Comparison of Sagittal Vertical Axis and Decompression on the Clinical Outcome of Cervical Spondylotic Myelopathy

Purpose: To compare the sagittal alignment of different surgical approaches in patients with multiple levels cervical spondylotic myelopathy and explore the relationship between the cervical sagittal alignment and patient’s health relative quality of life. Method: A total of 97 multiple levels cervical spondylotic myelopathy patients who underwent surgery from January 2013 to January 2019 were collected in this study. Patients were divided into three groups: anterior cervical discectomy with fusion, anterior cervical corpectomy with fusion and laminectomy with fusion groups. Clinical outcomes and sagittal alignment parameters were compared preoperative and postoperative. Results: There were no significant differences in the average age and sex ratio among the groups. Sagittal parameters correlated to health relative quality of life were C7 slope, occipito-C2 angle, external auditory meatus tilt and cervical sagittal vertical axis. Both anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion groups exhibited better sagittal alignment and clinical outcomes improvement postoperatively. Anterior cervical discectomy with fusion provided better clinical outcomes and the better improvement of cervical lordosis, C7 slope, occipito-C2 angle and cervical sagittal vertical axis compared with patients with Laminectomy with fusion. Conclusion: C7 slope, occipito-C2 angle, external auditory meatus tilt and cervical sagittal vertical axis are the most important cervical sagittal parameters correlated to clinical outcomes in patients with multilevels cervical spondylotic myelopathy; anterior cervical discectomy with fusion and anterior cervical corpectomy with fusion provides more efficient to restoration of cervical sagittal alignment.

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Improvement in cervical lordosis and sagittal alignment after vertebral body sliding osteotomy in patients with cervical spondylotic myelopathy and kyphosis

Journal of Neurosurgery Spine ◽

10.3171/2020.3.spine2089 ◽

2020 ◽

Vol 33 (3) ◽

pp. 307-315 ◽

Cited By ~ 1

Author(s):

Dong-Ho Lee ◽

Choon Sung Lee ◽

Chang Ju Hwang ◽

Jae Hwan Cho ◽

Jae-Woo Park ◽

...

Keyword(s):

Vertebral Body ◽

Cervical Spondylotic Myelopathy ◽

Sagittal Alignment ◽

Japanese Orthopaedic Association ◽

Vertical Axis ◽

Sacral Slope ◽

Cervical Lordosis ◽

Sagittal Vertical Axis ◽

Segmental Lordosis

OBJECTIVEVertebral body sliding osteotomy (VBSO) is a safe, novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. Another advantage of VBSO may be the restoration of cervical lordosis through multilevel anterior cervical discectomy and fusion (ACDF) above and below the osteotomy level. This study aimed to evaluate the improvement and maintenance of cervical lordosis and sagittal alignment after VBSO.METHODSA total of 65 patients were included; 34 patients had undergone VBSO, and 31 had undergone anterior cervical corpectomy and fusion (ACCF). Preoperative, postoperative, and final follow-up radiographs were used to evaluate the improvements in cervical lordosis and sagittal alignment after VBSO. C0–2 lordosis, C2–7 lordosis, segmental lordosis, C2–7 sagittal vertical axis (SVA), T1 slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and Japanese Orthopaedic Association scores were measured. Subgroup analysis was performed between 15 patients with 1-level VBSO and 19 patients with 2-level VBSO. Patients with 1-level VBSO were compared to patients who had undergone 1-level ACCF.RESULTSC0–2 lordosis (41.3° ± 7.1°), C2–7 lordosis (7.1° ± 12.8°), segmental lordosis (3.1° ± 9.2°), and C2–7 SVA (21.5 ± 11.7 mm) showed significant improvements at the final follow-up (39.3° ± 7.2°, 13° ± 9.9°, 15.2° ± 8.5°, and 18.4 ± 7.9 mm, respectively) after VBSO (p = 0.049, p < 0.001, p < 0.001, and p = 0.038, respectively). The postoperative segmental lordosis was significantly larger in 2-level VBSO (18.8° ± 11.6°) than 1-level VBSO (10.3° ± 5.5°, p = 0.014). The final segmental lordosis was larger in the 1-level VBSO (12.5° ± 6.2°) than the 1-level ACCF (7.2° ± 7.6°, p = 0.023). Segmental lordosis increased postoperatively (p < 0.001) and was maintained until the final follow-up (p = 0.062) after VBSO. However, the postoperatively improved segmental lordosis (p < 0.001) decreased at the final follow-up (p = 0.045) after ACCF.CONCLUSIONSNot only C2–7 lordosis and segmental lordosis, but also C0–2 lordosis and C2–7 SVA improved at the final follow-up after VBSO. VBSO improves segmental cervical lordosis markedly through multiple ACDFs above and below the VBSO level, and a preserved vertebral body may provide more structural support.

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INFLUENCE OF THE SAGITTAL BALANCE ON THE CLINICAL OUTCOME IN SPINAL FUSION

Coluna/Columna ◽

10.1590/s1808-185120161501153517 ◽

2016 ◽

Vol 15 (1) ◽

pp. 52-56 ◽

Cited By ~ 2

Author(s):

Marcela Almeida Campos Coutinho ◽

Raphael de Rezende Pratali ◽

Marcel Machado da Motta ◽

Carla Balkanyi Hoffman ◽

Carlos Eduardo Gonçales Barsotti ◽

...

Keyword(s):

Clinical Outcome ◽

Spinal Fusion ◽

Vertical Axis ◽

Sagittal Vertical Axis ◽

Functional Parameters ◽

Radiographic Parameters ◽

Study Results ◽

Fusion Methods ◽

Spinopelvic Balance ◽

Satisfaction With Treatment

ABSTRACT Objective: Evaluates which radiographic parameters of the sagittal and spinopelvic balance influence the clinical and functional outcomes of a sample of patients undergoing spinal fusion. Methods: We studied 32 patients who underwent spinal fusion. Radiographs of the total spine were obtained from all patients. The clinical and functional parameters studied were analysis of pain by visual analogic scale (VAS) and Oswestry and SRS-30 questionnaires. We analyzed the correlation between the clinical and functional parameters and radiographic parameters of the sagittal and spinopelvic balance. Results: There was no significant correlation between parameters pelvic incidence (PI), pelvic tilt (PT), lumbar lordosis (LL) and difference between PI and LL (PI-LL) and clinical parameters (p > 0.05 and r <0.2). Significant correlation were identified only between Sagittal Vertical Axis (SVA) and Satisfaction with Treatment domain of SRS-30 (r = 0.402 e p = 0.023) and between thoracic kyphosis (TK) and the total SRS-30 (r = 0.419 and p = 0.017). Conclusions: According to the study results, it was not possible to precisely characterize the role of the parameters of the sagittal and spinopelvic balance in the post-operative analysis of the clinical outcome of spinal fusion. There was a significant correlation only between SVA and the Satisfaction with Treatment domain of SRS-30 and between TK and total SRS-30.

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The Effect of Early Mobilisation on the Sagittal Alignment and Clinical Outcome Following Conservative Treatment of the AO A3 and A4 Thoracolumbar Spine Fracture in Comparison to A1 Fractures. A Retrospective Study

10.21203/rs.3.rs-539565/v1 ◽

2021 ◽

Author(s):

Mahmoud Elshamly ◽

Stefan Toegel ◽

Josef G Grohs

Keyword(s):

Conservative Treatment ◽

Clinical Outcome ◽

Thoracolumbar Spine ◽

Vertical Axis ◽

Sacral Slope ◽

Compensatory Mechanisms ◽

Sagittal Vertical Axis ◽

Sagittal Malalignment ◽

Neurologically Intact

Abstract BackgroundThe aim of the study was to correlate the clinical and radiological outcomes following the conservative treatment of neurologically intact patients with AO A4, A3, and A1 thoracolumbar (TL) fractures.MethodsRetrospective study included 3 cohorts of conservatively treated patients with AO A4, A3, and A1 TL fracture without the use of bracing or casting. At the final follow up segmental kyphotic angle (SKA), regional lordotic angle (RLA), lordosis gap (LG), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), sagittal vertical axis (SVA), lumbar lordosis (LL), thoracic kyphosis (TK), and femoral obliquity angle (FOA), and the Oswestry disability index (ODI) were assessed. Data were analyzed using descriptive statistics, non-parametric inferential statistics, and Spearman correlation analyses.ResultsAge was significantly higher in A4 group than in A1 group (p=0.04). The median 1ry SKA of the A3 group (15 ± 3) was significantly higher than in A1 group (7 ± 7, p=0.04). The median of total ODI in the A4 group (42 ± 53) and A3 group (31.3 ± 27) was clinically higher than in A1 group (11.1 ± 25), however, this difference was not statistically significant. Age as well as SVA correlated significantly with PT, FOA, SKA at the follow up, and the total ODI.ConclusionAge of the patient is a significant confounder that has an important impact on the type of fracture, sagittal malalignment, its compensatory mechanisms, and the resulting clinical outcome following conservative treatment of AO A4 and A3 TL fracture.

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The impact of spinopelvic morphology on the short-term outcome of pedicle subtraction osteotomy in 104 patients

Journal of Neurosurgery Spine ◽

10.3171/2016.11.spine16601 ◽

2017 ◽

Vol 27 (1) ◽

pp. 74-80 ◽

Cited By ~ 7

Author(s):

Karin Eskilsson ◽

Deep Sharma ◽

Christer Johansson ◽

Rune Hedlund

Keyword(s):

Clinical Outcome ◽

Sagittal Plane ◽

Vertical Axis ◽

Pedicle Subtraction Osteotomy ◽

Sacral Slope ◽

Sagittal Imbalance ◽

Sagittal Vertical Axis ◽

Term Outcome ◽

Pelvic Morphology ◽

The Impact

OBJECTIVEPedicle subtraction osteotomy (PSO) is commonly performed for correction of spinal sagittal plane deformities. The PSO results in complex, multiple changes of the spinopelvic alignment. The influence of the variability of individual pelvic morphology has not been fully analyzed in previous outcome studies of sagittal imbalance. The aim of this study was to define radiological variables affecting the outcome after PSO in adult spinal deformities, with special emphasis on the variability of pelvic morphology.METHODSClinical and radiographic outcomes were analyzed in a retrospective analysis of 104 patients who underwent a PSO at a single center. The radiographic variables studied were sagittal vertical axis (SVA), T1SPI (T-1 spinopelvic inclination), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS). To control for the individual variation of pelvic morphology, the LL/PI, PT/PI, and SS/PI ratios were calculated. Clinical outcome was assessed using the visual analog scale for pain, Oswestry Disability Index, and EQ-5D preoperatively and at a minimum 1-year follow-up. Correlation coefficients were calculated between each individual radiographic variable and the outcome measures. The importance of LL mismatch to TK, reflecting the importance of a harmonious spine, was analyzed by comparing the outcome of patients with a TK+LL+PI ≤ 45° to those with a sum > 45°.RESULTSSVA and T1SPI demonstrated the strongest correlation with the clinical outcome scores (r = 0.4–0.5, p < 0.001). LL correlated weakly with the clinical outcome (r = 0.2–0.3, p < 0.003). Mismatch of LL to PI, however, did not correlate significantly with the outcome. Similarly, only weak and inconsistent correlation was observed between PT, SS, PT/PI, SS/PI, and functional outcome. Patients with a TK+LL+PI ≤ 45° had a significantly lower ODI score (33 vs 44) and a significantly higher EQ-5D score (0.64 vs 0.40) than patients with a sum > 45° (LL is a negative value).CONCLUSIONSPSO resulted in a substantial correction of sagittal imbalance and improved outcome in most patients in this study. Correction of the global sagittal balance appears to be a necessary precondition for a good outcome. A harmonious spine with a TK and an LL of similar magnitude seems to add to a positive outcome.

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Cervical alignment following laminoplasty for cervical spondylotic myelopathy

Surgical Neurology International ◽

10.25259/sni_346_2019 ◽

2019 ◽

Vol 10 ◽

pp. 156

Author(s):

Ravi Sharma ◽

Sachin A. Borkar ◽

Manoj Phalak ◽

S. Leve Joseph ◽

Shashank S. Kale

Keyword(s):

Cervical Spondylotic Myelopathy ◽

Generalized Linear Model ◽

Vertical Axis ◽

Posterior Longitudinal Ligament ◽

X Rays ◽

Sagittal Vertical Axis ◽

T1 Slope ◽

Group A ◽

Cobb’S Angle ◽

Group B

Background: Laminoplasty can result in the loss of cervical lordosis (LOCL) or the development of kyphosis after surgery. Here, we evaluated the clinical and radiological parameters involved in predicting the postoperative LOCL following laminoplasty in patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). Methods: For 50 patients with CSM and 35 with OPLL undergoing laminoplasty, preoperative and 1-year postoperative X-rays were obtained to determine the incidence and risk factors contributing to postoperative LOCL. The patients were divided into two groups depending on whether the preoperative T1 slope was above or below the median preoperative T1S (26°); Group A – high T1 slope group (n = 40) and Group B – low T1 slope group (n = 45). Results: Following laminoplasty, Group A patients had significantly higher preoperative lordosis (C2-C7 Cobb’s angle) (P = 0.001) and significantly higher LOCL (P = 0.02) versus Group B patients with low T1 slopes. The preoperative T1 slope was also found to be significantly correlated with the preoperative C2-C7 Cobb’s angles (R = 0.619, P = 0.001), LOCL (R = 0.487, P = 0.001), and preoperative C2-C7 sagittal vertical axis (R = 0.480, P = 0.001). Utilizing multivariate analysis and a generalized linear model, the preoperative T1 slope significantly impacted the Oswestry disability index (ODI) index (P = 0.002) and frequency of LOCL (P = 0.001) following laminoplasty. Conclusion: The preoperative T1 slope is a significant predictor of the LOCL and change in ODI following laminoplasty for CSM/OPLL utilizing a cutoff value of 29.5°.

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Differences in radiological and functional outcomes between cervical spondylotic myelopathy and ossification of the posterior longitudinal ligament after multi-level laminoplasty

10.21203/rs.3.rs-24947/v1 ◽

2020 ◽

Author(s):

Dongwoo Yu ◽

Sang Woo Kim ◽

Ikchan Jeon

Keyword(s):

Sagittal Balance ◽

Recovery Rate ◽

Cervical Spondylotic Myelopathy ◽

Functional Outcomes ◽

Vertical Axis ◽

Posterior Longitudinal Ligament ◽

Sagittal Vertical Axis ◽

Japanese Orthopedic Association ◽

Significant Difference ◽

Multi Level

Abstract Objective The purpose of this study was to compare the radiological and functional outcomes between patients with cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL) after multi-level laminoplasty. Methods This study included 75 patients (32 with CSM and 43 with OPLL) with preserved cervical sagittal balance who underwent multi-level laminoplasty for cervical myelopathy. The radiological outcomes were analyzed using the following parameters: C2–C7 Cobb angle in neutral (C27AN), flexed (C27AF), and extended (C27AE) neck postures; C2–C7 range of motion (C27ROM); T1 slope (T1S); and C2–C7 sagittal vertical axis (C27SVA). The functional outcomes were analyzed using the modified Japanese Orthopedic Association (mJOA) score, Nurick grade, and recovery rate. The radiological and functional outcomes between the two groups were evaluated 12-months postoperatively. Results C27AF, C27ROM, and C27SVA in the CSM group and C27ROM in the OPLL group decreased significantly (p < 0.05). There was a significant difference in ΔC27SVA between the two groups (9.41 ± 17.06 mm vs. 1.10 ± 17.15 mm, p < 0.05). However, there were no significant intra- or intergroup changes and differences in C27AN (p > 0.05). The functional outcomes including mJOA score (p = 0.251), Nurick grade (p = 0.316), and recovery rate (p = 0.435) showed no significant intergroup differences. Conclusions Although there were no significant differences in functional outcomes between the two groups, the CSM group showed a greater deterioration in sagittal balance with an increase of C27SVA than the OPLL group after multi-level laminoplasty.

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Sagittal profile modifications in hybrid versus all screw technique in adolescent idiopathic scoliosis

Scientific Reports ◽

10.1038/s41598-020-79523-4 ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Laura Scaramuzzo ◽

Antonino Zagra ◽

Giuseppe Barone ◽

Stefano Muzzi ◽

Leone Minoia ◽

...

Keyword(s):

Adolescent Idiopathic Scoliosis ◽

Idiopathic Scoliosis ◽

Cobb Angle ◽

Thoracic Kyphosis ◽

Sagittal Alignment ◽

Vertical Axis ◽

Sagittal Profile ◽

Sacral Slope ◽

Sagittal Vertical Axis ◽

Lenke Classification

AbstractAim of the study was to evaluate sagittal parameters modifications, with particular interest in thoracic kyphosis, in patients affected by adolescent idiopathic scoliosis (AIS) comparing hybrid and all-screws technique. From June 2010 to September 2018, 145 patients were enrolled. Evaluation included: Lenke classification, Risser scale, coronal Cobb angle, thoracic kyphosis (TK), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS). Patients were divided in two groups (1 all-screws and 2 hybrid); a further division, in both groups, was done considering preoperative TK values. Descriptive and inferential statistical analysis was conducted. 99 patients were in group 1, 46 in group 2 (mean follow-up 3.7 years). Patients with a normo-kyphotic profile developed a little variation in TK (Δ pre–post = 2.4° versus − 2.0° respectively). Hyper-kyphotic subgroups had a tendency of restoring a good sagittal alignment. Hypo-kyphotic subgroups, patients treated with all-screw implants developed a higher increase in TK mean Cobb angle (Δ pre–post = 10°) than the hybrid subgroup (Δ pre–post = 5.4°) (p = 0.01). All-screws group showed better results in restoring sagittal alignment in all subgroups compared to hybrid groups, especially in hypo-TK subgroup, with the important advantage to give better correction on coronal plane.

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The Pelvic Incidence Stratified Sagittal Spinopelvic Alignment in Asymptomatic Chinese Population With Different Age Groups

Global Spine Journal ◽

10.1177/2192568221989647 ◽

2021 ◽

pp. 219256822198964

Author(s):

Siyu Zhou ◽

Zhuoran Sun ◽

Wei Li ◽

Da Zou ◽

Weishi Li

Keyword(s):

Chinese Population ◽

Pelvic Incidence ◽

Sagittal Alignment ◽

Age Groups ◽

Vertical Axis ◽

Elderly Subjects ◽

Sagittal Vertical Axis ◽

Cross Sectional ◽

Sagittal Parameters ◽

Very High

Study Design: Cross-sectional study. Objective: To provide the age- and pelvic incidence-related variations of sagittal alignment in asymptomatic Chinese population. Methods: This study recruited asymptomatic adult subjects. All subjects undertook the standing whole spinal radiograph and the sagittal parameters were measured: sagittal vertical axis (SVA), T1 pelvic angle (TPA), lumbar lordosis (LL), thoracic kyphosis (TK), pelvic incidence (PI) and pelvic tilt (PT). All subjects were divided into young, middle aged and elderly groups, then each age group was further divided into 5 subgroups (very low, low, average, high and very high) based on PI values. The relations between PI, age and other parameters were evaluated. The differences in sagittal parameters of each PI subgroup were compared. Results: 546 subjects were included with an average age of 38.6 years (18 to 81). The number of subjects over 70 years and with very low PI was relatively small. The average of PI, TPA, PT and LL were 45.9° ± 8.4°, 6.4° ± 6.2°, 11.9° ± 6.6° and 49.2° ± 10.1°, respectively. SVA, TPA, TK and PT increased with age ( P < 0.05), while SVA, TPA, PT, PI-LL also increased with PI ( P < 0.05). LL, PT, TPA, PI-LL and LL-TK were different among the 5 PI subgroups ( P < 0.05). However, the values of LL in elderly subjects with high and very high PI were similar. Conclusion: The age- and PI-related variations in sagittal alignment of Chinese population were provided. The sagittal parameters were significantly influenced by age and PI. The individual pelvic morphology should be carefully considered during the assessment and restoration of sagittal balance.

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