Analysis of the reciprocal changes in upper cervical profile and the risk factors for increasing cervical sagittal vertical axis after laminoplasty for ossification of the posterior longitudinal ligament of the cervical spine

2020 ◽  
Vol 194 ◽  
pp. 105788
Author(s):  
Masashi Miyazaki ◽  
Toshinobu Ishihara ◽  
Tetsutaro Abe ◽  
Shozo Kanezaki ◽  
Naoki Notani ◽  
...  
Keyword(s):  
Risk Factors ◽  
Cervical Spine ◽  
Vertical Axis ◽  
Posterior Longitudinal Ligament ◽  
Sagittal Vertical Axis ◽  
Upper Cervical

scholarly journals Risk Factors for Cervical Deformity After Posterior Cervical Decompression Surgery: A Multicenter Study

2021 ◽  
pp. 219256822110366
Author(s):  
Shin Oe ◽  
Kenta Kurosu ◽  
Tomohiko Hasegawa ◽  
Satoshi Shimizu ◽  
Go Yoshida ◽  
...  
Keyword(s):  
Risk Factors ◽  
Multicenter Study ◽  
Multiple Logistic Regression Analysis ◽  
Vertical Axis ◽  
Posterior Longitudinal Ligament ◽  
Decompression Surgery ◽  
Sagittal Vertical Axis ◽  
Fusion Surgery ◽  
Cervical Deformity ◽  
Significant Difference

Study Design: Retrospective multicenter study. Objective: Posterior decompression surgery for cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) is a common surgery; however, it can cause postoperative cervical deformity (CD). The purpose of this study was to investigate the risk factors for CD. Methods: The participants were 193 patients underwent laminoplasty or laminectomy for CSM or OPLL. CD was defined as a C2-7 sagittal vertical axis (SVA) ≥ 40 mm or a cervical lordosis angle (CL) ≤ −10°. The participants were divided into 2 groups: NCD (without CD before surgery), CD (with CD before surgery). NCD group was divided based on the presence of CD 1 year after surgery as follows: postoperative CD (PCD) and no PCD (NPCD). Results: There were 153 patients (NCD), 40 (CD), 126 (NPCD), and 27 (PCD). There was significant difference in the number of decompressed lamina (NPCD: PCD = 4.1:4.5), the presence of C2 decompression (2: 11%), and C5 palsy (0: 11%). The risk factors for onset of CD, PCD, and CL ≤ −10° as assessed by multiple logistic regression analysis were preoperative C2-7 SVA ≥ 30 mm (odds ratio [OR]: 19.0), decompression of C2 or C7 lamina (OR 3.1), and preoperative CL ≤ 2° (OR 42.0), respectively. Conclusions: To prevent postoperative CD, it is important to avoid decompression of the C2 or C7 lamina. Moreover, in case with C2-7 SVA ≥ 30 mm or CL ≤ 2° before surgery, it is important to explain the risks and consider adding fusion surgery.

scholarly journals Chronic infectious lesions of the cervical spine in adults: monocentric cohort analysis and literature review

2021 ◽  
Vol 18 (3) ◽  
pp. 68-76
Author(s):  
D. G. Naumov ◽  
S. G. Tkach ◽  
A. Yu. Mushkin ◽  
M. E. Makogonova
Keyword(s):  
Cervical Spine ◽  
Surgical Treatment ◽  
Sagittal Balance ◽  
Cohort Analysis ◽  
Pain Syndrome ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Comorbidity Index ◽  
Anterior Reconstruction ◽  
Infectious Spondylitis

Objective. To analyze the results of surgical treatment of chronic infectious cervical spondylitis and literature data.Material and Methods. Design: retrospective monocentric cohort study for 2017–2020. The study included medical history and clinical and instrumental data of 25 patients who underwent 28 reconstructive surgeries on the suboccipital (n1 = 3) and subaxial (n2 = 25) spine. The average follow-up period was 1 year 2 months ± 4 months. Statistical analysis was performed using the Statistical Package for the Social Sciences (SPSS), version 22.0.Results. The effect of the duration of the therapeutic pause (p = 0.043) and the T1 slope (T1S) (p = 0.022) on the intensity of vertebrogenic pain syndrome was established. When assessing the parameters of the sagittal balance a direct relationship between the age of patients and the value of cervical sagittal vertical axis (CSVA) (p = 0.035) was revealed, while CSVA (p = 0.514) and neck tilt angle (NTA) (p = 0.617) did not significantly affect the intensity of vertebral pain syndrome. The extent of vertebral destruction did not affect either the intensity of vertebral pain (p = 0.872) or the indices of the sagittal balance: CSVA (p = 0.116), T1S (p = 0.154), and NTA (p = 0.562). A significant predictor of postoperative complications is the level of comorbidity with an index of 7 or more (p = 0.027) according to the Charlson scale.Conclusion. The leading predictors of complications of surgical treatment of cervical infectious spondylitis are the Charlson comorbidity index (7 points or more) and the variant of anterior reconstruction (the use of a blocked extraspinal plate). The factors influencing the intensity of vertebrogenic pain syndrome in this pathology are the duration of the therapeutic pause and the magnitude of T1S compensation. Anterior reconstruction of the cervical spine in the presence of infectious spondylitis provides a correction of the sagittal balance parameters, with the possibility of long-term maintaining the achieved values.

Association of findings on preoperative extension lateral cervical radiography with osteotomy type, approach, and postoperative cervical alignment after cervical deformity surgery

2021 ◽  
pp. 1-6
Author(s):  
Hai V. Le ◽  
Joseph B. Wick ◽  
Renaud Lafage ◽  
Gregory M. Mundis ◽  
Robert K. Eastlack ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Vertical Axis ◽  
Spine Deformity ◽  
Lower Grade ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
T1 Slope ◽  
Radiographic Parameters ◽  
Cervical Spine Radiography

OBJECTIVE The authors’ objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. METHODS A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2–7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed. RESULTS On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope. CONCLUSIONS Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

scholarly journals Risk factors for adjacent segment degeneration after iliac screw fixation in lumbar degenerative kyphoscoliosis

2017 ◽  
Vol 25 (1) ◽  
pp. 230949901668472 ◽  
Author(s):  
Sang-Il Kim ◽  
Kee-Yong Ha ◽  
Dong-Whan Suh ◽  
In-Soo Oh
Keyword(s):  
Risk Factors ◽  
Pedicle Screws ◽  
Vertical Axis ◽  
Adjacent Segment Degeneration ◽  
Adjacent Segment ◽  
Sagittal Vertical Axis ◽  
Scoliosis Research Society ◽  
Iliac Screw ◽  
Group 2 ◽  
Group 1

Purpose: To analyze pre- and postoperative spinopelvic parameters and sagittal profiles in lumbar degenerative kyphoscoliosis (LDK) patients who underwent surgery using iliac screw (IS) and the incidence and risk factor of radiological adjacent segment degeneration (ASD). Methods: A total of 32 patients, who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screws and IS instrumentation for LDK with a minimum 2-year follow-up, were included. Ten cases with ASD (group 1) and 22 cases without ASD (group 2) were compared to see pre- and postoperative change in sagittal view of spine and adjacent segment. Parameters of both groups were analyzed before and after surgery with each parameters being tested on correlativity. All deformity types of patients were classified using Scoliosis Research Society (SRS)-Schwab classification. Risk factors of ASD were evaluated using variables of SRS-Schwab classification. Results: Group 1, rather than group 2, showed significant increment in pelvic incidence (PI). Curve types, classified using SRS-Schwab classification, were all corrected using IS; and after correction, coronal curve type was N curve and PI minus lumbar lordosis (LL) and pelvic tilt showed tendency to decrease. Cases with preoperative sagittal vertical axis (SVA) more than 10 cm and with postoperative PI minus LL more than 20° were at higher risk of developing ASD. Conclusion: For those with high PI, it might be a risk to cause ASD. Maintaining normal thoracic and lumbar angle, correction of SVA less than 4 cm, and PI minus LL below 20° are proper ways to avoid ASD after surgery.

scholarly journals Clinically Significant Thromboembolic Disease in Adult Spinal Deformity Surgery: Incidence and Risk Factors in 737 Patients

2017 ◽  
Vol 8 (3) ◽  
pp. 224-230 ◽  
Author(s):  
Han Jo Kim ◽  
Sravisht Iyer ◽  
Basel G. Diebo ◽  
Michael P. Kelly ◽  
Daniel Sciubba ◽  
...  
Keyword(s):  
Risk Factors ◽  
Mortality Rate ◽  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Area Under The Curve ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Venous Thromboembolic Events ◽  
Venous Thromboembolic ◽  
Spinal Deformity Surgery

Study Design: Retrospective cohort study. Objectives: Describe the rate and risk factors for venous thromboembolic events (VTEs; defined as deep venous thrombosis [DVT] and/or pulmonary embolism [PE]) in adult spinal deformity (ASD) surgery. Methods: ASD patients with VTE were identified in a prospective, multicenter database. Complications, revision, and mortality rate were examined. Patient demographics, operative details, and radiographic and clinical outcomes were compared with a non-VTE group. Multivariate binary regression model was used to identify predictors of VTE. Results: A total of 737 patients were identified, 32 (4.3%) had VTE (DVT = 14; PE = 18). At baseline, VTE patients were less likely to be employed in jobs requiring physical labor (59.4% vs 79.7%, P < .01) and more likely to have osteoporosis (29% vs 15.1%, P = .037) and liver disease (6.5% vs 1.4%, P = .027). Patients with VTE had a larger preoperative sagittal vertical axis (SVA; 93 mm vs 55 mm, P < .01) and underwent larger SVA corrections. VTE was associated with a combined anterior/posterior approach (45% vs 25%, P = .028). VTE patients had a longer hospital stay (10 vs 7 days, P < .05) and higher mortality rate (6.3% vs 0.7%, P < .01). Multivariate analysis demonstrated osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE ( r2 = .11, area under the curve = 0.74, P < .05). Conclusions: The incidence of VTE in ASD is 4.3% with a DVT rate of 1.9% and PE rate of 2.4%. Osteoporosis, lack of physical labor, and increased SVA correction were independent predictors of VTE. Patients with VTE had a higher mortality rate compared with non-VTE patients.

scholarly journals Analysis of risk factors for C5 nerve root paralysis after posterior cervical decompression

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Bo Liu ◽  
Yanchen Chu ◽  
Jinfeng Ma ◽  
Xiaojie Tang ◽  
Junpeng Pan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Spinal Cord ◽  
Cervical Spine ◽  
Nerve Root ◽  
Posterior Longitudinal Ligament ◽  
Spine Curvature ◽  
Independent Risk Factors ◽  
T2 Hyperintensity ◽  
Intervertebral Foramina ◽  
Posterior Longitudinal Ligament Ossification

Abstract Background C5 nerve root paralysis is a nonnegligible complication after posterior cervical spine surgery (PCSS). The cause of its occurrence remains controversial. The purpose of this study was to analyse the incidence of and risk factors for C5 nerve root paralysis after posterior cervical decompression. Methods We retrospectively analysed the clinical data of 640 patients who underwent PCSS in the Department of Orthopaedics, Affiliated Hospital of Qingdao University from September 2013 to September 2019. According to the status of C5 nerve root paralysis after surgery, all patients were divided into paralysis and normal groups. Univariate and multivariate analyses were used to determine the independent risk factors for C5 nerve root paralysis. A receiver operating characteristic (ROC) curve was used to demonstrate the discrimination of all independent risk factors. Results Multivariate logistic regression analysis revealed that male sex, preoperative cervical spine curvature, posterior longitudinal ligament ossification, and preoperative C4/5 spinal cord hyperintensity were independent risk factors for paralysis, whereas the width of the intervertebral foramina was an independent protective factor for paralysis. The area under the curve (AUC) values of the T2 signal change at C4-C5, sex, cervical foramina width, curvature and posterior longitudinal ligament ossification were 0.706, 0.633, 0.617, 0.637, and 0.569, respectively. Conclusions Male patients with C4-C5 intervertebral foramina stenosis, preoperative C4-C5 spinal cord T2 high signal, combined with OPLL, and higher preoperative cervical spine curvature are more likely to develop C5 nerve root paralysis after surgery. Among the above five risk factors, T2 hyperintensity change in C4-C5 exhibits the highest correlation with C5 paralysis and strong diagnostic power. It seems necessary to inform patients who have had cervical spine T2 hyperintensity before surgery of C5 nerve root paralysis after surgery, especially those with altered spinal cord T2 signals in the C4-C5 segment.

scholarly journals Significance of various risk factors for proximal junctional kyphosis and instability of instrumentation in surgical treatment for adult spinal deformities

2021 ◽  
Vol 18 (1) ◽  
pp. 14-23
Author(s):  
I. V. Basankin ◽  
D. A. Ptashnikov ◽  
S. V. Masevnin ◽  
A. A. Afaunov ◽  
A. A. Giulzatyan ◽  
...  
Keyword(s):  
Risk Factors ◽  
Surgical Treatment ◽  
Lumbar Lordosis ◽  
Significant Risk ◽  
Vertical Axis ◽  
Type I ◽  
Proximal Junctional Kyphosis ◽  
Sagittal Vertical Axis ◽  
Transpedicular Instrumentation ◽  
Junctional Kyphosis

Objective. To analyze the significance of the influence of various risk factors on the development of proximal junctional kyphosis (PJK) and instability of instrumentation.Material and Methods. The results of surgical treatment of 382 patients with scoliotic deformities of the lumbar spine of type I and IIIb according to Aebi were analyzed. Patients were operated on through the posterior approach using the TLIF-PLIF technique with extended rigid transpedicular instrumentation. Potential risk factors influencing the development of proximal junctional kyphosis and instability of instrumentation were analyzed.Results. It was found that only three risk factors significantly affect the development of PJK: correction of lumbar lordosis more than 30° (p = 0.036) increases the likelihood of its development by 1.5 times, osteoporosis (p = 0.001) – by 2.5 times, and proximal junctionalangle ≥10° (p = 0.001) – by 3.5 times. Three factors showed a statistically significant effect on the incidence of instrumentation instability: correction of lumbar lordosis more than 30° (p = 0.034) increases the likelihood of its occurrence by 1.7 times, osteoporosis (p = 0.018) – by 1.8 times, and deviation of the sagittal vertical axis by more than 50 mm (p = 0.001) – by 3.3 times.Conclusion. The most significant risk factors for the occurrence of PJK and instability of instrumentation are osteoporosis, correction of lumbar lordosis more than 30°, an increase in the proximal junctional angle ≥10°, and an anterior deviation of sagittal vertical axis more than 50 mm. Consideration of these factors in the preoperative period, as well as during surgery, can decrease likelihood of the occurrence of PJK and instability of instrumentation.

scholarly journals Risk factor analysis of proximal junctional kyphosis after posterior osteotomy in patients with ankylosing spondylitis

2018 ◽  
Vol 29 (1) ◽  
pp. 75-80 ◽  
Author(s):  
Tianhao Wang ◽  
Yongfei Zhao ◽  
Yan Liang ◽  
Haocong Zhang ◽  
Zheng Wang ◽  
...  
Keyword(s):  
Risk Factors ◽  
Ankylosing Spondylitis ◽  
Oswestry Disability Index ◽  
Vertical Axis ◽  
Pedicle Subtraction Osteotomy ◽  
Proximal Junctional Kyphosis ◽  
Sagittal Vertical Axis ◽  
Radiographic Measurements ◽  
Lowest Instrumented Vertebra ◽  
Junctional Kyphosis

OBJECTIVEThe aim of this paper was to analyze the incidence and risk factors of proximal junctional kyphosis (PJK) in patients with ankylosing spondylitis (AS) who underwent pedicle subtraction osteotomy.METHODSThe records of 83 patients with AS and thoracolumbar kyphosis who underwent surgery at the authors’ institution between 2007 and 2013 were reviewed. The patients were divided into 2 groups based on the presence or absence of PJK. The radiographic measurements, including proximal junctional angle (PJA), sagittal parameters, and pelvic parameters of these 2 groups, were compared at different time points: before surgery and 2 weeks, 12 months, and 2 years after surgery. Oswestry Disability Index scores were also evaluated.RESULTSOverall, 14.5% of patients developed PJK. Before surgery, the mean PJAs in the 2 groups were 13.6° and 8.5°, respectively (p = 0.008). There were no significant differences in age, sex, and body mass index between groups. Patients with PJK had a larger thoracolumbar kyphotic angle (50.8° ± 12.6°) and a greater sagittal vertical axis (21.7 ± 4.3 cm) preoperatively than those without PJK. The proportion of patients with PJK whose fusion extended to the sacrum was 41.2% (7/17), which is significantly greater than the proportion of patients with PJK whose lowest instrumented vertebra was above the sacrum. Oswestry Disability Index scores did not significantly increase in the PJK group compared with the non-PJK group.CONCLUSIONSThe authors found that PJK occurs postoperatively in patients with AS with an incidence of 14.5%. Risk factors of PJK include larger preoperative sagittal vertical axis, PJA, and osteotomy angle. Reducing the osteotomy angle in some severe cases and extending fusion to a higher, flatter level would be also beneficial in decreasing the risk of PJK.

Sign in / Sign up

Export Citation Format

Share Document