerative cervical myelopathy (DCM) were investigated in the current study. METHODS A total of 250 surgical patients with DCM were recruited. The clinical data and radiographical characteristics, including CFD, cervical sagittal balance parameters, Hounsfield unit (HU) values, disc degeneration (DD), and modic change, were collected. The detailed correlation between these characteristics and CFD was analyzed. Characteristics, including CFD, were compared among the various cervical alignment types and different CFD groups. Finally, the risk factors for CFD were revealed via logistic regression. RESULTS CFD was prevalent in DCM patients. Age, cervical sagittal vertical axis (cSVA), range of motion, T1 slope, thoracic inlet angle, DD, HU value, and modic change correlated with CFD segmentally and globally (P < 0.05). The lordosis and sigmoid types had a significantly higher CFD prevalence (P < 0.05). Furthermore, the average CFD threshold for the severe CFD group was 1.625 (area under the curve, 0.958). Additionally, 167 patients with average CFD <1.625 and 83 patients with CFD of ≥1.625 were classified into the mild CFD group and severe CFD group, respectively. Finally, multivariate analysis was performed, and age, cSVA, HU value, modic change, and DD were determined to be independent risk factors for CFD. CONCLUSIONS The load distribution tends to shift to a more shear-like pattern in the sigmoid and kyphosis types and in those with a higher cSVA, thereby promoting CFD. Aging, cervical malalignment, low bone mineral density, DD, and modic change were revealed to result in high risks of CFD.
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Affiliation(s)
- Yuliang Wu
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Bo Sun
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Zhengqi Huang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Weitao Han
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wanli Zheng
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China; Department of Orthopedics, The Eighth Affiliated Hospital of Sun Yat-sen University, Shenzhen, China
| | - Chao Zhang
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shun Han
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Shuangxing Li
- Department of Orthopedics, Shenshan Medical Center, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Shanwei, China
| | - Bo Gao
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China
| | - Wei Ye
- Department of Spine Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, China.
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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.
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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
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Kedar E, Ezra D, Pelleg-Kallevag R, Stein D, Peled N, May H, Hershkovitz I. Capturing the cervical spine shape: Angular measurements versus geometric morphometric methods. Clin Anat 2024. [PMID: 38655670 DOI: 10.1002/ca.24166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 03/19/2024] [Accepted: 04/07/2024] [Indexed: 04/26/2024]
Abstract
The cervical spine manifests a wide shape variation. However, the traditional methods to evaluate the cervical spine curve were never tested against its actual shape. The study's main aim was to determine whether the shape classification of the cervical spine, based on traditional angular measurements, coincides with each other and with the shape captured by the 2D landmark-based geometric morphometric method. The study's second aim was to reveal the associations between the cervical spine shape and the demographic parameters, the head's position, and the spine's sagittal balance. CT scans of the cervical spine of 163 individuals were evaluated to achieve these goals. The shape was assessed by measuring the C2-C7 Cobb angle (CA), the C2-C7 posterior tangent angle (PTA), the curvedness of the arch, and by a 2D landmark-based geometric morphometric method. The position of the head and the sagittal balance of the spine were evaluated by measuring the foramen magnum-C2 Cobb angle (FMCA) and the T1 slope angle (T1SA), respectively. Based on the size of the angle measured, each individual was classified into one of the three cervical 'shape groups' (lordotic, straight, and kyphotic). We found that cervical lordosis was the dominant shape regardless of the measuring methods utilized (46.6%-54.6%), followed by straight neck (28.2%-30.1%), and kyphosis (15.3%-25.2%); however, about a third of the 163 individuals were classified into a different shape group using the CA and PTA methods. The cervical spine angle was sex-independent and age-dependent. The T1SA was significantly correlated with CA and PTA (r = 0.640 and r = 0.585, respectively; p < 0.001). In conclusion, the cervical spine shape evaluation is method-dependent and varies with age.
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Affiliation(s)
- Einat Kedar
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
| | - David Ezra
- School of Nursing Sciences, Tel Aviv Yaffo Academic College, Tel Aviv, Israel
| | - Ruth Pelleg-Kallevag
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
- Department of Physical Therapy, Zefat Academic College, Jerusalem, Israel
| | - Dan Stein
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
| | - Nathan Peled
- Radiology Department, Elisha Medical Hospital, Haifa, Israel
| | - Hila May
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
| | - Israel Hershkovitz
- Department of Anatomy and Anthropology, Faculty of Medical & Health Sciences, Tel Aviv University, Tel Aviv, Israel
- Shmunis Family Anthropology Institute, Dan David Center for Human Evolution and Biohistory Research, Tel Aviv University, Tel Aviv, Israel
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10
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Liu X, Astudillo Potes MD, Serdiuk V, Dashtdar B, Schreiber AC, Rezaei A, Lee Miller A, Hamouda AM, Shafi M, Elder BD, Lu L. Injectable bioactive poly(propylene fumarate) and polycaprolactone based click chemistry bone cement for spinal fusion in rabbits. J Biomed Mater Res A 2024. [PMID: 38644548 DOI: 10.1002/jbm.a.37725] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2024] [Revised: 04/02/2024] [Accepted: 04/04/2024] [Indexed: 04/23/2024]
Abstract
Degenerative spinal pathology is a widespread medical issue, and spine fusion surgeries are frequently performed. In this study, we fabricated an injectable bioactive click chemistry polymer cement for use in spinal fusion and bone regrowth. Taking advantages of the bioorthogonal click reaction, this cement can be crosslinked by itself eliminating the addition of a toxic initiator or catalyst, nor any external energy sources like UV light or heat. Furthermore, nano-hydroxyapatite (nHA) and microspheres carrying recombinant human bone morphogenetic protein-2 (rhBMP-2) and recombinant human vascular endothelial growth factor (rhVEGF) were used to make the cement bioactive for vascular induction and osteointegration. After implantation into a rabbit posterolateral spinal fusion (PLF) model, the cement showed excellent induction of new bone formation and bridging bone, achieving results comparable to autograft control. This is largely due to the osteogenic properties of nano-hydroxyapatite (nHA) and the released rhBMP-2 and rhVEGF growth factors. Since the availability of autograft sources is limited in clinical settings, this injectable bioactive click chemistry cement may be a promising alternative for spine fusion applications in addressing various spinal conditions.
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Affiliation(s)
- Xifeng Liu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Maria D Astudillo Potes
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Vitalii Serdiuk
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Babak Dashtdar
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Areonna C Schreiber
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Asghar Rezaei
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - A Lee Miller
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mahnoor Shafi
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Benjamin D Elder
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
- Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA
| | - Lichun Lu
- Department of Physiology and Biomedical Engineering, Mayo Clinic, Rochester, Minnesota, USA
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, Minnesota, USA
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11
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Lin A, Skaggs DL, Andras LM, Tolo V, Tamrazi B, Illingworth KD. Increasing Cervical Kyphosis Correlates With Cervical Degenerative Disk Disease in Patients With Adolescent Idiopathic Scoliosis. Spine (Phila Pa 1976) 2024; 49:486-491. [PMID: 37694562 DOI: 10.1097/brs.0000000000004824] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/12/2023] [Accepted: 08/23/2023] [Indexed: 09/12/2023]
Abstract
STUDY DESIGN Retrospective review. OBJECTIVE Our goal was to investigate the incidence of cervical degenerative disk disease (DDD) in patients with adolescent idiopathic scoliosis (AIS), before surgical intervention. SUMMARY OF BACKGROUND DATA AIS is often associated with thoracic hypokyphosis and compensatory cervical kyphosis. In adults, cervical kyphosis is associated with DDD. Although cervical kyphosis has been reported in up to 60% AIS patients, the association with cervical DDD has not been reported. MATERIALS AND METHODS A retrospective review was conducted from January 2014 to December 2019 of all consecutive AIS patients. Inclusion criteria were AIS patients over 10 years of age with cervical magnetic resonance imaging and anterior-posterior and lateral spine radiographs within 1 year of each other. Magnetic resonance imaging were reviewed for evidence of cervical DDD. Severity of cervical changes were graded using the Pfirrmann classification and by a quantitative measure of disk degeneration, the magnetic resonance signal intensity ratio. RESULTS Eighty consecutive patients were included (mean age: 14.1 years, SD=2.5 years). Increasing cervical kyphosis was significantly correlated to decreasing thoracic kyphosis ( r =0.49, P <0.01) and increasing major curve magnitude ( r =0.22, P =0.04). Forty-five patients (56%) had the presence of DDD (grades 2-4) with a mean cervical kyphosis of 11.1° (SD=9.5°, P <0.01). More cervical kyphosis was associated with more severe cervical DDD as graded by Pfirrmann classification level ( P <0.01). Increasing cervical kyphosis was also positively associated with increasing magnetic resonance signal intensity ratio ( P <0.01). Nine patients had ventral cord effacement secondary to DDD with a mean cervical kyphosis of 22.8° (SD=8.6°) compared with 2.6° (SD=11.2°) in those who did not ( P <0.01). CONCLUSIONS Cervical kyphosis was significantly associated with increasing severity of cervical DDD in patients with AIS. Patients with evidence of ventral cord effacement had the largest degree of cervical kyphosis with a mean of 22.8±8.6°. This is the first study to evaluate the association between cervical kyphosis in AIS with cervical DDD.
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Affiliation(s)
- Adrian Lin
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - David L Skaggs
- Department of Orthopaedics, Cedars-Sinai Medical Center, Los Angeles, CA
| | - Lindsay M Andras
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Vernon Tolo
- Children's Orthopaedic Center, Children's Hospital Los Angeles, Los Angeles, CA
| | - Benita Tamrazi
- Department of Radiology, Children's Hospital Los Angeles, Los Angeles, CA
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12
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Shen YW, Yang Y, Hong Y, Ding C, Rong X, Meng Y, Wang BY, Wu TK, Liu H. Association of Craniocervical Sagittal Alignment With the Outcomes of Cervical Disc Replacement. Global Spine J 2024; 14:846-855. [PMID: 36044545 DOI: 10.1177/21925682221124531] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVE To explore the association between craniocervical sagittal balance and clinical and radiological outcomes of cervical disc replacement (CDR). METHODS Patients who underwent 1-level and 2-level CDR were retrospectively analyzed. Clinical outcomes were evaluated using scores on the Japanese Orthopaedic Association (JOA), Visual Analogue Scale (VAS), and Neck Disability Index (NDI). The craniocervical sagittal alignment parameters, including the C0-C2 Cobb angle, C2-C7 Cobb angle, C2 slope, T1 slope, C2-C7 sagittal vertical axis (SVA), C1-C7 SVA, the center of gravity of the head (CGH)-C7 SVA, and range of motion (ROM) at the surgical segments were measured. RESULTS A total of 169 patients were involved. Significantly lower pre- and postoperative C2 slope and CGH-C7 SVA were found in arthroplasty levels with better ROMs. Patients with a higher preoperative C2 slope and CGH-C7 SVA had lower cervical lordosis and ROM after surgery. There were no significant differences in the clinical outcomes between patients with different sagittal balance statuses. C2-C7 SVA and CGH-C7 SVA were significantly associated with radiographic adjacent segment pathology (rASP). CONCLUSION Craniocervical sagittal balance is associated with cervical lordosis and ROM at the index level after CDR. A higher preoperative SVA is related to the presence and progression of rASP. A relationship between sagittal alignment and clinical outcomes was not observed.
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Affiliation(s)
- Yi-Wei Shen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yi Yang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ying Hong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Chen Ding
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Xin Rong
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Yang Meng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Bei-Yu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Ting-Kui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, Chengdu, China
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13
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Zhu Q, Li N, Ding Y, Zhang Z, Jiang W, Jiang T, Qiao Q, Qian Y, Cheng H. Incidence of Adjacent Segment Degeneration and Its Associated Risk Factors Following Anterior Cervical Discectomy and Fusion: A Meta-Analysis. World Neurosurg 2024; 183:e153-e172. [PMID: 38103684 DOI: 10.1016/j.wneu.2023.12.050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2023] [Revised: 12/08/2023] [Accepted: 12/09/2023] [Indexed: 12/19/2023]
Abstract
OBJECTIVE This study aimed to investigate the incidence of adjacent segment degeneration (ASD) and its associated risk factors in adults after anterior cervical discectomy and fusion (ACDF) surgery. METHODS An exhaustive search across multiple databases was conducted, including Embase, PubMed, Cochrane Library, and the Web of Science, to identify pertinent studies. We collected such patient data as demographic variables (including age, gender, body mass index), cervical spondylosis type (such as radiculopathy and myelopathy), diabetes status, smoking and drinking history, and radiological risk factors (such as preoperative ASD status, developmental spinal stenosis, T1 slope, and postoperative less cervical lordosis). Incidence estimates were calculated based on relevant data. Risk factors were assessed using odds ratios and weighted mean differences with 95% confidence intervals (CIs). RESULTS Our analysis incorporated a total of 21 studies for incidence analysis. The overall incidence of CASD following ACDF was found to be 11% and radiographical ASD was 30%. Old age (weighted mean difference = 3.21; 95% CI: 0.06, 6.36; P = 0.05), preoperative ASD status (odds ratio = 2.65; 95% CI: 1.53, 4.60; P < 0.01), developmental spinal stenosis (odds ratio = 2.46; 95% CI: 1.61, 3.77; P < 0.01), and postoperative reduction in cervical lordosis were identified as significant risk factors for the occurrence of CASD. CONCLUSIONS The incidence of CASD following ACDF was 11%. Risk factors for CASD included old age, preoperative adjacent segment degeneration, developmental spinal stenosis, and postoperative reduction in cervical lordosis. These findings provide valuable insights for the assessment of adjacent segment disease risk after ACDF, aiding surgeons in diagnosis and treatment decisions.
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Affiliation(s)
- Qianmiao Zhu
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ning Li
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yi Ding
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Zifeng Zhang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Wenkang Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Ting Jiang
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Qiujiang Qiao
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Yuhang Qian
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China
| | - Huilin Cheng
- Department of Neurosurgery, Zhongda Hospital, School of Medicine, Southeast University, Nanjing, Jiangsu, China.
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14
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Takakura K, Takasawa E, Mieda T, Tsukui T, Inomata K, Tomomatsu Y, Honda A, Chikuda H. Usefulness of the preoperative thoracic inlet angle in comparison to the T1 slope for predicting cervical kyphosis after laminoplasty. 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; 33:1179-1186. [PMID: 38170271 DOI: 10.1007/s00586-023-08095-4] [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: 07/23/2023] [Revised: 11/02/2023] [Accepted: 12/09/2023] [Indexed: 01/05/2024]
Abstract
PURPOSE Thoracic inlet angle (TIA) is a sagittal radiographic parameter with a constant value regardless of posture and is significantly correlated with the sagittal balance of the cervical spine. However, the practical use of TIA has not been studied. This study aimed to investigate the usefulness of the preoperative TIA for predicting the development of kyphotic deformity after cervical laminoplasty in comparison to the preoperative T1 slope (T1S). METHODS A total of 98 patients who underwent cervical laminoplasty without preoperative kyphotic alignment were included (mean age, 73.7 years; 41.8% female). Radiography was evaluated before surgery and at the 2-year follow-up examination. The cervical sagittal parameters were measured on standing radiographs, and the TIA was measured on T2-weighted MRI in a supine position. Cervical alignment with a C2-C7 angle of ≥ 0° was defined as lordosis, and that with an angle of < 0° was defined as kyphosis. RESULTS Postoperative kyphosis occurred in 11 patients (11.2%). Preoperatively, the kyphosis group showed significantly lower values in the T1S (23.5° vs. 30.3°, p = 0.034) and TIA (76.1° vs. 81.8°, p = 0.042). We performed ROC curve analysis to clarify the impact of the preoperative TIA and T1S on kyphotic deformity after laminoplasty. The optimal cutoff angles for TIA and T1S were 68° and 19°, respectively, with similar diagnostic accuracy. CONCLUSION This study demonstrated the clinical utility of the preoperative TIA for predicting the risk of postoperative kyphotic deformity after cervical laminoplasty. These findings suggest the importance of the preoperative assessment of thoracic inlet alignment in cervical spine surgery.
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Affiliation(s)
- Kenta Takakura
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Eiji Takasawa
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan.
| | - Tokue Mieda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Toshiki Tsukui
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Kazuhiro Inomata
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Yusuke Tomomatsu
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Akira Honda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
| | - Hirotaka Chikuda
- Department of Orthopaedic Surgery, Gunma University Graduate School of Medicine, 3-39-22 Showa, Maebashi, Gunma, 371-8511, Japan
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15
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Suzuki H, Funaba M, Fujimoto K, Ichihara Y, Nishida N, Sakai T. Current Concepts of Cervical Spine Alignment, Sagittal Deformity, and Cervical Spine Surgery. J Clin Med 2024; 13:1196. [PMID: 38592040 PMCID: PMC10932435 DOI: 10.3390/jcm13051196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/08/2024] [Revised: 01/29/2024] [Accepted: 02/17/2024] [Indexed: 04/10/2024] Open
Abstract
There are not many reports on cervical spine alignment, and only a few analyze ideal surgical approaches and optimal amounts of correction needed for the various types of deformity. We comprehensively reviewed the present literature on cervical spinal deformities (with or without myelopathy) and their surgical management to provide a framework for surgical planning. A general assessment of the parameters actually in use and correlations between cervical and thoracolumbar spine alignment are provided. We also analyzed posterior, anterior, and combined cervical surgical approaches and indications for the associated techniques of laminoplasty, laminectomy and fusion, and anterior cervical discectomy and fusion. Finally, on the basis of the NDI, SF-36, VAS, and mJOA questionnaires, we fully evaluated the outcomes and measures of postoperative health-related quality of life. We found the need for additional prospective studies to further enhance our understanding of the importance of cervical alignment when assessing and treating cervical deformities with or without myelopathy. Future studies need to focus on correlations between cervical alignment parameters, disability scores, and myelopathy outcomes. Through this comprehensive literature review, we offer guidance on practical and important points of surgical technique, cervical alignment, and goals surgeons can meet to improve symptoms in all patients.
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Affiliation(s)
- Hidenori Suzuki
- Department of Orthopedics Surgery, Graduate School of Medicine, Yamaguchi University, Yamaguchi 755-8505, Japan; (M.F.); (K.F.); (Y.I.); (N.N.); (T.S.)
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16
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Abdelmalek G, Coban D, Patel N, Changoor S, Sahai N, Sinha K, Hwang K, Emami A. Are Patients With Segmental Cervical Kyphosis Appropriate Candidates for Cervical Disc Arthroplasty (CDA)? A Clinical and Radiographic Analysis Compared to Anterior Cervical Discectomy and Fusion (ACDF). Global Spine J 2024:21925682241232616. [PMID: 38359817 DOI: 10.1177/21925682241232616] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/17/2024] Open
Abstract
STUDY DESIGN Retrospective cohort study. OBJECTIVES To compare the clinical and radiographic outcomes of Anterior Cervical Discectomy and fusion (ACDF) and cervical disc arthroplasty (CDA) in patients with preoperative segmental kyphosis. METHODS Patients with segmental cervical kyphosis at the operative levels undergoing 1- or 2-level ACDF or CDA from 2017 to 2020 with 2 years of follow were identified. Patient demographics, perioperative data, complication rates, radiographic findings and reported outcomes were analyzed. RESULTS A total of 48 patients met inclusion criteria and were included in our study (ACDF: n = 24, CDA: n = 24). Patient demographic data between the 2 cohorts was similar expect for proportion of males (ACDF: 62.5% vs CDA: 33.3%, P = .043). There was no statistical significance in the change of segmental lordosis (ACDF: +8.09° vs CDA: +5.88°, P = .075) between the preoperative and final postoperative period. Additionally, the change in cervical lordosis was similar between groups (ACDF:+ 9.86° vs CDA: +7.60°, P = .226). VAS scores were similar between the 2 groups at every follow-up interval. NDI scores were significantly different at the 6-month, 12 month and the final follow-up. Mean improvements between preoperative and final postoperative periods were statistically superior in the CDA cohort compared to the ACDF cohort (ACDF: 22.8 vs CDA: 24.1, P = .0375). CONCLUSION CDA was superior to ACDF in regards to NDI scores following index procedure in patients with preoperative segmental cervical kyphosis. Those in the CDA cohort had similar complication rates, revision rates and radiographic outcomes as those who underwent ACDF.
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Affiliation(s)
- George Abdelmalek
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Daniel Coban
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Neil Patel
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Stuart Changoor
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Nikhil Sahai
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Kumar Sinha
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Ki Hwang
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
| | - Arash Emami
- Department of Orthopaedic Surgery, St Joseph's University Medical Center, Paterson, NJ, USA
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17
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Stanners M, O'Riordan M, Hartley L, Theodosiou E, Souppez JB, Gardner A. The mechanical properties of the spinal cord: a protocol for a systematic review of previous testing procedures and results. Syst Rev 2024; 13:56. [PMID: 38326889 PMCID: PMC10848440 DOI: 10.1186/s13643-023-02417-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Accepted: 12/05/2023] [Indexed: 02/09/2024] Open
Abstract
BACKGROUND Spinal cord compression is a pathology seen in routine clinical practice. However, there remain a number of unanswered questions around both the understanding of the pathogenesis and the best method of treatment of the condition. This is partly due to the issues of the real-life testing of the physical properties of the spinal cord, either through the use of cadaveric human specimens or through animal testing, both of which have methodological, as well as ethical, issues. DESIGN AND METHODS This paper details a protocol for a systematic review of the literature on the mechanical properties of the spinal cord. We will conduct a literature search of a number of electronic databases, along with the grey literature, as a single-stage search. All literature will be screened for appropriate studies which will then be reviewed fully to extract relevant information on the methodology and mechanics of the reported testing along with the results. Two reviewers will separately screen and extract the data, with a comparison of results to ensure concordance. Conflicts will be resolved through discussion and independent arbitration as required. The methodological quality of the studies will be assessed within the ARRIVE guidelines using the CAMARADES framework and SYRCLE risk of bias tool. A narrative synthesis will be created with the appropriate tables to describe the demographics and findings of the included studies. DISCUSSION The systematic review described here will form the basis of an understanding of the current literature around the physical properties of the spinal cord. This will allow future work to develop a physical model of the spinal cord, which is translatable to patients for analysis and testing in a controlled and repeatable fashion. Such a model would be the basis for further clinical research to improve outcomes from this condition. TRIAL REGISTRATION Prospero registration number: CRD42022361933.
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Affiliation(s)
| | | | - Laura Hartley
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK
| | | | | | - Adrian Gardner
- Aston University, Aston Street, Birmingham, B4 7ET, UK.
- The Royal Orthopaedic Hospital NHS Foundation Trust, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
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18
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Burkhardt BW, Kerolus MG, Witiw CD, Oertel JM, Fessler RG. Anterior cervical discectomy and fusion with a dynamic translational plating versus a rigid carbon fiber reinforced PEEK plating system - a comparison study of radiographic parameters. Br J Neurosurg 2024; 38:99-103. [PMID: 34524041 DOI: 10.1080/02688697.2021.1976394] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2020] [Accepted: 08/31/2021] [Indexed: 10/20/2022]
Abstract
PURPOSE In this study the authors compare the radiographic findings of patients undergoing 1-3 level ACDF a rigid CFRP plate and a translational titanium plate system with a focus on radiographic alignment. MATERIAL AND METHODS A retrospective review 70 consecutive patients undergoing a 1 to 3 level ACDF for cervical spondylosis was conducted. 2 groups depending on the cervical plating system were created including 38 patients in group 1 (dynamic plate) and 32 in group 2 (rigid CFRP plate). Plain neutral radiographs preoperatively, immediately after surgery and at most recent follow-up were used to assess parameters on sagittal alignment, fusion height, adjacent segment ossification (ASO), fusion rate and implant failure. RESULTS There were no significant differences between groups preoperatively. Both groups had a more than 12 months follow-up (p = 0.327). Improvement of C2-7 lordosis was seen in both groups but only in group 1 it reached statistical significance at final follow-up. Significant improvement in sagittal segmental alignment was noted in both groups following surgery. A significant sagittal correction of 5.5 ± 9.1 degrees (p = 0.002) was maintained through follow-up only in group 2. No significantly different was seen for segmental fusion rates and loss of fusion height. There were no instances of implant failure within both groups. Worsening of ASO was 20% for both groups. CONCLUSION ACDF allows for correction and maintenance of cervical alignment. Rigid rigid plate appears more effective at maintaining segmental lordotic correction. The fusion rate and implant failure was not different for both groups.
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Affiliation(s)
- Benedikt W Burkhardt
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Mena G Kerolus
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
| | - Christopher D Witiw
- Division of Neurosurgery, University of Toronto, St. Michael's Hospital, Toronto, Canada
| | - Joachim M Oertel
- Department of Neurosurgery, Saarland University Medical Center and Saarland University Faculty of Medicine, Homburg, Germany
| | - Richard G Fessler
- Department of Neurological Surgery, Rush University Medical Center, Chicago, IL, USA
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Liu T, Tian S, Zhang J, He M, Deng L, Ding W, Wang Z, Yang D. Comparison of Cervical Sagittal Parameters among Patients with Neck Pain and Patients with Cervical Spondylotic Radiculopathy and Cervical Spondylotic Myelopathy. Orthop Surg 2024; 16:329-336. [PMID: 38093558 PMCID: PMC10834188 DOI: 10.1111/os.13951] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/08/2023] [Revised: 10/19/2023] [Accepted: 10/24/2023] [Indexed: 02/03/2024] Open
Abstract
OBJECTIVE Previous studies have shown that cervical sagittal alignment is strongly associated with cervical deformity, myelopathy, and cervical adjacent-segmental disease, and these cervical sagittal parameters are correlated with health-related quality of life. However, less attention has been paid to cervical sagittal balance in various cervical disorders. This study aimed to compare cervical sagittal parameters between patients with nonspecific neck pain (NS-NP) and patients with cervical spondylotic radiculopathy (CSR) and cervical spondylotic myelopathy (CSM). METHODS We retrospectively examined 236 patients from between January 2020 and October 2022. We divided them into three groups (NS-NP, CSR, and CSM) and collected general information and cervical sagittal parameters for these patients. The variation of parameters between the size of these parameters and gender differences was analyzed. Pearson's or Spearman's correlation was applied to analyze the association of cervical sagittal parameters of all patients between the three groups. RESULTS There were significant differences in age and sex among the three groups (p < 0.001), with the NS-NP group being the youngest and NS-NP being more common in women. The parameters of cervical sagittal position significantly differed among the three groups (p < 0.05). Pearson's or Spearman's correlation result showed that the C2-C7 Cobb angle was negatively associated with the C2-C7 sagittal vertical angle (SVA), and the C2-C7 Cobb angle and T1 slope (T1s) were negatively associated with the spino-cranial angle (SCA). There was a positive correlation between the C2-C7 Cobb angle and C7 slope (C7s), C2-C7 SVA and T1s, C2-C7 SVA and SCA, and C7s and T1s. CONCLUSION This study showed that between the three groups, patients with nonspecific neck pain had smaller SCA, and among patients with NS-NP, women had more significant SCA. The smaller anteroposterior diameter of the thorax in women might explain this difference.
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Affiliation(s)
- Tao Liu
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Shuo Tian
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Jianzhou Zhang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Mengzi He
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Longlian Deng
- Department of Gastrointestinal Surgery, Bayannur Hospital, Inner Mongolia Medical University, Bayannur, China
| | - Wenyuan Ding
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
| | - Zheng Wang
- Department of Orthopaedics, Xuanwu Hospital, Capital Medical University, Beijing, China
| | - Dalong Yang
- Department of Spinal Surgery, The Third Hospital of Hebei Medical University, Shijiazhuang, China
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Gallagher DO, Taghlabi KM, Bondar K, Saifi C. Degenerative Cervical Myelopathy: A Concept Review and Clinical Approach. Clin Spine Surg 2024; 37:1-8. [PMID: 38285428 DOI: 10.1097/bsd.0000000000001463] [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: 09/04/2022] [Accepted: 05/09/2023] [Indexed: 01/30/2024]
Abstract
STUDY DESIGN Narrative review. OBJECTIVE To provide an overview of the evaluation and diagnosis of degenerative cervical myelopathy (DCM). SUMMARY OF BACKGROUND DATA DCM describes several etiologies of degenerative, nontraumatic spinal cord impairment. Early diagnosis and intervention can decrease neurological decline. METHODS An extensive literature review was conducted. RESULTS The incidence and prevalence of DCM are increasing worldwide. Asymptomatic spinal cord compression can progress to cervical myelopathy. Static and dynamic factors contribute to spinal cord compression. Patients frequently present with decreased manual dexterity, gait instability, and neck pain. On physical exam, patients frequently present with upper motor neuron signs, a Lhermitte sign, a failed Romberg test, global proprioceptive dysfunction, and decreased pain sensation. Anatomic variation may complicate physical exam interpretation. The modified Japanese Orthopaedic Association Scale and Nurick Classification, based on functional impairment, provide diagnostic utility. Magnetic Resonance Imaging imaging is useful in narrowing the differential diagnosis, evaluating the severity of neurological impairment, and predicting disease progression. CONCLUSIONS Understanding the pathophysiology of DCM and the diagnostic utility of the signs and symptoms of DCM is critical. The decision for anterior cervical discectomy and fusion (ACDF), laminoplasty, or combined ACDF and posterior cervical fusion is individualized for each patient.
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Affiliation(s)
- Daniel O Gallagher
- Department of Education, Rutgers Robert Wood Johnson Medical School, New Brunswick, NJ
| | | | - Kevin Bondar
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
| | - Comron Saifi
- Department of Orthopedic Surgery and Sports Medicine, Houston Methodist Hospital, Houston, TX
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Passias PG, Naessig S, Williamson TK, Lafage R, Lafage V, Smith JS, Gupta MC, Klineberg E, Burton DC, Ames C, Bess S, Shaffrey C, Schwab FJ. Compensation from mild and severe cases of early proximal junctional kyphosis may manifest as progressive cervical deformity at two year follow-up. Spine Deform 2024; 12:221-229. [PMID: 38041769 DOI: 10.1007/s43390-023-00763-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 07/29/2023] [Indexed: 12/03/2023]
Abstract
BACKGROUND Postoperative reciprocal changes (RC) in the cervical spine associated with varying factors of proximal junctional kyphosis (PJK) following fusions of the thoracopelvic spine are poorly understood. PURPOSE Explore reciprocal changes in the cervical spine associated with varying factors (severity, progression, patient age) of PJK in patients undergoing adult spinal deformity (ASD) correction. PATIENTS AND METHODS Retrospective review of a multicenter ASD database. INCLUSION ASD patients > 18 y/o, undergoing fusions from the thoracic spine (UIV: T6-T12) to the pelvis with two-year radiographic data. ASD was defined as: Coronal Cobb angle ≥ 20°, Sagittal Vertical Axis ≥ 5 cm, Pelvic Tilt ≥ 25°, and/or Thoracic Kyphosis ≥ 60°. PJK was defined as a ≥ 10° measure of the sagittal Cobb angle between the inferior endplate of the UIV and the superior endplate of the UIV + 2. Patients were grouped by mild (M; 10°-20°) and severe (S; > 20°) PJK at one year. Propensity Score Matching (PSM) controlled for CCI, age, PI and UIV. Unpaired and paired t test analyses determined difference between RC parameters and change between time points. Pearson bi-variate correlations analyzed associations between RC parameters (T4-T12, TS-CL, cSVA, C2-Slope, and T1-Slope) and PJK descriptors. RESULTS 284 ASD patients (UIV: T6: 1.1%; T7: 0.7%; T8: 4.6%; T9: 9.9%; T10: 58.8%; T11: 19.4%; T12: 5.6%) were studied. PJK analysis consisted of 182 patients (Mild = 91 and Severe = 91). Significant difference between M and S groups were observed in T4-T12 Δ1Y(- 16.8 v - 22.8, P = 0.001), TS-CLΔ1Y(- 0.6 v 2.8, P = 0.037), cSVAΔ1Y(- 1.8 v 1.9, P = 0.032), and C2 slopeΔ1Y(- 1.6 v 2.3, P = 0.022). By two years post-op, all changes in cervical alignment parameters were similar between mild and severe groups. Correlation between age and cSVAΔ1Y(R = 0.153, P = 0.034) was found. Incidence of severe PJK was found to correlate with TS-CLΔ1Y(R = 0.142, P = 0.049), cSVAΔ1Y(R = 0.171, P = 0.018), C2SΔ1Y(R = 0.148, P = 0.040), and T1SΔ2Y(R = 0.256, P = 0.003). CONCLUSIONS Compensation within the cervical spine differed between individuals with mild and severe PJK at one year postoperatively. However, similar levels of pathologic change in cervical alignment parameters were seen by two years, highlighting the progression of cervical compensation due to mild PJK over time. These findings provide greater evidence for the development of cervical deformity in individuals presenting with proximal junctional kyphosis.
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Affiliation(s)
- Peter G Passias
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA.
| | - Sara Naessig
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Tyler K Williamson
- Department of Orthopedic Surgery, NYU Langone Health, New York, NY, 10003, USA
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | | | - Douglas C Burton
- Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Shay Bess
- Rocky Mountain Scoliosis and Spine, Denver, CO, USA
| | | | - Frank J Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
- Department of Orthopedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
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22
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Karabag H, Iplikcioglu AC. Upper and lower cervical alignment parameters measured on supine magnetic resonance imaging with the occipital slope as a key marker of cervical alignment. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2024; 15:61-65. [PMID: 38644912 PMCID: PMC11029111 DOI: 10.4103/jcvjs.jcvjs_185_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2023] [Accepted: 01/09/2024] [Indexed: 04/23/2024] Open
Abstract
Objectives Cervical spine alignment is evaluated by measuring the cervical angles or parameters on standing plain radiography. In this study, we aimed to evaluate mainly the upper cervical alignment and the correlation between upper and lower cervical sagittal parameters measured on supine magnetic resonance imaging (MRI). Materials and Methods Cervical MRIs of 210 outpatients were reviewed to measure the upper and lower cervical sagittal parameters. Their mean values were compared with normative values measured on standing X-ray from the literature. Correlations between the parameters were analyzed using the Pearson's correlation coefficient. Results The C0 slope was correlated with all other parameters, except for the C2-7 sagittal vertical axis. The strongest correlations (r > 0.500) were between the CL and C2 slope, between the CO2 and C0 slope, and between the C2 slope and C0 slope. Conclusion On supine MRI, the C0 slope is a key marker of cervical spinal alignment. A strong correlation was observed between the C2 slope and C0 slope; therefore, the relationship between upper and lower cervical alignment could be assessed using slopes on MRI.
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Affiliation(s)
- Hamza Karabag
- Department of Neurosurgery, Faculty of Medicine, Harran University, Şanlıurfa, İstanbul, Turkey
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Wang C, Ni M, Tian S, Ouyang H, Liu X, Fan L, Dong P, Jiang L, Lang N, Yuan H. Deep learning model for measuring the sagittal Cobb angle on cervical spine computed tomography. BMC Med Imaging 2023; 23:196. [PMID: 38017414 PMCID: PMC10685593 DOI: 10.1186/s12880-023-01156-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/05/2023] [Accepted: 11/15/2023] [Indexed: 11/30/2023] Open
Abstract
PURPOSES To develop a deep learning (DL) model to measure the sagittal Cobb angle of the cervical spine on computed tomography (CT). MATERIALS AND METHODS Two VB-Net-based DL models for cervical vertebra segmentation and key-point detection were developed. Four-points and line-fitting methods were used to calculate the sagittal Cobb angle automatically. The average value of the sagittal Cobb angle was manually measured by two doctors as the reference standard. The percentage of correct key points (PCK), matched samples t test, intraclass correlation coefficient (ICC), Pearson correlation coefficient, mean absolute error (MAE), and Bland‒Altman plots were used to evaluate the performance of the DL model and the robustness and generalization of the model on the external test set. RESULTS A total of 991 patients were included in the internal data set, and 112 patients were included in the external data set. The PCK of the DL model ranged from 78 to 100% in the test set. The four-points method, line-fitting method, and reference standard measured sagittal Cobb angles were - 1.10 ± 18.29°, 0.30 ± 13.36°, and 0.50 ± 12.83° in the internal test set and 4.55 ± 20.01°, 3.66 ± 18.55°, and 1.83 ± 12.02° in the external test set, respectively. The sagittal Cobb angle calculated by the four-points method and the line-fitting method maintained high consistency with the reference standard (internal test set: ICC = 0.75 and 0.97; r = 0.64 and 0.94; MAE = 5.42° and 3.23°, respectively; external test set: ICC = 0.74 and 0.80, r = 0.66 and 0.974, MAE = 5.25° and 4.68°, respectively). CONCLUSIONS The DL model can accurately measure the sagittal Cobb angle of the cervical spine on CT. The line-fitting method shows a higher consistency with the doctors and a minor average absolute error.
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Affiliation(s)
- Chunjie Wang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Ming Ni
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Shuai Tian
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Hanqiang Ouyang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Xiaoming Liu
- Beijing United Imaging Research Institute of Intelligent Imaging, Beijing, 100089, China
| | - Lianxi Fan
- United Imaging Intelligence (Beijing) Co., Ltd., Beijing, 100089, China
| | - Pei Dong
- United Imaging Intelligence (Beijing) Co., Ltd., Beijing, 100089, China
| | - Liang Jiang
- Department of Orthopedics, Peking University Third Hospital, Beijing, 100191, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, 100191, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, 100191, China
| | - Ning Lang
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China
| | - Huishu Yuan
- Department of Radiology, Peking University Third Hospital, 49 Huayuan North Road, Haidian District, Beijing, 100191, China.
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An S, Lee JB, Lee S, Oh Y, Park JY, Hur JW. True Continuous Segment of Ossification of Posterior Longitudinal Ligament is Protective Against Postoperative Early Kyphosis Progression After Laminoplasty. Neurosurgery 2023:00006123-990000000-00973. [PMID: 37991350 DOI: 10.1227/neu.0000000000002773] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2023] [Accepted: 10/09/2023] [Indexed: 11/23/2023] Open
Abstract
BACKGROUND AND OBJECTIVES Ossification of the posterior longitudinal ligament (OPLL) is a potentially catastrophic disease. Laminoplasty (LP) is a common surgical intervention, but postoperative kyphosis progression is a major complication, for which various risk factors have been identified and used in surgical decision-making. Our focus is on the ability of OPLL with specific morphological traits, designated as the true continuous segment (TCS), to stabilize alignment and prevent postoperative kyphosis after LP. METHODS This retrospective case-control study included patients who underwent cervical LP for OPLL treatment with a minimum 1-year follow-up. Demographic, operative, and radiographic parameters were analyzed. TCS is defined as a continuous segment of OPLL that spans the disk space more than half of the adjacent vertebral body height without crack, or OPLL segment attached to both upper and lower adjacent vertebral bodies by bridging, or obvious interbody autofusion, and is identified from preoperative computed tomography. A subgroup analysis for preoperatively lordotic patients, divided into 2 groups based on cervical alignment at the final follow-up, was conducted to identify risk factors for kyphosis progression. Difference analysis, linear regression analysis for loss of lordosis (LoL), and logistic regression analysis for kyphosis progression were used. RESULTS A total of 84 patients were identified. Among them, 78 patients with preoperatively lordotic alignment were divided into 2 groups: those who maintained lordotic alignment (n = 60) and those who progressed to kyphosis (n = 18). Regression analyses revealed a significant protective effect of TCS count against LoL and postoperative kyphosis, with a TCS count of 3 or more conclusively preventing kyphosis (sensitivity 1.000, specificity 0.283, area under the curve 0.629). CONCLUSION For patients with OPLL, TCS was shown to protect against the LoL after LP. Therefore, TCS should be identified and considered when planning surgical treatment for OPLL.
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Affiliation(s)
- Sungjae An
- Department of Neurosurgery, College of Medicine, Korea University, Seoul, Republic of Korea
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Chen S, Huang K, Liu H, Wu T, He J, Yao M, Wang B. Overloaded vertebral body: a unique radiographic phenomenon following multilevel anterior cervical discectomy and fusion. J Orthop Surg Res 2023; 18:879. [PMID: 37980487 PMCID: PMC10657634 DOI: 10.1186/s13018-023-04365-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/16/2023] [Accepted: 11/11/2023] [Indexed: 11/20/2023] Open
Abstract
PURPOSE Because previous studies have not focused on postoperative cervical collapse, the purpose of the present study was to introduce the overloaded vertebral body (OVB) phenomenon following multilevel zero-profile anterior cervical discectomy and fusion (ACDF) as well as to investigate its effects on radiographic outcomes. METHODS We conducted a retrospective study involving patients who underwent ACDF. A total of 55 patients were included in the analysis, including 110 OVB and 110 non-OVB. The evaluated vertebral parameters included the vertebral cross-sectional area (CSA), wedge angle (WA), vertebral height [anterior (AH) and posterior (PH)] and anterior-posterior vertebral diameter [upper (UD) and lower (LD)]. RESULTS The CSA and WA were significantly lower in the OVB group than in the non-OVB group at 3, 6, and 12 months after surgery as well as at the final follow-up (p < 0.01). The AH of the OVB group was significantly lower at 3, 6, and 12 months after surgery as well as at the final follow-up compared to 1 week after surgery (p < 0.01). CONCLUSIONS OVB, a new phenomenon following multilevel ACDF, is defined as the cervical vertebral body located in the middle of the surgical segments in multilevel anterior cervical spine surgery. Statistical analysis of vertebral parameters, including CSA, WA, AH, PH, UD, and LD, showed that OVB occurs mainly at the anterior edge of the vertebra and that its largest radiographic manifestation is the loss of height at the anterior edge of the vertebra in the early postoperative period.
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Affiliation(s)
- Shihao Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Kangkang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Junbo He
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Minghe Yao
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
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Li H, Ma Z, Wang X, Yuan S, Tian Y, Wang L, Liu X. Comparative study of preoperative sagittal alignment between patients with multisegment cervical ossification of the posterior longitudinal ligament and cervical spondylotic myelopathy. Spine J 2023; 23:1667-1673. [PMID: 37355047 DOI: 10.1016/j.spinee.2023.06.390] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Revised: 06/03/2023] [Accepted: 06/17/2023] [Indexed: 06/26/2023]
Abstract
BACKGROUND CONTEXT Preoperative sagittal alignment is of great significance in the development of spinal deformities, degenerative diseases, preoperative planning, postoperative clinical evaluation, and functional recovery. However, few reports have focused on the difference in preoperative sagittal alignment between patients with ossification of the posterior longitudinal ligament (OPLL) and patients with cervical spondylotic myelopathy (CSM). PURPOSE To compare preoperative sagittal alignment between patients with multisegment cervical OPLL and multilevel CSM. STUDY DESIGN Retrospective study. PATIENT SAMPLE A total of 243 patients were included in this study. OUTCOME MEASURES The outcome measures were the Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, number of hand actions in 10 seconds, hand-grip strength, C2 to C7 Cobb angle, C2 to C5 Cobb angle, C5 to C7 Cobb angle, C2 to C7 sagittal vertical axis, C7 slope, T1 slope, K-line, K-line tilt, and range of motion (ROM). METHODS The outcome measures were calculated in the OPLL group and CSM group and the data were analyzed using the unpaired t-test, χ² test, and one-way analysis of variance. RESULTS A total of 243 patients (136 men, 107 women; mean age, 59.1±10.6 years) underwent surgical treatment from September 2013 to December 2021. In total, 123 patients were diagnosed with multisegment cervical OPLL, including continuous type (n=39), segmental type (n=38), and mixed type (n=46). The remaining 120 patients had multisegment CSM. The disease course in the OPLL group was significantly shorter than that in the CSM group (p<.05). Among the above preoperative measurements, the JOA score, number of hand actions in 10 seconds, hand-grip strength, and VAS score were not significantly different between the two groups (p>.05). The C2 to C7 Cobb angle was significantly larger in the OPLL than CSM group (17.7°±9.2° and 14.9°±9.3°, respectively; p< .05), as was the C5 to C7 Cobb angle (10.0°±6.3° and 7.5°±6.1°, respectively; p<.05). The ROM was significantly smaller in the OPLL than CSM group (33.1°±8.1° and 40.1°±10.9°, respectively; p<.001). Within the OPLL group, the ROM was significantly smaller in the continuous type than in the segmental type (p<.05). CONCLUSION Patients with multisegment cervical OPLL have greater lordotic preoperative sagittal alignment and smaller preoperative ROM than patients with CSM.
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Affiliation(s)
- Hao Li
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Zhihao Ma
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Xia Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Suomao Yuan
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Yonghao Tian
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Lianlei Wang
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China
| | - Xinyu Liu
- Department of Orthopedics, Qilu Hospital of Shandong University, Wenhua West Rd 107#, Jinan, Shandong, 250012, P. R. China.
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Song SY, Seo MS, Kim CW, Kim YH, Yoo BC, Choi HJ, Seo SH, Kang SW, Song MG, Nam DC, Kim DH. AI-Driven Segmentation and Automated Analysis of the Whole Sagittal Spine from X-ray Images for Spinopelvic Parameter Evaluation. Bioengineering (Basel) 2023; 10:1229. [PMID: 37892959 PMCID: PMC10604000 DOI: 10.3390/bioengineering10101229] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/20/2023] [Revised: 10/15/2023] [Accepted: 10/18/2023] [Indexed: 10/29/2023] Open
Abstract
Spinal-pelvic parameters are utilized in orthopedics for assessing patients' curvature and body alignment in diagnosing, treating, and planning surgeries for spinal and pelvic disorders. Segmenting and autodetecting the whole spine from lateral radiographs is challenging. Recent efforts have employed deep learning techniques to automate the segmentation and analysis of whole-spine lateral radiographs. This study aims to develop an artificial intelligence (AI)-based deep learning approach for the automated segmentation, alignment, and measurement of spinal-pelvic parameters through whole-spine lateral radiographs. We conducted the study on 932 annotated images from various spinal pathologies. Using a deep learning (DL) model, anatomical landmarks of the cervical, thoracic, lumbar vertebrae, sacrum, and femoral head were automatically distinguished. The algorithm was designed to measure 13 radiographic alignment and spinal-pelvic parameters from the whole-spine lateral radiographs. Training data comprised 748 digital radiographic (DR) X-ray images, while 90 X-ray images were used for validation. Another set of 90 X-ray images served as the test set. Inter-rater reliability between orthopedic spine specialists, orthopedic residents, and the DL model was evaluated using the intraclass correlation coefficient (ICC). The segmentation accuracy for anatomical landmarks was within an acceptable range (median error: 1.7-4.1 mm). The inter-rater reliability between the proposed DL model and individual experts was fair to good for measurements of spinal curvature characteristics (all ICC values > 0.62). The developed DL model in this study demonstrated good levels of inter-rater reliability for predicting anatomical landmark positions and measuring radiographic alignment and spinal-pelvic parameters. Automated segmentation and analysis of whole-spine lateral radiographs using deep learning offers a promising tool to enhance accuracy and efficiency in orthopedic diagnostics and treatments.
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Affiliation(s)
- Sang-Youn Song
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Min-Seok Seo
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Chang-Won Kim
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Yun-Heung Kim
- Deepnoid. Inc., Seoul 08376, Republic of Korea; (Y.-H.K.); (B.-C.Y.); (H.-J.C.)
| | - Byeong-Cheol Yoo
- Deepnoid. Inc., Seoul 08376, Republic of Korea; (Y.-H.K.); (B.-C.Y.); (H.-J.C.)
| | - Hyun-Ju Choi
- Deepnoid. Inc., Seoul 08376, Republic of Korea; (Y.-H.K.); (B.-C.Y.); (H.-J.C.)
| | - Sung-Hyo Seo
- Department of Biomedical Research Institute, Gyeongsang National University Hospital, Jinju 52727, Republic of Korea;
| | - Sung-Wook Kang
- Precision Mechanical Process and Control R&D Group, Korea Institute of Industrial Technology, Seoul 06211, Republic of Korea;
| | - Myung-Geun Song
- Department of Orthopaedic Surgery, College of Medicine, Inha University Hospital, Incheon 22212, Republic of Korea;
| | - Dae-Cheol Nam
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
| | - Dong-Hee Kim
- Department of Orthopaedic Surgery, Institute of Medical Science, Gyeongsang National University Hospital and Gyeongsang National University School of Medicine, Jinju 52727, Republic of Korea; (S.-Y.S.); (M.-S.S.); (C.-W.K.)
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Oh BH, Kim JY, Lee JB, Kim IS, Hong JT, Sung JH, Lee HJ. Analysis of sagittal parameters for easier and more accurate determination of cervical spine alignment. Medicine (Baltimore) 2023; 102:e35511. [PMID: 37832123 PMCID: PMC10578776 DOI: 10.1097/md.0000000000035511] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 09/14/2023] [Indexed: 10/15/2023] Open
Abstract
Cross-sectional comparative study. This study aimed to analyze the role of cervical parameters, in terms of the perception process, when evaluating cervical sagittal balance on an X-ray image. Reports on the role of cervical parameters in the perception of cervical sagittal balance have not been made. The study included 4 board-certified neurosurgeons and 6 residents of a neurosurgical department. They were instructed to answer a total of 40 questions. The parameter that was the most helpful in deriving the answer was checked. The correct answer rate, dependency on the parameter, and correct answer contribution of the parameter were analyzed. Among the various parameters, 5 parameters [C2-7 angle (C2-7A), T1 slope minus cervical lordosis (T1s-CL), C2 slope (C2s), C7 slope (C7s), and C2-7 sagittal vertical axis) were selected. The simple parameter (C2s, C7s) has a higher dependency and correct answer contribution than the complex parameter (C2-7A, T1s-CL). The angular (C2-7A, T1s-CL, C2s, C7s) parameters have a higher dependency; however, both the length and angular parameters correct answer contribution were similar. The cervical parameters that have simpler properties were highly preferred and had a lower perception error.
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Affiliation(s)
- Byeong Ho Oh
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Jee Yong Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jong Beom Lee
- Department of Neurosurgery, Chungbuk National University Hospital, Cheongju, Republic of Korea
| | - Il Sup Kim
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Jae Taek Hong
- Department of Neurosurgery, Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea
| | - Jae Hoon Sung
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
| | - Ho Jin Lee
- Department of Neurosurgery, St. Vincent Hospital, The Catholic University of Korea, Suwon, Republic of Korea
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Wróblewski R, Koszela K, Mańczak M, Sudoł-Szopińska I, Gasik R. Relationship between Cervical Instability in the Course of Rheumatoid Arthritis and Pelvic Parameters of Sagittal Balance. J Clin Med 2023; 12:6507. [PMID: 37892648 PMCID: PMC10607725 DOI: 10.3390/jcm12206507] [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: 08/16/2023] [Revised: 09/10/2023] [Accepted: 10/12/2023] [Indexed: 10/29/2023] Open
Abstract
BACKGROUND The aim of the study is to search for a relationship between cervical instability in the course of rheumatoid arthritis (RA) and pelvic parameters of sagittal balance and lumbar lordosis (LL). METHODS The study included 47 patients with rheumatoid arthritis with instability of the cervical segment, who were referred for a consultation to assess indications for surgical treatment. The patients underwent a radiological functional examination of the cervical region and postural examination of the entire spine. The basic parameters of the lumbar section and pelvis of these patients were compared with the population values. Then, using statistical methods, the correlation between radiological parameters of various types of instability and lumbar lordosis (LL), pelvic parameters (PI, SS, PT), as well as the patient's age and duration of the disease was assessed. RESULTS A statistical correlation was found between the instability in the cervical spine C2-C3 level and the value of the PT and PI angles. A statistically significant correlation was discovered between C1-C2 instability and younger patient age. There was no significant difference in the values of the pelvic parameters and lumbar lordosis in patients with rheumatoid arthritis compared to the population values. CONCLUSIONS Preliminary results suggest that there is a relationship between selected pelvic parameters and the development of instability in patients with rheumatoid arthritis. This may be important in planning treatment and assessing disease progression. Further studies on a larger group of patients are needed, as well as studies evaluating the correlation between other sagittal balance parameters and cervical instability in patients with RA.
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Affiliation(s)
- Robert Wróblewski
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Kamil Koszela
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Małgorzata Mańczak
- Department of Gerontology, Public Health and Didactics, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Iwona Sudoł-Szopińska
- Department of Radiology, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
| | - Robert Gasik
- Department of Neuroorthopedics and Neurology Clinic and Polyclinic, National Institute of Geriatrics, Rheumatology and Rehabilitation in Warsaw, 1 Spartanska Street, 02-637 Warsaw, Poland
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Nakarai H, Cina A, Jutzeler C, Grob A, Haschtmann D, Loibl M, Fekete TF, Kleinstück F, Wilke HJ, Tao Y, Galbusera F. Automatic Calculation of Cervical Spine Parameters Using Deep Learning: Development and Validation on an External Dataset. Global Spine J 2023:21925682231205352. [PMID: 37811580 DOI: 10.1177/21925682231205352] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/10/2023] Open
Abstract
STUDY DESIGN Retrospective data analysis. OBJECTIVES This study aims to develop a deep learning model for the automatic calculation of some important spine parameters from lateral cervical radiographs. METHODS We collected two datasets from two different institutions. The first dataset of 1498 images was used to train and optimize the model to find the best hyperparameters while the second dataset of 79 images was used as an external validation set to evaluate the robustness and generalizability of our model. The performance of the model was assessed by calculating the median absolute errors between the model prediction and the ground truth for the following parameters: T1 slope, C7 slope, C2-C7 angle, C2-C6 angle, Sagittal Vertical Axis (SVA), C0-C2, Redlund-Johnell distance (RJD), the cranial tilting (CT) and the craniocervical angle (CCA). RESULTS Regarding the angles, we found median errors of 1.66° (SD 2.46°), 1.56° (1.95°), 2.46° (SD 2.55), 1.85° (SD 3.93°), 1.25° (SD 1.83°), .29° (SD .31°) and .67° (SD .77°) for T1 slope, C7 slope, C2-C7, C2-C6, C0-C2, CT, and CCA respectively. As concerns the distances, we found median errors of .55 mm (SD .47 mm) and .47 mm (.62 mm) for SVA and RJD respectively. CONCLUSIONS In this work, we developed a model that was able to accurately predict cervical spine parameters from lateral cervical radiographs. In particular, the performances on the external validation set demonstrate the robustness and the high degree of generalizability of our model on images acquired in a different institution.
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Affiliation(s)
- Hiroyuki Nakarai
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
- Department of Spine Surgery, Hospital for Special Surgery, New York, US
- Spine Group (UTSG), The University of Tokyo, Bunkyo-ku, Japan
| | - Andrea Cina
- Department of Health Sciences and Technologies, ETH Zürich, Zürich, Switzerland
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
| | - Catherine Jutzeler
- Department of Health Sciences and Technologies, ETH Zürich, Zürich, Switzerland
| | - Alexandra Grob
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
- Department of Neurosurgery, University Hospital Zürich, Zürich, Switzerland
| | - Daniel Haschtmann
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Markus Loibl
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Tamas F Fekete
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Frank Kleinstück
- Department of Spine Surgery and Neurosurgery, Schulthess Klinik, Zürich, Switzerland
| | - Hans-Joachim Wilke
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research, Ulm University, Ulm, Germany
| | - Youping Tao
- Institute of Orthopaedic Research and Biomechanics, Centre for Trauma Research, Ulm University, Ulm, Germany
| | - Fabio Galbusera
- Department of Teaching, Research and Development, Schulthess Klinik, Zürich, Switzerland
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Zhang Z, Zhu C, Liu L, Li T, Yang X, Song Y. Preoperative Skull Traction, Anterior Debridement, Bone Grafting, and Internal Fixation for Cervical Tuberculosis with Severe Kyphosis. Orthop Surg 2023; 15:2549-2556. [PMID: 37526198 PMCID: PMC10549853 DOI: 10.1111/os.13830] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/19/2023] [Revised: 06/16/2023] [Accepted: 06/19/2023] [Indexed: 08/02/2023] Open
Abstract
OBJECTIVE Cervical tuberculosis (CTB) readily causes local kyphosis, and its surgical strategy remains controversial. Although some previous studies suggested that the anterior approach could effectively treat CTB, patients in these studies only suffered mild to moderate kyphosis. Therefore, little is known about whether the anterior approach can achieve satisfactory outcomes in CTB patients with severe kyphosis. This study was performed to evaluate the safety and efficacy of preoperative skull traction combined with anterior surgery for the treatment of CTB patients with a severe kyphosis angle of more than 35°. METHODS In this retrospective study, we enrolled 31 CTB patients with severe kyphosis who underwent preoperative skull traction combined with anterior surgery from April 2015 to January 2021. Patients were followed up for at least 2 years. Clinical data, such as operative time, blood loss, and postoperative hospital stay, were collected. The clinical outcomes included American Spinal Injury Association (ASIA) spinal cord injury grade, Japanese Orthopaedic Association (JOA) score, visual analog scale (VAS) score, and related complications. The radiological outcomes included the Cobb angle of cervical kyphosis at each time point and the bony fusion state. Clinical efficacy was evaluated by paired Student's t-test, Mann-Whitney U-test, and others. RESULTS Six patients had involvement of one vertebra, 21 had involvement of two vertebrae, and four had involvement of three vertebrae. The most common level of vertebral involvement was C4-5, whereas the most common apical vertebra of kyphosis was C4. The mean kyphosis angle was 46.1° ± 7.7° preoperatively, and the flexibility on dynamic extension-flexion X-rays and cervical MRI was 17.5% ± 7.8% and 43.6% ± 11.0%, respectively (p = 0.000). The kyphosis angle significantly decreased to 13.2° ± 3.2° after skull traction, and it further corrected to -6.1° ± 4.3° after surgery, which was well maintained at the final follow-up with a mean Cobb angle of -5.4° ± 3.9°. The VAS and JOA scores showed significant improvement after surgery. The erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels normalized at 3 months after surgery. All patients achieved solid bone fusion, and no complications related to the instrumentation or recurrence were observed. CONCLUSION Preoperative skull traction combined with anterior debridement, autologous iliac bone grafting, and internal plate fixation can be an effective and safe surgical method for the treatment of cervical tuberculosis with severe kyphosis. Skull traction can improve the safety and success rate of subsequent anterior corrective surgery.
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Affiliation(s)
- Zhuang Zhang
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Ce Zhu
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Li‐min Liu
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Tao Li
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Xi Yang
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
| | - Yue‐ming Song
- Department of Orthopaedics, Orthopaedic Research Institute, West China HospitalSichuan UniversityChengduChina
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Zaidman N, De Witte O. Cervical sagittal balance: a predictor of neck pain after anterior cervical spine surgery? Br J Neurosurg 2023; 37:1052-1056. [PMID: 33263432 DOI: 10.1080/02688697.2020.1850643] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2020] [Accepted: 11/10/2020] [Indexed: 10/22/2022]
Abstract
PURPOSE To determine the possible relation between cervical sagittal balance and neck pain in patients having anterior cervical spine (ACS) surgery. MATERIALS AND METHODS Retrospective monocentric study on 85 patients who underwent ACS surgery between 2014 and 2016. Clinically, all patients were assessed using the Neck Disability Index (NDI). Radiological assessment was achieved by MRI or CT-scan of the cervical spine allowing measurement of radiological parameters for preoperative cervical sagittal balance. These same criteria were measured postoperatively using X-rays. RESULTS There is a statistically significant increase in the Cobb angle postoperatively (10.34 degrees) compared to preoperatively (6.68 degrees) (p < 0.05). Concomitantly, there is a statistically significant decrease in NDI postoperatively (22.69%) compared to preoperatively (42.31%) (p < 0.01). There is a negative correlation between Cobb angle and NDI (r= -0.31) (p < 0.05). CONCLUSION An improvement in the cervical sagittal balance after ACS surgery is accompanied by a reduction of neck pain. Radiological parameters of cervical sagittal balance may be taken into account when planning surgery in order to maintain cervical alignment and thereby limit the occurrence of neck pain.
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Affiliation(s)
- Nathalie Zaidman
- Department of Neurosurgery, The National Hospital for Neurology and Neurosurgery, London, UK
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Lamas V, Chapon R, Prost S, Blondel B, Fuentes S, Sauleau EA, Charles YP. Variation of cervical sagittal alignment parameters according to age and pelvic incidence in degenerative spinal deformity patients. 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; 32:3624-3633. [PMID: 37505278 DOI: 10.1007/s00586-023-07861-8] [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: 01/23/2023] [Revised: 06/05/2023] [Accepted: 07/07/2023] [Indexed: 07/29/2023]
Abstract
INTRODUCTION In asymptomatic subjects, variations of cervical sagittal alignment parameters according to age and spinopelvic organization have been reported. A large range of compensation phenomena has been observed in degenerative spinal deformity in order to maintain horizontal gaze, but it remains unclear how age and spinopelvic morphology could additionally influence cervical alignment. The aim of this observational retrospective study was to describe the distribution of cervical sagittal alignment parameters according to age and pelvic incidence in subjects with and without degenerative spinal deformity in order to precisely evaluate cervical compensation phenomena in adult spinal deformity (ASD). MATERIAL AND METHODS Radiographs of 478 subjects (327 females and 151 males) were distributed into 235 asymptomatic and 243 deformed subjects. Occipito-cervical parameters were McGregor-C1, McGregor-C2, C1-C2 and occipito-C2 angles. The cervicothoracic inflection point (CTIP) was determined. Caudal cervical sagittal alignment parameters were: C2-C7 lordosis, C2-apex (superior arch), apex-CTIP (inferior arch), occipito-C3 and occipito-C4 angles, C7-slope and T1-slope. The distribution of parameters was analyzed using a Bayesian inference (significant when Pr > 0.975 or Pr < 0.025). Comparisons between asymptomatic and deformed subjects were done after matching on age (40-60 years; > 60 years) and on PI (< 45°; 45-60°; > 60°). RESULTS Among occipito-cervical parameters, there was no significant change in McGregor-C1 angle. However, McGregor-C2 angle was significantly higher in the ASD group (Pr = 0.0029), with influence of age (Pr = 0.023), but PI influence. C1-C2 lordosis was significantly higher in the ASD group compared to the asymptomatic group (Pr < 0.0007), without influence of age or PI noticed. C2-C7 lordosis was also higher in the ASD group (Pr < 0.025) with a role of age and PI (Pr < 0.025). Cervical lordosis in the superior arch was significantly higher in the ASD group (Pr > 0.999), without influence of age or PI. In the inferior arch, the lordosis angle was not modified according to the group, but there was an influence of age (Pr < 0.0007). C7-slope and T1-slope were higher according the age group (Pr < 0.0012), without influence of the group or PI. CONCLUSION This observational study highlights cervical sagittal alignment adaptations in degenerative spinal deformity, matched on age and pelvic incidence. The inferior cervical spine seemed to be modified with a higher lordosis, increasing with age responding to the age-related thoracic kyphosis increase. In addition to that, the superior cervical spine hyperextends more in adult degenerative deformity to maintain horizontal gaze. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Vincent Lamas
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Renan Chapon
- Service de Neurochirurgie, Centre Hospitalier Universitaire Dijon-Bourgogne, Dijon, France
| | - Solène Prost
- Unité de Chirurgie Rachidienne, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Stéphane Fuentes
- Service de Neurochirurgie, Centre Hospitalier Universitaire de La Timone, Aix-Marseille Université, Marseille, France
| | - Erik André Sauleau
- Service de Santé Publique, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, Strasbourg, France
| | - Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Fédération de Médecine Translationnelle (FMTS), Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France
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Rossanez R, de Rezende Pratali R, Smith JS, Nasreddine MA, Pereira da Silva Herrero CF. Internal Chain of Correlation of Sagittal Cervical Alignment in Asymptomatic Subjects. Global Spine J 2023; 13:2439-2445. [PMID: 35343268 PMCID: PMC10538324 DOI: 10.1177/21925682221087185] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Cross-sectional observational study in a prospective cohort. OBJECTIVE To analyze the cervical alignment characteristics and their chain of correlation in a sample of asymptomatic individuals. METHODS Asymptomatic adults who had full spinal radiographs performed. Cervical radiographic parameters were measured, including upper cervical curvature (McGregor line-C2), lower cervical curvature (C2-C7), McGregor slope, and sagittal vertical axis from C2-C7 (CSVA) and T1-slope (T1S). Subjects were stratified by age into 3 groups (18-39 years, 40-59 years, and >60 years), and radiographic parameters were compared across age groups and based on sex. RESULTS 102 asymptomatic subjects (mean age, 50 years) were included. The T1S significantly increased with age, accompanied by an increase in C2-C7 lordosis. The cervical sagittal alignment, represented by CSVA, did not significantly differ based on age. There was a close correlation among the cervical sagittal parameters, such that the CSVA may be predicted based on the T1S and C2-C7 lordosis. Comparisons of the normative values identified in the present study with those reported in previous studies demonstrate variability in what constitutes normal in different populations. CONCLUSION This analysis of cervical alignment in a sample of asymptomatic volunteers revealed that with increasing age there is an observed increase in the sagittal inclination of the base of the cervical spine (T1S) that is accompanied by an increase in cervical lordosis as a means of maintaining cervical sagittal alignment (CSVA). The variability in what constitutes normal values for cervical parameters suggests that further study is warranted using standardized methodologies across diverse populations.
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Affiliation(s)
- Roberto Rossanez
- Health Sciences Applied to the Locomotor System Graduate Program, Ribeirão Preto Medical School of University of São Paulo, Ribeirão Preto, Brazil
| | | | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, VA, USA
| | - Mohamed Ahmed Nasreddine
- Spine Surgery Group, Hospital Do Servidor Público Estadual de São Paulo (HSPE), São Paulo, Brazil
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Okubo T, Nagoshi N, Tsuji O, Nishimura S, Suzuki S, Nori S, Yagi M, Matsumoto M, Nakamura M, Watanabe K. Spinous Process-Splitting Laminectomy Approach for Tumor Excision at Conus Medullaris or Cauda Equina Level Results in Satisfactory Clinical Outcomes Without Affecting Global Spinal Sagittal Alignment. Global Spine J 2023; 13:1745-1753. [PMID: 34620008 PMCID: PMC10556912 DOI: 10.1177/21925682211047460] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective comparative study. OBJECTIVES The present study investigated radiographical changes in global spinal sagittal alignment (GSSA) and clinical outcomes following tumor resection using spinous process-splitting laminectomy (SPSL) approach without fixation in patients with conus medullaris (CM) or cauda equina (CE) tumor. METHODS Forty-one patients with CM or CE tumor (19 males, 22 females, mean age at surgery of 52.9 ± 13.0 years) were included in this study. The variations of outcome variables were analyzed in various GSSA profiles using radiographic outcomes. The clinical outcomes were assessed using Japan Orthopaedic Association (JOA) score and JOA back pain evaluation questionnaire (JOABPEQ). RESULTS In all cases, the various GSSA parameters (sagittal vertical axis, C2-7 lordosis, T1 slope, thoracic kyphosis, T10-L2 kyphosis, lumbar lordosis [LL; upper, middle, and lower], sacral slope, pelvic incidence, and pelvic tilt) did not significantly change in the 2-years postoperative period. Moreover, age at surgery, the number of resected laminae, preoperative T12-L2 kyphosis, or LL did not affect the postoperative changes in T12-L2 kyphosis or LL, and had no statistically significant correlation among them. The scores of each postoperative JOA domain and the Visual Analogue Scale included in the JOABPEQ were significantly improved. There was no statistical significant group difference in each sagittal profile or clinical outcomes between CM and CE groups postoperatively. CONCLUSIONS Tumor resection using SPSL approach did not affected the various GSSA parameters examined and resulted in satisfactory clinical outcomes, indicating that SPSL approach is a suitable surgical technique for patients with CM or CE tumor.
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Affiliation(s)
- Toshiki Okubo
- Department of Orthopaedic Surgery, National Hospital Organization, Murayama Medical Center, Tokyo, Japan
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Narihito Nagoshi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Osahiko Tsuji
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Soraya Nishimura
- Department of Orthopaedics Surgery, Kawasaki Municipal Hospital, Kanagawa, Japan
| | - Satoshi Suzuki
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Satoshi Nori
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Mitsuru Yagi
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Morio Matsumoto
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Masaya Nakamura
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
| | - Kota Watanabe
- Department of Orthopaedic Surgery, Keio University School of Medicine, Tokyo, Japan
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Guo W, Xing H, Gong X, He L, Zhang Z, Jia C. Effects of Yi Jin Jing on juvenile cervical spondylopathy in China: A parallel, randomized, assessor-blinded clinical trial. Niger J Clin Pract 2023; 26:1234-1241. [PMID: 37794534 DOI: 10.4103/njcp.njcp_410_22] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/06/2023]
Abstract
Background Cervical spondylopathy is a common musculo-articular disorder, multiple exercises are recommended. Chinese fitness exercises are prevalent and used to treat various diseases. Aim To explore the efficacy of Chinese fitness exercise Yi Jin Jing exercise in intervening the cervical spondylopathy in adolescents. Patients and Methods The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. Methods The study was conducted in 60 adolescent patients with cervical spondylopathy, with 30 patients in each group. The observation group was required to take Yi Jin Jing exercise, and the control group took the brisk walking exercise. The first week was the preparatory period for the patients, and then the participants were required to do exercises three times a week for at least 30 minutes in the later 3 weeks. Before and after treatment, Neck Disability Index (NDI) scores, pain visual analog scale (VAS) scores, and cervical curvature in both groups were observed, and the incidence of adverse events in both groups was recorded during the trial. Results The NDI and VAS scores in both groups statistically decreased after intervention and mildly increased at follow-up, while the reduction in scores of the Yi Jin Jing group was more significant. Cervical curvature in both groups improved on day 28 compared to day 0. There were no adverse reactions during the evaluation period. Conclusion The Chinese health-care qigong Yi Jin Jing exercise is more effective than brisk walking in improving the cervical range of motion and relieving pain in adolescents with cervical spondylopathy. Trial registration/Protocol registration: Clinical Trial Registry (ChiCTR2000030723).
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Affiliation(s)
- W Guo
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - H Xing
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - X Gong
- Deparment of Acupuncture and Moxibustion, Guangdong Second Provincial General Hospital, Guangzhou, China
| | - L He
- Deparment of Acupuncture and Moxibustion, Baiyun Hospital of The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
| | - Z Zhang
- The First Clinical Medical College, Guangzhou University of Chinese Medicine, Guangzhou, China
| | - C Jia
- Deparment of Acupuncture and Moxibustion, The First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou, China
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Mori K, Takahashi J, Oba H, Mimura T, Imai S. Reciprocal Change of Cervical Spine after Posterior Spinal Fusion for Lenke Type 1 and 2 Adolescent Idiopathic Scoliosis. J Clin Med 2023; 12:5599. [PMID: 37685668 PMCID: PMC10488443 DOI: 10.3390/jcm12175599] [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: 07/31/2023] [Revised: 08/19/2023] [Accepted: 08/25/2023] [Indexed: 09/10/2023] Open
Abstract
Reciprocal sagittal alignment changes after adolescent idiopathic scoliosis (AIS) posterior corrective surgery have been reported in the cervical spine, but the evidence is not yet sufficient. Furthermore, much remains unknown about the effects of cervical kyphosis on clinical outcomes in AIS. Forty-five consecutive patients (4 males and 41 females) with AIS and Lenke type 1 or 2 curves underwent a posterior spinal fusion, and a minimum of 24-month follow-up was collected from our prospective database. We investigated radiographic parameters and SRS-22r. Before surgery, cervical kyphosis (cervical lordosis < 0°) was present in 89% and cervical hyperkyphosis (cervical lordosis < -10°) in 60%. There were no significant differences in age, sex, or Lenke type between the hyperkyphosis and the non-hyperkyphosis groups. Although cervical lordosis increased significantly after surgery, cervical kyphosis was observed in 73% of patients 2 years after surgery. We found a significant correlation between Δthoracic kyphosis (TK) and Δcervical lordosis. Preoperative cervical kyphosis, ΔT1 slope, and ΔTK were independently associated factors for postoperative cervical hyperkyphosis. The cervical hyperkyphosis group had significantly lower SRS-22r domains. In AIS corrective surgery, restoring TK leading to a gain of T1 slope may lead to an improvement of cervical sagittal alignment. Remaining cervical hyperkyphosis after AIS surgery may affect clinical outcomes.
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Affiliation(s)
- Kanji Mori
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu 520-2192, Shiga, Japan;
| | - Jun Takahashi
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan; (J.T.); (H.O.); (T.M.)
| | - Hiroki Oba
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan; (J.T.); (H.O.); (T.M.)
| | - Tetsuhiko Mimura
- Department of Orthopaedic Surgery, Shinshu University School of Medicine, Asahi 3-1-1, Matsumoto 390-8621, Nagano, Japan; (J.T.); (H.O.); (T.M.)
| | - Shinji Imai
- Department of Orthopaedic Surgery, Shiga University of Medical Science, Tsukinowa-cho, Seta, Otsu 520-2192, Shiga, Japan;
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Chai Z, Yang X, Lu H, Zhai Y, Zhang W, Yu H. Relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis. J Orthop Surg Res 2023; 18:514. [PMID: 37468995 DOI: 10.1186/s13018-023-04011-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/28/2023] [Accepted: 07/14/2023] [Indexed: 07/21/2023] Open
Abstract
PURPOSE To explore the relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis (DCK). METHODS A retrospective analysis of 127 patients with degenerative cervical spondylosis treated in our spinal deformity center from January 2019 to June 2022. Patients were categorized into two groups and compared based on C2-7 angle (C2-7 ≥ 5° as kyphosis group, C2-7 < 5° as lordosis group). Pearson correlation or Spearman correlation was used to analyze the relationship between C2S and conventional radiological parameters and health -related quality-of-life (HRQOL) outcomes as measured by the EuroQol 5 dimension questionnaire (EQ5D), NRS, and the neck disability index (NDI). The cutoff value of C2S was determined by a receiver operating characteristic (ROC) curve. RESULTS There were 127 patients who met inclusion criteria (79 men and 48 women). Average 56.00 ± 10.27 years old (range 31-81 years old). C2S of kyphosis group is higher than non-kyphosis group. Aggravating cervical kyphosis increases cSVA positively. For all patients, C2S demonstrated a significant correlation with the O-C2 angle, C2-7 angle, cSVA, and TS-CL (p < 0.05). NRS, NDI and EQ5D-VAS scores revealed a significant correlation with C2S and cSVA (p < 0.01). For the subgroup of patients presenting with DCK, ROC curves demonstrated the cutoff values of C2S as 26.3°, and 30.5°, according to a cSVA of 40 mm, and severe disability expressed by NDI, respectively. CONCLUSION On the basis of retaining the consistency of cranio-cervical and cervico-thoracic structure, C2S can better analyze the sagittal alignment of DCK patients than TS-CL and has good practicability in clinical application and HRQOL evaluation.
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Affiliation(s)
- Zihao Chai
- Department of Orthopedics, Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Xiaolu Yang
- Department of Orthopedics, Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Haitao Lu
- Department of Orthopedics, Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Yunlei Zhai
- Department of Orthopedics, Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Wei Zhang
- Department of Orthopedics, Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China
| | - Haiyang Yu
- Department of Orthopedics, Fuyang People's Hospital of Anhui Medical University, 501 Sanqing Road, Fuyang, 236000, Anhui, China.
- Spinal Deformity Clinical Medicine and Research Center of Anhui Province, 501 Sanqing Road, Fuyang, 236000, Anhui, China.
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Wang Z, Hu X, Cui P, Liu X, Zhu W, Kong C, Wang W, Lu S. Description of age-related changes in cervical sagittal alignment based on pelvic incidence classification in asymptomatic Chinese population. 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; 32:2402-2414. [PMID: 37193902 DOI: 10.1007/s00586-023-07769-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 05/06/2023] [Indexed: 05/18/2023]
Abstract
PURPOSE To investigate the pelvic incidence (PI)- and age-related cervical alignment changes of Chinese healthy population. METHODS Six hundred and twenty-five asymptomatic adult subjects, who underwent the standing whole spinal radiograph, were recruited in this work. The sagittal parameters were measured, including Occipito-C2 angle (O-C2), C2-7 angle (C2-7), cranial arch, caudal arch, T1-slope (T1S), C2-7 sagittal vertical axis (C2-7 SVA), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic tilt (PT), sacral slope (SS), PI, and sagittal vertical axis (SVA). All subjects were stratified into 5 age groups, namely 40-59 years, 60-64 years, 65-69 years, 70-74 years, and 75 years and above, with each age group further divided into 2 subgroups based on PI (deeming PI < 50° as low PI, and PI ≥ 50° as high PI). The correlations between PI or age, and other sagittal parameters were assessed. The age-related changes of sagittal parameters in each PI subgroup were also assessed, followed by one-way analysis of variance analysis for change comparison between age groups. RESULTS The average cervical sagittal parameters were as below: 18.2 ± 6.8° for O-C2, 10.4 ± 10.2° for C2-7, 3.9 ± 7.5° for cranial arch, 6.5 ± 7.1° for caudal arch, 23.6 ± 7.3° for T1S, and 21.0 ± 9.7 mm for C2-7 SVA. There was no obvious difference observed between PI and cervical sagittal parameters, excepting for caudal arch. While, C2-7, cranial arch, caudal arch, T1S, and C2-7 SVA increased remarkably with the age. Thereof, C2-7 exhibited great increases at the age of 60-64 years and 70-74 years, respectively, cranial arch increased notably at 60-64 years of age, and caudal arch developed obviously at 70-74 years of age, regardless of PI. CONCLUSION This study showed the PI- and age-related cervical alignment changes of Chinese healthy population. Based on the classification in our study, high or low PI apparently did not correlate with the occurrence of cervical degenerative disease.
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Affiliation(s)
- Zheng Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Xinli Hu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Peng Cui
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Xu Liu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Weiguo Zhu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Chao Kong
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China
| | - Wei Wang
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
| | - Shibao Lu
- Department of Orthopedics, Xuanwu Hospital, Capital Medical University, Changchun Rd. No.45 Changchun Street, Xicheng District, Beijing, 100053, People's Republic of China.
- National Clinical Research Center for Geriatric Diseases, Beijing, 100053, People's Republic of China.
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Palmieri M, Donno L, Cimolin V, Galli M. Cervical Range of Motion Assessment through Inertial Technology: A Validity and Reliability Study. SENSORS (BASEL, SWITZERLAND) 2023; 23:6013. [PMID: 37447862 DOI: 10.3390/s23136013] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 06/14/2023] [Accepted: 06/27/2023] [Indexed: 07/15/2023]
Abstract
Inertial technology has spread widely for its comfortable use and adaptability to various motor tasks. The main objective of this study was to assess the validity of inertial measurements of the cervical spine range of motion (CROM) when compared to that of the optoelectronic system in a group of healthy individuals. A further aim of this study was to determine the optimal placement of the inertial sensor in terms of reliability of the measure, comparing measurements obtained from the same device placed at the second cervical vertebra (C2), the forehead (F) and the external occipital protuberance (EOP). Twenty healthy subjects were recruited and asked to perform flexion-extension, lateral bending, and axial rotation movements of the head. Outcome measurements of interest were CROM and mean angular velocities for each cervical movement. Results showed that inertial measurements have good reliability (0.75 < ICC < 0.9). Excellent reliability (ICC > 0.9) was found in both flexion and right lateral bending angles. All parameters extracted with EOP placement showed ICC > 0.62, while ICC < 0.5 was found in lateral bending mean angular velocities both for F and C2 placements. Therefore, the optimal sensor's positioning emerged to be EOP. These results suggest that inertial technology could be useful and reliable for the evaluation of the CROM.
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Affiliation(s)
- Martina Palmieri
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Lucia Donno
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
| | - Veronica Cimolin
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
- Istituto Auxologico Italiano, IRCCS, San Giuseppe Hospital, 28824 Piancavallo, Italy
| | - Manuela Galli
- Department of Electronics, Information and Bioengineering, Politecnico di Milano, Piazza Leonardo da Vinci 32, 20133 Milan, Italy
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Li J, Cao S, Guo D, Lu T, Zang Q. Biomechanical properties of different anterior and posterior techniques for atlantoaxial fixation: a finite element analysis. J Orthop Surg Res 2023; 18:456. [PMID: 37365580 DOI: 10.1186/s13018-023-03905-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/07/2023] [Accepted: 06/03/2023] [Indexed: 06/28/2023] Open
Abstract
BACKGROUND Many techniques for atlantoaxial fixation have been developed. However, the biomechanical differences among various atlantoaxial fixation methods remain unclear. This study aimed to evaluate the biomechanical influence of anterior and posterior atlantoaxial fixation techniques on fixed and nonfixed segments. METHODS An occiput-C7 cervical finite element model was used to construct 6 surgical models including a Harms plate, a transoral atlantoaxial reduction plate (TARP), an anterior transarticular screw (ATS), a Magerl screw, a posterior screw-plate, and a screw-rod system. Range of motion (ROM), facet joint force (FJF), disc stress, screw stress, and bone-screw interface stress were calculated. RESULTS The C1/2 ROMs were relatively small in the ATS and Magerl screw models under all loading directions except for extension (0.1°-1.0°). The posterior screw-plate system and screw-rod system generated greater stresses on the screws (77.6-1018.1 MPa) and bone-screw interfaces (58.3-499.0 MPa). The Harms plate and TARP models had relatively small ROMs (3.2°-17.6°), disc stress (1.3-7.6 MPa), and FJF (3.3-106.8 N) at the nonfixed segments. Changes in disc stress and FJF of the cervical segments were not consistent with changes in ROM. CONCLUSIONS ATS and Magerl screws may provide good atlantoaxial stability. The posterior screw-rod system and screw-plate system may have higher risks of screw loosening and breakage. The Harms plate and TARP model may more effectively relieve nonfixed segment degeneration than other techniques. The C0/1 or C2/3 segment may not be more susceptible to degeneration than other nonfixed segments after C1/2 fixation.
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Affiliation(s)
- Jie Li
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Shuai Cao
- Department of Orthopedics, Civil Aviation General Hospital, No. 1, Gaojing Stress, Chaoyang District, Beijing, 100123, China
| | - Dong Guo
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China
| | - Teng Lu
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China.
| | - Quanjin Zang
- Department of Orthopedics, The Second Affiliated Hospital of Xi'an Jiaotong University, 157Th West Fifth Road, Xi'an, 710004, Shaanxi Province, China.
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Tharu NS, Lee TTY, Lai KKL, Lau TE, Chan CY, Zheng YP. Sagittal Spinal Alignment in People with Chronic Spinal Cord Injury and Normal Individual: A Comparison Study Using 3D Ultrasound Imaging. J Clin Med 2023; 12:jcm12113854. [PMID: 37298049 DOI: 10.3390/jcm12113854] [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: 02/15/2023] [Revised: 05/16/2023] [Accepted: 06/01/2023] [Indexed: 06/12/2023] Open
Abstract
The aim of this study was to compare the sagittal spinal alignment of people with chronic spinal cord injury (SCI) with normal individuals and to determine whether transcutaneous electrical spinal cord stimulation (TSCS) could cause a change in the thoracic kyphosis (TK) and lumbar lordosis (LL) to re-establish normal sagittal spinal alignment. A case series study was conducted, wherein twelve individuals with SCI and ten neurologically intact subjects were scanned using 3D ultrasonography. In addition, three people with SCI having complete tetraplegia participated further to receive a 12-week treatment (TSCS with task-specific rehabilitation) after evaluation of sagittal spinal profile. Pre- and post-assessments were conducted to evaluate the differences in sagittal spinal alignment. The results showed that the TK and LL values for a person with SCI in a dependent seated posture were greater than those of normal subjects for: standing (by TK: 6.8° ± 1.6°; LL: 21.2° ± 1.9°), sitting straight (by TK: 10.0° ± 4.0°; LL: 1.7° ± 2.6°), and relaxed sitting (by TK: 3.9° ± 0.3°; LL: 7.7° ± 1.4°), respectively, indicating an increased risk for spinal deformity. In addition, TK decreased by 10.3° ± 2.3° after the TSCS treatment, showing a reversible change. These results suggest that the TSCS treatment could be used to restore normal sagittal spinal alignment for individuals with chronic SCI.
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Affiliation(s)
- Niraj Singh Tharu
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Timothy Tin-Yan Lee
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Kelly Ka-Lee Lai
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Ting-Er Lau
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Chui-Yi Chan
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
| | - Yong-Ping Zheng
- Department of Biomedical Engineering, The Hong Kong Polytechnic University, Hong Kong SAR, China
- Research Institute for Smart Ageing, The Hong Kong Polytechnic University, Hong Kong SAR, China
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Song QX, Su XJ, Wang K, Chao-Zhu, Zhi-Chen, Quan-Li, Liu ZD, Shen HX. Is Complete Correction of Cervical Sagittal Malalignment Necessary During 4-Level Anterior Cervical Discectomy and Fusion Surgery in Patients With Kyphosis? Global Spine J 2023; 13:1311-1318. [PMID: 34263657 PMCID: PMC10416596 DOI: 10.1177/21925682211031175] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
STUDY DESIGN Retrospective analysis. OBJECTIVE We investigated whether complete correction of cervical sagittal malalignment is necessary during 4-level anterior cervical discectomy and fusion (ACDF) in patients with kyphosis. METHODS This retrospective study included 84 patients who underwent 4-level ACDF surgery at a university hospital between January 2010 and December 2015. Based on the degree of cervical lordosis correction, patients were categorized into the following groups: mild (0-10°), moderate (10-20°), and complete correction (>20°). The clinical outcomes, radiological parameters, and functional outcomes were analyzed. RESULTS We observed no significant intergroup differences in the baseline characteristics. The cervical sagittal vertical axis (CSVA) correction loss at the final follow-up was lesser in the mild- and moderate- than in the complete-correction group. The spinocranial angle (SCA) and T1 slope (T1 S) were significantly higher in the moderate- and complete-correction groups than in the mild-correction group, 3 days postoperatively. The cervical proximal junctional kyphosis (CPJK), adjacent segment degeneration (ASD), and ASD following CPJK rates were higher in the complete-correction group. We observed no significant intergroup differences in postoperative complications; however, 5 patients showed internal fixation failure in the complete-correction group; 4 of these patients required reoperation. No significant intergroup difference was observed in the Japanese Orthopedic Association and neck disability index scores at any time point. CONCLUSIONS A mild-to-moderate correction of cervical lordosis is superior to complete correction in patients with kyphosis who undergo 4-level ACDF because this approach is associated with lesser axial stress and CSVA correction loss.
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Affiliation(s)
- Qing-Xin Song
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Xin-Jin Su
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Kun Wang
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Chao-Zhu
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zhi-Chen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Quan-Li
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Zu-De Liu
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
| | - Hong-Xing Shen
- Department of Spine Surgery, Renji Hospital, School of Medicine, Shanghai Jiao Tong University, Shanghai, China
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Chen S, Deng Y, Liu H, Wu T, Huang K, He J, Wang B. Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience. J Orthop Surg Res 2023; 18:345. [PMID: 37165448 PMCID: PMC10170693 DOI: 10.1186/s13018-023-03819-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Accepted: 05/02/2023] [Indexed: 05/12/2023] Open
Abstract
INTRODUCTION According to the different numbers and relative locations of cervical disc replacement (CDR) and anterior cervical discectomy and fusion (ACDF), three-level hybrid surgery (HS) has many constructs. The purpose of this retrospective study was to compare the sagittal alignment parameters of HS and ACDF for cervical degenerative disc disease (CDDD) and the association of the respective parameters. METHODS This study involved patients with three-level CDDD who underwent ACDF or HS at our institution between June 2012 and August 2021. This follow-up included one-level CDR and two-level ACDF (type I group), two-level CDR and one-level ACDF (type II group) and three-level ACDF. Cervical sagittal alignment parameters included cervical lordosis (CL), segment alignment (SA), T1 slope (T1S), C2-C7 sagittal vertical axis (SVA), T1S-CL, C2 slope (C2S), occipital to C2 angle (O-C2A) and segment range of motion (ROM). Postoperative complications included adjacent segment degeneration, imbalance, prosthetic subsidence and heterotopic ossification. RESULTS The three groups with a total of 106 patients were better matched in terms of demographics. Patients who underwent HS had significantly higher CL than those who underwent ACDF at 1 week, 6 months, 12 months and the final follow-up after surgery, as well as significantly better SA at 12 months and the final follow-up. There was no significant difference in T1S, SVA, T1S-CL, C2S, O-C2A or segment ROM among the three groups after surgery. The T1S-CL was significantly associated with C2S in the type I and type II groups at the preoperative and final follow-up. There was no significant difference in postoperative complications among the three groups. CONCLUSIONS Most improvements in cervical sagittal alignment (CL, SA, T1S, SVA, T1S-CL, C2S, O-C2A, and segmental ROM) were observed in all three groups postoperatively. HS was more advantageous than ACDF in the maintenance of postoperative CL and SA. Thus, three-level HS may be better for maintaining cervical curvature. The number of replacement segments differed in those who underwent HS but did not affect the correlation between T1S-CL and C2S, both of which are well balanced.
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Affiliation(s)
- Shihao Chen
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Yuxiao Deng
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Hao Liu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Tingkui Wu
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Kangkang Huang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Junbo He
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China
| | - Beiyu Wang
- Department of Orthopedics, Orthopedic Research Institute, West China Hospital, Sichuan University, 37 Guoxue Lane, Chengdu, 610041, Sichuan, China.
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Ye J, Rider SM, Lafage R, Gupta S, Farooqi AS, Protopsaltis TS, Passias PG, Smith JS, Lafage V, Kim HJ, Klineberg EO, Kebaish KM, Scheer JK, Mundis GM, Soroceanu A, Bess S, Ames CP, Shaffrey CI, Gupta MC. Distal junctional kyphosis in adult cervical deformity patients: where does it occur? 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; 32:1598-1606. [PMID: 36928488 DOI: 10.1007/s00586-023-07631-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/19/2023] [Revised: 01/19/2023] [Accepted: 02/28/2023] [Indexed: 03/18/2023]
Abstract
PURPOSE To evaluate the impact of the lowest instrumented vertebra (LIV) on Distal Junctional kyphosis (DJK) incidence in adult cervical deformity (ACD) surgery. METHODS Prospectively collected data from ACD patients undergoing posterior or anterior-posterior reconstruction at 13 US sites was reviewed up to 2-years postoperatively (n = 140). Data was stratified into five groups by level of LIV: C6-C7, T1-T2, T3-Apex, Apex-T10, and T11-L2. DJK was defined as a kyphotic increase > 10° in Cobb angle from LIV to LIV-1. Analysis included DJK-free survival, covariate-controlled cox regression, and DJK incidence at 1-year follow-up. RESULTS 25/27 cases of DJK developed within 1-year post-op. In patients with a minimum follow-up of 1-year (n = 102), the incidence of DJK by level of LIV was: C6-7 (3/12, 25.00%), T1-T2 (3/29, 10.34%), T3-Apex (7/41, 17.07%), Apex-T10 (8/11, 72.73%), and T11-L2 (4/8, 50.00%) (p < 0.001). DJK incidence was significantly lower in the T1-T2 LIV group (adjusted residual = -2.13), and significantly higher in the Apex-T10 LIV group (adjusted residual = 3.91). In covariate-controlled regression using the T11-L2 LIV group as reference, LIV selected at the T1-T2 level (HR = 0.054, p = 0.008) or T3-Apex level (HR = 0.081, p = 0.010) was associated with significantly lower risk of DJK. However, there was no difference in DJK risk when LIV was selected at the C6-C7 level (HR = 0.239, p = 0.214). CONCLUSION DJK risk is lower when the LIV is at the upper thoracic segment than the lower cervical segment. DJK incidence is highest with LIV level in the lower thoracic or thoracolumbar junction.
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Affiliation(s)
- Jichao Ye
- Department of Orthopaedic Surgery, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong Province, China
| | - Sean M Rider
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid, Campus, Box 8233, St. Louis, MO, 63110, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sachin Gupta
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | - Ali S Farooqi
- Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, PA, USA
| | | | - Peter G Passias
- Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Han-Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA
| | - Khaled M Kebaish
- Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA
| | - Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Gregory M Mundis
- Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, CA, USA
| | - Alex Soroceanu
- University of Calgary Spine Program, University of Calgary, Alberta, Canada
| | - Shay Bess
- Rocky Mountain Hospital for Children, Presbyterian/St Luke's Medical Center, Denver, CO, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, CA, USA
| | - Christopher I Shaffrey
- Departments of Neurological Surgery and Orthopedic Surgery, Duke University, Durham, NC, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University School of Medicine, 660 S. Euclid, Campus, Box 8233, St. Louis, MO, 63110, USA.
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Shi T, Chen Z, Li W, Wang Z, Liu W. Prevalence of sleep disturbance in patients with cervical radiculopathy and an analysis of risk factors: a cross-sectional study. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2023; 32:1624-1635. [PMID: 36935452 DOI: 10.1007/s00586-023-07655-y] [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: 11/19/2022] [Revised: 02/01/2023] [Accepted: 03/12/2023] [Indexed: 03/21/2023]
Abstract
OBJECTIVE Previous research has shown that many patients with musculoskeletal diseases suffer from sleep disturbances. However, the sleep quality of patients with cervical radiculopathy (CR) has yet to be fully investigated. This study aims to investigate the prevalence and status of sleep disturbances in patients with CR and identify the mechanisms and risk factors associated with this condition. METHODS We conducted a cross-sectional study of patients diagnosed with CR. The Pittsburgh Sleep Quality Index (PSQI) and Insomnia Severity Index (ISI) were used to evaluate the sleep quality of patients and determine whether patients experience sleep disturbances. In addition, we analyzed the clinical and radiological risk factors of sleep disturbance and determined the key risk factors related to sleep disturbance by multivariable analysis. RESULTS According to specific inclusion and exclusion criteria, 186 patients with CR were finally included, with a mean age of 59.1 ± 14.3 years, of which 113 (60.8%) were female. Sleep disturbance was defined as a PSQI score ≥ 6 and was identified in 56.5% of patients (105/186). By performing multivariate analysis, we determined that sleep disturbance was closely related to the female gender, a higher Beck Depression Inventory (BDI) score, a reduction in cervical mobility, an increase in C2-C7 sagittal vertical axis (C2-C7 SVA), and severe asymmetry of the paravertebral muscle at C5 and C6 levels. CONCLUSION In this study, we identified the high prevalence and potential high-risk factors of sleep disturbance in patients with CR. Clinicians should closely evaluate and monitor such patients and consider appropriate treatment strategies. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Tengbin Shi
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Zhi Chen
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Wenwen Li
- School of Health, Fujian Medical University, Fuzhou, 350108, Fujian, People's Republic of China
| | - Zhenyu Wang
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China
| | - Wenge Liu
- Department of Orthopedics, Fujian Medical University Union Hospital, 29 Xinquan Road, Gulou, Fuzhou, 086-350001, Fujian, People's Republic of China.
- School of Health, Fujian Medical University, Fuzhou, 350108, Fujian, People's Republic of China.
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Yang H, Huang J, Hai Y, Fan Z, Zhang Y, Yin P, Yang J. Is It Necessary to Cross the Cervicothoracic Junction in Posterior Cervical Decompression and Fusion for Multilevel Degenerative Cervical Spine Disease? A Systematic Review and Meta-Analysis. J Clin Med 2023; 12:jcm12082806. [PMID: 37109143 PMCID: PMC10144726 DOI: 10.3390/jcm12082806] [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: 02/06/2023] [Revised: 03/08/2023] [Accepted: 03/22/2023] [Indexed: 04/29/2023] Open
Abstract
BACKGROUND Posterior cervical decompression and fusion (PCF) is a common procedure for treating patients with multilevel degenerative cervical spine disease. The selection of lower instrumented vertebra (LIV) relative to the cervicothoracic junction (CTJ) remains controversial. This study aimed to compare the outcomes of PCF construct terminating at the lower cervical spine and crossing the CTJ. METHODS A comprehensive literature search was performed for relevant studies in the PubMed, EMBASE, Web of Science, and Cochrane Library database. Complications, rate of reoperation, surgical data, patient-reported outcomes (PROs), and radiographic outcomes were compared between PCF construct terminating at or above C7 (cervical group) and at or below T1 (thoracic group) in patients with multilevel degenerative cervical spine disease. A subgroup analysis based on surgical techniques and indications was performed. RESULTS Fifteen retrospective cohort studies comprising 2071 patients (1163 in the cervical group and 908 in the thoracic group) were included. The cervical group was associated with a lower incidence of wound-related complications (RR, 0.58; 95% CI 0.36 to 0.92, p = 0.022; 831 patients in cervical group vs. 692 patients in thoracic group), a lower reoperation rate for wound-related complications (RR, 0.55; 95% CI 0.32 to 0.96, p = 0.034; 768 vs. 624 patients), and less neck pain at the final follow-up (WMD, -0.58; 95% CI -0.93 to -0.23, p = 0.001; 327 vs. 268 patients). However the cervical group also developed a higher incidence of overall adjacent segment disease (ASD, including distal ASD and proximal ASD) (RR, 1.87; 95% CI 1.27 to 2.76, p = 0.001; 1079 vs. 860 patients), distal ASD (RR, 2.18; 95% CI 1.36 to 3.51, p = 0.001; 642 vs. 555 patients), overall hardware failure (including hardware failure of LIV and hardware failure occurring at other instrumented vertebra) (RR, 1.48; 95% CI 1.02 to 2.15, p = 0.040; 614 vs. 451 patients), and hardware failure of LIV (RR, 1.89; 95% CI 1.21 to 2.95, p = 0.005; 380 vs. 339 patients). The operating time was reasonably shorter (WMD, -43.47; 95% CI -59.42 to -27.52, p < 0.001; 611 vs. 570 patients) and the estimated blood loss was lower (WMD, -143.77; 95% CI -185.90 to -101.63, p < 0.001; 721 vs. 740 patients) when the PCF construct did not cross the CTJ. CONCLUSIONS PCF construct crossing the CTJ was associated with a lower incidence of ASD and hardware failure but a higher incidence of wound-related complications and a small increase in qualitative neck pain, without difference in neck disability on the NDI. Based on the subgroup analysis for surgical techniques and indications, prophylactic crossing of the CTJ should be considered for patients with concurrent instability, ossification, deformity, or a combination of anterior approach surgeries as well. However, long-term follow-up outcomes and patient selection-related factors such as bone quality, frailty, and nutrition status should be addressed in further studies.
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Affiliation(s)
- Honghao Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
| | - Jixuan Huang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
| | - Yong Hai
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
| | - Zhexuan Fan
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
| | - Yiqi Zhang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
| | - Peng Yin
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
| | - Jincai Yang
- Department of Orthopedic Surgery, Beijing Chao-Yang Hospital, Capital Medical University, Gongti South Rd, No. 8, Beijing 100020, China
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Zhou Z, Lin F, Zhang Y, Jin Z, Liu D, Deng Y, Wang X, Zhou X. Correlation and reliability of cervical sagittal alignment parameters between plain radiographs and multipositional MRI images. Spinal Cord 2023; 61:307-312. [PMID: 37005475 DOI: 10.1038/s41393-023-00895-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2022] [Revised: 03/17/2023] [Accepted: 03/23/2023] [Indexed: 04/04/2023]
Abstract
STUDY DESIGN A retrospective study. OBJECTIVES To assess the validity and reliability of cervical sagittal alignment parameters from multipositional magnetic resonance imaging (MRI) and dynamic cervical radiography. SETTING Hospital in Suzhou, China. METHODS Patients who underwent both multipositional MRI and dynamic plain radiography of the cervical spine within a 2-week interval between January 2013 and October 2021 were retrospectively enrolled in this study. The C2-7 angle, C2-7 cervical sagittal vertical axis (C2-7 SVA), T1 slope (T1S), cervical tilt, cranial tilt, and K-line tilt were measured in three different positions (neutral, flexion, and extension) with multipositional MRI and dynamic radiography. Inter- and intraobserver reliabilities were assessed by intraclass correlation coefficients (ICCs). Pearson correlation coefficients were used for statistical analyses. RESULTS A total of 65 (30 males and 35 females) patients with a mean age of 53.4 years (range 23-69 years) were retrospectively enrolled in this study. Significant positive correlations were noted regarding all parameters between the plain radiographs and multipositional MRI images. Inter- and intraobserver reliabilities were excellent for all cervical sagittal alignment parameters measured in the two imaging modalities. All cervical sagittal parameters had significant positive correlations with those from multipositional MRI in all three positions (p < 0.05). Pearson correlation coefficients demonstrated moderate and strong correlations between the two examinations. CONCLUSIONS Cervical sagittal alignment parameters measured on multipositional MRI could reliably substitute for those measured on plain radiographs. Multipositional MRI is a valuable, radiation-free alternative for diagnostic evaluation in degenerative cervical diseases.
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Affiliation(s)
- Zhiqiang Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Fanguo Lin
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yao Zhang
- Department of Orthopedics, Suqian First Hospital, Suqian, China
| | - Zhigao Jin
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Dong Liu
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Yekun Deng
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China
| | - Xiaotong Wang
- Department of Hepatology and Gastroenterology, The Affiliated Infectious Hospital of Soochow University, Suzhou, China.
| | - Xiaozhong Zhou
- Department of Orthopedics, The Second Affiliated Hospital of Soochow University, Suzhou, China.
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Strauss S, Lightstone DF, Fedorchuk C, Pomahac R, Oakley PA, Harrison DE. Post-concussion syndrome and concussion incidence improved in a pro rugby player following cervical spine rehab: case study and 6-year follow-up. Concussion 2023; 8:CNC107. [PMID: 37691851 PMCID: PMC10485734 DOI: 10.2217/cnc-2023-0004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2023] [Accepted: 04/17/2023] [Indexed: 09/12/2023] Open
Abstract
Aim To report improvements in post-concussion syndrome and concussion incidence following cervical spinal alignment correction. Case presentation A 27-year-old professional rugby player with 20 documented concussions presented with abnormal cervical spinal alignment and post-concussion syndrome. After 30 sessions of cervical rehabilitation, health outcomes improved. Post-treatment radiographs showed improved cervical lordosis from -13.5° to -37.4° (ideal is -42°) and right head translation from -22.7 to -11.3 mm (ideal is 0 mm). 2-year follow-up radiographs and 6-year follow-up health outcomes showed post-treatment improvements were maintained. The patient reported two documented concussions in the 6 years following treatment while maintaining the same lifestyle and professional rugby career. Conclusion Correction of abnormal cervical spinal alignment may help athletes with post-concussion syndrome and reduce risk of concussion.
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Affiliation(s)
- Seth Strauss
- Private Practice, 757 Long Point Road, Suite C, Mount Pleasant, SC 29464, USA
| | - Douglas F Lightstone
- Institute for Spinal Health & Performance, 460 Brannon Road, Suite 101, Cumming, GA 30041, USA
| | - Curtis Fedorchuk
- Institute for Spinal Health & Performance, 460 Brannon Road, Suite 101, Cumming, GA 30041, USA
| | - Robert Pomahac
- Institute for Spinal Health & Performance, 460 Brannon Road, Suite 101, Cumming, GA 30041, USA
| | - Paul A Oakley
- CBP Non-Profit, 950 East Riverside Drive, Eagle, ID 83616, USA
| | - Deed E Harrison
- CBP Non-Profit, 950 East Riverside Drive, Eagle, ID 83616, USA
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50
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Nishimura H, Endo K, Sawaji Y, Suzuki H, Aihara T, Murata K, Konishi T, Yamauchi H, Ueshima T, Yamamoto K. Global Sagittal Spinal Compensation for Dropped Head Alignment. Spine (Phila Pa 1976) 2023; 48:421-427. [PMID: 36728796 DOI: 10.1097/brs.0000000000004562] [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: 10/13/2022] [Accepted: 12/14/2022] [Indexed: 02/03/2023]
Abstract
STUDY DESIGN This is a retrospective radiographic study of a consecutive series of cases in patients with dropped head syndrome (DHS) at a single tertiary referral center. OBJECTIVE The aim was to clarify the compensation among parameters of spinal sagittal alignment in patients with DHS. SUMMARY OF BACKGROUND DATA The treatment strategy for DHS should vary according to the types of global sagittal spinal alignment. However, theoretical evidence in consideration of spinal sagittal compensation against the dropped head condition is lacking. MATERIALS AND METHODS One hundred sixteen patients diagnosed with isolated neck extensor myopathy were enrolled. Radiographic measurements were made, including parameters of spinal sagittal alignment. The patients were divided into three groups according to sagittal spinal balance: C7SVA (sagittal vertical axis) ≥ +50 mm (P-DHS; positive imbalanced DHS), -50 mm ≤C7SVA <+50 mm (B-DHS; balanced DHS), and C7SVA <-50 mm (N-DHS; negative imbalanced DHS). Correlations among the various spinal parameters were analyzed. RESULTS Among all types of DHS, there was no correlation between C2-C7 angle (C2-C7A) and T1 slope. In B-DHS, other correlations among the adjacent spinal segments were maintained. In N-DHS, there was no correlation between C2-C7A and TK, and in P-DHS, there was also no correlation between TK and lumbar lordosis. CONCLUSIONS The loss of compensation at the cervicothoracic junction was observed in all DHS types. B-DHS showed decompensation only at the cervicothoracic junction. N-DHS presented additional decompensation of the thoracic spine, and P-DHS showed decompensation between the thoracic and lumbar spine. Evaluation of global sagittal spinal balance is important for determining global spinal compensation associated with DHS and when considering treatment strategy.
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Affiliation(s)
- Hirosuke Nishimura
- Department of Orthopedic Surgery, Tokyo Medical University, Shinjuku-ku, Tokyo, Japan
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