Does Cervical Sagittal Alignment Correlate with Outcomes following Posterior Laminectomy and Fusion for Cervical Myelopathy?

2015 ◽  
Vol 15 (10) ◽  
pp. S144
Author(s):  
John A. Sielatycki ◽  
Sheyan J. Armaghani ◽  
Arnold Silverberg ◽  
Matthew J. McGirt ◽  
Clinton J. Devin ◽  
...  
Keyword(s):  
Cervical Myelopathy ◽  
Sagittal Alignment ◽  
Cervical Sagittal Alignment ◽  
Posterior Laminectomy ◽  
Laminectomy And Fusion

Prediction of the Risk of C5 Palsy After Posterior Laminectomy and Fusion With Cervical Myelopathy Using Support Vector Machine: an Analysis of 184 Consecutive Patients

2021 ◽  
Author(s):  
Haosheng Wang ◽  
Zhi-Ri Tang ◽  
Wenle Li ◽  
Tingting Fan ◽  
Jianwu Zhao ◽  
...  
Keyword(s):  
Support Vector Machine ◽  
Receiver Operating Characteristic Curve ◽  
Cervical Myelopathy ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Support Vector ◽  
Svm Model ◽  
Operating Characteristic Curve ◽  
Posterior Laminectomy ◽  
Laminectomy And Fusion

Abstract Background: This study aimed to predict the C5 palsy (C5P) after posterior laminectomy and fusion (PLF) with cervical myelopathy (CM) from routinely available variables by using support vector machine (SVM) method.Methods: We conducted a retrospective investigation based on 184 consecutive patients with CM after PLF, and data was collected from March 2013 to December 2019. Clinical and imaging variables were obtained and imported into univariable and multivariable logistics regression analysis to identify risk factors for C5P. According to published reports and clinical experience, a series of variables was selected to develop an SVM machine learning model to predict C5P. The accuracy (ACC), area under the receiver operating characteristic curve (AUC) and confusion matrices were used to evaluate the performance of the prediction model.Results: Among the total 184 consecutive patients, C5P occurred in 26 patients (14.13%). Multivariate analyses demonstrated the following 4 independent factors associated with C5P: electromyogram abnormal (odds ratio [OR] = 7.861), JOA recovery rate (OR = 1.412), modified Pavlov ratio (OR = 0.009), and presence of foraminal stenosis C4-C5 (OR = 15.492). The SVM model achieved an area under receiver operating characteristic curve (AUC) of 0.923 and ACC of 0.918. Meanwhile, the confusion matrix shown the classification results of the discriminant analysis. Conclusions: The designed SVM model presented a satisfied performance in predicting C5P from routinely available variables. However, future external validation is needed.

scholarly journals Prediction of the risk of C5 palsy after posterior laminectomy and fusion with cervical myelopathy using a support vector machine: an analysis of 184 consecutive patients

2021 ◽  
Vol 16 (1) ◽  
Author(s):  
Haosheng Wang ◽  
Zhi-Ri Tang ◽  
Wenle Li ◽  
Tingting Fan ◽  
Jianwu Zhao ◽  
...  
Keyword(s):  
Support Vector Machine ◽  
Receiver Operating Characteristic Curve ◽  
Cervical Myelopathy ◽  
Operating Characteristic ◽  
Characteristic Curve ◽  
Support Vector ◽  
Svm Model ◽  
Operating Characteristic Curve ◽  
Posterior Laminectomy ◽  
Laminectomy And Fusion

Abstract Background This study aimed to predict C5 palsy (C5P) after posterior laminectomy and fusion (PLF) with cervical myelopathy (CM) from routinely available variables using a support vector machine (SVM) method. Methods We conducted a retrospective investigation based on 184 consecutive patients with CM after PLF, and data were collected from March 2013 to December 2019. Clinical and imaging variables were obtained and imported into univariable and multivariable logistic regression analyses to identify risk factors for C5P. According to published reports and clinical experience, a series of variables was selected to develop an SVM machine learning model to predict C5P. The accuracy (ACC), area under the receiver operating characteristic curve (AUC), and confusion matrices were used to evaluate the performance of the prediction model. Results Among the 184 consecutive patients, C5P occurred in 26 patients (14.13%). Multivariate analyses demonstrated the following 4 independent factors associated with C5P: abnormal electromyogram (odds ratio [OR] = 7.861), JOA recovery rate (OR = 1.412), modified Pavlov ratio (OR = 0.009), and presence of C4–C5 foraminal stenosis (OR = 15.492). The SVM model achieved an area under the receiver operating characteristic curve (AUC) of 0.923 and an ACC of 0.918. Additionally, the confusion matrix showed the classification results of the discriminant analysis. Conclusions The designed SVM model presented satisfactory performance in predicting C5P from routinely available variables. However, future external validation is needed.

scholarly journals Effect of Cervical Sagittal Balance on Laminoplasty in Patients With Cervical Myelopathy

2017 ◽  
Vol 7 (2) ◽  
pp. 154-161 ◽  
Author(s):  
Minori Kato ◽  
Takashi Namikawa ◽  
Akira Matsumura ◽  
Sadahiko Konishi ◽  
Hiroaki Nakamura
Keyword(s):  
Neck Pain ◽  
Cervical Myelopathy ◽  
Sagittal Balance ◽  
Sagittal Alignment ◽  
Clinical Status ◽  
Cervical Sagittal Balance ◽  
Cervical Sagittal Alignment ◽  
Group A ◽  
Group B ◽  
The Relationship

Study Design: Retrospective clinical study. Objective: We evaluated the relationship between cervical sagittal alignment parameters and clinical status in patients with cervical myelopathy and analyzed the effect of cervical sagittal balance on cervical laminoplasty. Methods: Patients with cervical myelopathy (n = 110) who underwent laminoplasty were included in this study. The relationship between cervical sagittal alignment parameters and clinical status was evaluated. The changes in radiographic cervical sagittal parameters and clinical status 2 years after surgery were compared between patients with preoperative C2-7 SVA ≥35 mm (group A) and those with preoperative C2-7 SVA <35 mm (group B). Results: Preoperatively, C2-7 SVA had no correlation with defined health-related quality of life evaluation scores. At 2-year follow-up, the improvement in SF-36 physical component summary was significantly lower in group A than in group B. The postoperative change of C2-7 SVA did not significantly differ in 2 groups. Patients in group A maintained cervical regional balance after laminoplasty but experienced extensive postoperative neck pain. Conclusions: Our patients with a C2-7 SVA of ≥35 mm maintained cervical regional balance after laminoplasty and their improvement in myelopathy was equivalent to that in patients with a C2-7 SVA of <35 mm. However, the patents with a C2-7 SVA of ≥35 mm experienced severe postoperative neck pain. C2-7 SVA is a parameter worth considering because it can lead to poor QOL and axial neck pain after laminoplasty.

scholarly journals Cervical spine alignment, sagittal deformity, and clinical implications

2013 ◽  
Vol 19 (2) ◽  
pp. 141-159 ◽  
Author(s):  
Justin K. Scheer ◽  
Jessica A. Tang ◽  
Justin S. Smith ◽  
Frank L. Acosta ◽  
Themistocles S. Protopsaltis ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Cervical Myelopathy ◽  
Sagittal Alignment ◽  
Deformity Correction ◽  
Adjacent Segment ◽  
Sagittal Vertical Axis ◽  
Cervical Alignment ◽  
Cervical Deformity ◽  
Cervical Sagittal Alignment ◽  
Global Sagittal Alignment

This paper is a narrative review of normal cervical alignment, methods for quantifying alignment, and how alignment is associated with cervical deformity, myelopathy, and adjacent-segment disease (ASD), with discussions of health-related quality of life (HRQOL). Popular methods currently used to quantify cervical alignment are discussed including cervical lordosis, sagittal vertical axis, and horizontal gaze with the chin-brow to vertical angle. Cervical deformity is examined in detail as deformities localized to the cervical spine affect, and are affected by, other parameters of the spine in preserving global sagittal alignment. An evolving trend is defining cervical sagittal alignment. Evidence from a few recent studies suggests correlations between radiographic parameters in the cervical spine and HRQOL. Analysis of the cervical regional alignment with respect to overall spinal pelvic alignment is critical. The article details mechanisms by which cervical kyphotic deformity potentially leads to ASD and discusses previous studies that suggest how postoperative sagittal malalignment may promote ASD. Further clinical studies are needed to explore the relationship of cervical malalignment and the development of ASD. Sagittal alignment of the cervical spine may play a substantial role in the development of cervical myelopathy as cervical deformity can lead to spinal cord compression and cord tension. Surgical correction of cervical myelopathy should always take into consideration cervical sagittal alignment, as decompression alone may not decrease cord tension induced by kyphosis. Awareness of the development of postlaminectomy kyphosis is critical as it relates to cervical myelopathy. The future direction of cervical deformity correction should include a comprehensive approach in assessing global cervicalpelvic relationships. Just as understanding pelvic incidence as it relates to lumbar lordosis was crucial in building our knowledge of thoracolumbar deformities, T-1 incidence and cervical sagittal balance can further our understanding of cervical deformities. Other important parameters that account for the cervical-pelvic relationship are surveyed in detail, and it is recognized that all such parameters need to be validated in studies that correlate HRQOL outcomes following cervical deformity correction.

scholarly journals Perioperative Complications of Surgery for Degenerative Cervical Myelopathy: A Comparison Between 3 Procedures

2021 ◽  
pp. 219256822199830
Author(s):  
Mohamed Kamal Mesregah ◽  
Blake Formanek ◽  
John C. Liu ◽  
Zorica Buser ◽  
Jeffrey C. Wang
Keyword(s):  
Propensity Score ◽  
Cervical Myelopathy ◽  
Perioperative Complications ◽  
International Classification Of Diseases ◽  
Significance Level ◽  
Chi Squared ◽  
Retrospective Comparative Study ◽  
Posterior Laminectomy ◽  
Degenerative Cervical Myelopathy ◽  
New Onset

Study Design: Retrospective comparative study. Objectives: To compare the perioperative complications of propensity score-matched cohorts of patients with degenerative cervical myelopathy (DCM), who were treated with anterior cervical discectomy and fusion (ACDF), posterior laminectomy with fusion, or laminoplasty. Methods: The Humana PearlDiver Patient Record Database was queried using the International Classification of Diseases (ICD-9 and ICD-10) and the Current Procedural Terminology (CPT) codes. Propensity score-matched analysis was done using multiple Chi-squared tests with Bonferroni correction of the significance level. Results: Cohorts of 11,790 patients who had ACDF, 2,257 patients who had posterior laminectomy with fusion, and 477 patients who had laminoplasty, were identified. After propensity score matching, all the 3 groups included 464 patients. The incidence of dysphagia increased significantly following ACDF compared to laminoplasty, P < 0.001, and in laminectomy with fusion compared to laminoplasty, P < 0.001. The incidence of new-onset cervicalgia was higher in ACDF compared to laminoplasty, P = 0.005, and in laminectomy with fusion compared to laminoplasty, P = 0.004. The incidence of limb paralysis increased significantly in laminectomy with fusion compared to ACDF, P = 0.002. The revision rate at 1 year increased significantly in laminectomy with fusion compared to laminoplasty, P < 0.001, and in ACDF compared to laminoplasty, P < 0.001. Conclusions: The incidence of dysphagia following laminectomy with fusion was not different compared to ACDF. Postoperative new-onset cervicalgia and revisions were least common in laminoplasty. The highest rate of postoperative limb paralysis was noticed in laminectomy with fusion.

P43. Magnetic resonance imaging is inadequate to assess cervical sagittal alignment parameters

2021 ◽  
Vol 21 (9) ◽  
pp. S160-S161
Author(s):  
Harry M. Lightsey ◽  
Brian C. Goh ◽  
Daniel G. Tobert ◽  
Harold A. Fogel ◽  
Thomas D. Cha ◽  
...  
Keyword(s):  
Magnetic Resonance Imaging ◽  
Magnetic Resonance ◽  
Sagittal Alignment ◽  
Resonance Imaging ◽  
Cervical Sagittal Alignment

scholarly journals Cervical sagittal alignment after Prestige LP cervical disc replacement: radiological results and clinical impacts from a single-center experience

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xiaofei Wang ◽  
Yang Meng ◽  
Hao Liu ◽  
Hua Chen ◽  
Beiyu Wang ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Disc Replacement ◽  
Cervical Disc ◽  
Adjacent Segment ◽  
Single Center ◽  
Disc Disease ◽  
Sagittal Vertical Axis ◽  
Cervical Disc Replacement ◽  
Cervical Sagittal Alignment ◽  
The Impact

Abstract Background Cervical disc replacement (CDR) has been widely used to treat one- and two-level cervical degenerative disc disease. Studies have shown the effectiveness of CDR in preserving range of motion (ROM) and delaying adjacent segment degeneration (ASD). Cervical sagittal alignment is an important factor affecting favorable clinical outcomes in cervical spine surgery. This study aimed to explore whether cervical sagittal alignment can be maintained after CDR and to identify the impact of cervical sagittal alignment on outcomes after CDR. Methods This was a single-center, retrospective study. 132 patients who underwent one-level CDR were included. Cervical sagittal alignments, including cervical lordosis (CL), segmental alignment (SA), sagittal vertical axis (SVA), T1 slope (T1s), and T1s minus CL (T1s-CL), were measured. The effects of cervical sagittal alignment on the CDR outcomes were analyzed. Patients were divided into the heterotopic ossification (HO) group and ASD group to determine the potential impacts of cervical sagittal parameters. Results The cervical sagittal alignment parameters, except for the SVA, were significantly improved after CDR and showed decreasing trends at the last follow-up. Significantly higher CL and T1s were found in patients with better ROM after CDR. SVA ≥ 20 mm increased the risk of anterior HO (odds ratio = 2.945, P = 0.007). Significantly kyphotic SA and lower T1s values were found in the ASD patients than in the non-ASD patients (P < 0.05). Patients with ASD at the inferior level showed significantly worse CL (P < 0.05). Conclusion CDR had limited function of improving cervical sagittal alignment. Poor cervical sagittal alignment after CDR was associated with HO, ASD, and less ROM.

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