Impact of Cervical Sagittal Alignment on Axial Neck Pain and Health-related Quality of Life After Cervical Laminoplasty in Patients With Cervical Spondylotic Myelopathy or Ossification of the Posterior Longitudinal Ligament

2018 ◽  
Vol 31 (4) ◽  
pp. E245-E251 ◽  
Author(s):  
Hiroyasu Fujiwara ◽  
Takenori Oda ◽  
Takahiro Makino ◽  
Yu Moriguchi ◽  
Kazuo Yonenobu ◽  
...  
Keyword(s):  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Posterior Longitudinal Ligament ◽  
Cervical Laminoplasty ◽  
Health Related Quality ◽  
Cervical Sagittal Alignment ◽  
Related Quality ◽  
Health Related ◽  
Axial Neck Pain

The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

Neurosurgery ◽  
2012 ◽  
Vol 71 (3) ◽  
pp. 662-669 ◽  
Author(s):  
◽  
Jessica A. Tang ◽  
Justin K. Scheer ◽  
Justin S. Smith ◽  
Vedat Deviren ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Health Related Quality ◽  
Sf 36 ◽  
Cervical Sagittal Alignment ◽  
Related Quality ◽  
Health Related ◽  
Posterior Cervical Fusion ◽  
Sagittal Malalignment ◽  
Component Scores

Abstract BACKGROUND: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion. OBJECTIVE: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion. METHODS: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = −0.43, P < .001 and r = −0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant. CONCLUSION: Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.

The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

Neurosurgery ◽  
2012 ◽  
Vol 76 (suppl_1) ◽  
pp. S14-S21 ◽  
Author(s):  
Jessica A. Tang ◽  
Justin K. Scheer ◽  
Justin S. Smith ◽  
Vedat Deviren ◽  
Shay Bess ◽  
...  
Keyword(s):  
Sagittal Alignment ◽  
Health Related Quality ◽  
Sf 36 ◽  
Cervical Sagittal Alignment ◽  
Related Quality ◽  
Health Related ◽  
Posterior Cervical Fusion ◽  
Sagittal Malalignment ◽  
Component Scores

Abstract BACKGROUND: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion. OBJECTIVE: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion. METHODS: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r =−0.43, P< .001 and r =−0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant. CONCLUSION: Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.

Compensation for standing posture by whole-body sagittal alignment in relation to health-related quality of life

2020 ◽  
Vol 102-B (10) ◽  
pp. 1359-1367
Author(s):  
Kazuhiro Hasegawa ◽  
Masashi Okamoto ◽  
Shun Hatsushikano ◽  
Kei Watanabe ◽  
Masayuki Ohashi ◽  
...  
Keyword(s):  
Knee Flexion ◽  
Sagittal Alignment ◽  
Whole Body ◽  
Health Related Quality ◽  
Threshold Values ◽  
Standing Posture ◽  
Related Quality ◽  
Health Related ◽  
Lumbar Spinal

Aims The aim of this study is to test the hypothesis that three grades of sagittal compensation for standing posture (normal, compensated, and decompensated) correlate with health-related quality of life measurements (HRQOL). Methods A total of 50 healthy volunteers (normal), 100 patients with single-level lumbar degenerative spondylolisthesis (LDS), and 70 patients with adult to elderly spinal deformity (deformity) were enrolled. Following collection of demographic data and HRQOL measured by the Scoliosis Research Society-22r (SRS-22r), radiological measurement by the biplanar slot-scanning full body stereoradiography (EOS) system was performed simultaneously with force-plate measurements to obtain whole body sagittal alignment parameters. These parameters included the offset between the centre of the acoustic meatus and the gravity line (CAM-GL), saggital vertical axis (SVA), T1 pelvic angle (TPA), McGregor slope, C2-7 lordosis, thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), PI-LL, sacral slope (SS), pelvic tilt (PT), and knee flexion. Whole spine MRI examination was also performed. Cluster analysis of the SRS-22r scores in the pooled data was performed to classify the subjects into three groups according to the HRQOL, and alignment parameters were then compared among the three cluster groups. Results On the basis of cluster analysis of the SRS-22r subscores, the pooled subjects were divided into three HRQOL groups as follows: almost normal (mean 4.24 (SD 0.32)), mildly disabled (mean 3.32 (SD 0.24)), and severely disabled (mean 2.31 (SD 0.35)). Except for CAM-GL, all the alignment parameters differed significantly among the cluster groups. The threshold values of key alignment parameters for severe disability were TPA > 30°, C2-7 lordosis > 13°, PI-LL > 30°, PT > 28°, and knee flexion > 8°. Lumbar spinal stenosis was found to be associated with the symptom severity. Conclusion This study provides evidence that the three grades of sagittal compensation in whole body alignment correlate with HRQOL scores. The compensation grades depend on the clinical diagnosis, whole body sagittal alignment, and lumbar spinal stenosis. The threshold values of key alignment parameters may be an indication for treatment. Cite this article: Bone Joint J 2020;102-B(10):1359–1367.

scholarly journals Cervical Spondylotic Myelopathy Surgical Trial

Neurosurgery ◽  
2014 ◽  
Vol 75 (4) ◽  
pp. 334-346 ◽  
Author(s):  
Zoher Ghogawala ◽  
Edward C. Benzel ◽  
Robert F. Heary ◽  
K. Daniel Riew ◽  
Todd J. Albert ◽  
...  
Keyword(s):  
Resource Use ◽  
Cervical Spondylotic Myelopathy ◽  
Short Form ◽  
Controlled Trial ◽  
Health Resource ◽  
Health Related Quality ◽  
Randomized Controlled ◽  
Related Quality ◽  
Health Related

Abstract BACKGROUND: Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction in the world. There are significant practice variation and uncertainty as to the optimal surgical approach for treating CSM. OBJECTIVE: To determine whether ventral surgery is associated with superior Short Form-36 Physical Component Summary outcome at the 1-year follow-up compared with dorsal (laminectomy/fusion or laminoplasty) surgery for the treatment of CSM, to investigate whether postoperative sagittal balance is an independent predictor of overall outcome, and to compare health resource use for ventral and dorsal procedures. METHODS: The study is a randomized, controlled trial with a nonrandomized arm for patients who are eligible but decline randomization. Two hundred fifty patients (159 randomized) with CSM from 11 sites will be recruited over 18 months. The primary outcome is the Short Form-36 Physical Component Summary score. Secondary outcomes include disease-specific outcomes, overall health-related quality of life (EuroQOL 5-dimension questionnaire), and health resource use. EXPECTED OUTCOMES: This will be the first randomized, controlled trial to compare directly the health-related quality-of-life outcomes for ventral vs dorsal surgery for treating CSM. DISCUSSION: A National Institutes of Health-funded (1R13AR065834–01) investigator meeting was held before the initiation of the trial to bring multiple stakeholders together to finalize the study protocol. Study investigators, coordinators, and major stakeholders were able to attend and discuss strengths of, limitations of, and concerns about the study. The final protocol was approved for funding by the Patient-Centered Outcomes Research Institute (CE-1304–6173). The trial began enrollment on April 1, 2014.

scholarly journals Does Anterior Controllable Antidisplacement and Fusion Technique Improve Quality of Life in Revision Treatment for Cervical Ossification of the Posterior Longitudinal Ligament? Three-Year Follow-Up Study

2021 ◽  
Author(s):  
Hai-Dong Li ◽  
Ji-Kang Min
Keyword(s):  
Quality Of Life ◽  
Revision Surgery ◽  
Posterior Longitudinal Ligament ◽  
Health Related Quality ◽  
Posterior Surgery ◽  
Sf 36 ◽  
Related Quality ◽  
Health Related

Abstract Background: The laminoplasty and laminectomy are two comparatively safe posterior procedures for the treatment of OPLL. The long-term outcomes of posterior surgery seem to be favorable, however it is also criticized for C5 nerve root palsy, progression OPLL and bad cervical lordosis. An additional revision surgery was required for those patients who had the poor clinical improvement after the initial posterior surgery.Methods: This study was to identify the mid-term clinical results and the health-related quality of life (HRQoL) after anterior controllable antidisplacement and fusion (ACAF) technique for revision treatment of cervical ossification of the posterior longitudinal ligament (OPLL). All the patients were followed up for more than 3 years. The Japanese Orthopaedic Association (JOA) scales, Neck Disability Index (NDI) and Short-Form 36 (SF-36) were recorded to evaluate the health-related quality of life. And the neck and arm pain scale as an expression of visual analog scale (VAS) were also collected. Intraoperative parameters, clinical features, radiological investigations and the surgery-related complications were performed to analysis. Results: There were 20 patients who underwent ACAF revision surgery between March 2017 and January 2019. Clinical improvements were observed in all outcomes; significant improvements on the NDI, VAS, SF-36, and JOA scores were maintained at 3 years (P < 0.05). All the patients showed a better cervical alignment, and the average cervical lordosis was 17±4.6° after revision surgery. There was only one case of cerebrospinal fluid (CSF) leakage, no instance of C5 root platy, postoperative hematoma or esophageal injury occured. No instrumented failure or pseudarthrosis case was observed during the follow-up.Conclusions: This study suggested that ACAF is an effective and safe procedure for the revision treatment of cervical OPLL. Such a surgical technique can offer the postoperative improvement on pain levels and health-related quality of life.

scholarly journals Difference in Spinal Sagittal Alignment and Health-Related Quality of Life between Males and Females with Cervical Deformity

2017 ◽  
Vol 11 (6) ◽  
pp. 959-967 ◽  
Author(s):  
Shin Oe ◽  
Daisuke Togawa ◽  
Go Yoshida ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Sagittal Alignment ◽  
Health Related Quality ◽  
Sagittal Vertical Axis ◽  
Cervical Deformity ◽  
Spinal Sagittal Alignment ◽  
Related Quality ◽  
Health Related ◽  
Males And Females

<sec><title>Study Design</title><p>Large cohort study.</p></sec><sec><title>Purpose</title><p>To clarify spinal sagittal alignment and health-related quality of life (HRQOL) according to sex in volunteers aged &gt;50 years with cervical deformity (CD).</p></sec><sec><title>Overview of Literature</title><p>Adult spinal deformities, especially those associated with lumbosacral lesions, are more frequent in females; however, CD is observed to a greater extent in males.</p></sec><sec><title>Methods</title><p>We divided 656 volunteers (263 males, 393 females; age, 50–89 years [mean, 73 years]) as follows: males with CD (CDM; 82 patients); males without CD (NCDM, 181); females with CD (CDF, 36); and females without CD (NCDF, 357). CD was defined as C2–7 sagittal vertical axis (SVA) ≥40 mm. We measured pelvic tilt (PT), pelvic incidence minus lumbar lordosis (PI−LL), thoracic kyphosis, T1 slope, cervical lordosis, C7 SVA, and C2–7 SVA. HRQOL was evaluated using EuroQOL five dimensions questionnaire (EQ-5D).</p></sec><sec><title>Results</title><p>In CDM, NCDM, CDF, and NCDF groups, the respective parameters were as follows: PT: 15°, 14°, 26°, and 21°; PI−LL: 7°, 5°, 16°, and 10°; C2–7 SVA: 49, 24, 46, and 20 mm; C7 SVA: 61, 40, 75, and 47 mm; and EQ-5D: 0.82, 0.88, 0.78, and 0.81. PT and PI−LL were significantly greater in the CDF group than in the NCDF group (<italic>p</italic>&lt;0.05) but were not significantly different between CDM and NCDM groups. The CDF group already showed deterioration of spinopelvic alignment, although it was maintained in the CDM group. EQ-5D in showed significantly greater deterioration the CDM group than in the NCDM group; deterioration of lumbopelvic parameters had less influence in males (<italic>p</italic>&lt;0.05).</p></sec><sec><title>Conclusions</title><p>Sagittal spinal deformity may have different mechanisms in males and females. The deterioration of spinal sagittal alignment in males may originate from the cervical spine, and CD may be associated with HRQOL.</p></sec>

scholarly journals Normative values of spino-pelvic sagittal alignment, balance, age, and health-related quality of life in a cohort of healthy adult subjects

2016 ◽  
Vol 25 (11) ◽  
pp. 3675-3686 ◽  
Author(s):  
Kazuhiro Hasegawa ◽  
Masashi Okamoto ◽  
Shun Hatsushikano ◽  
Haruka Shimoda ◽  
Masatoshi Ono ◽  
...  
Keyword(s):  
Quality Of Life ◽  
Healthy Adult ◽  
Sagittal Alignment ◽  
Normative Values ◽  
Health Related Quality ◽  
Related Quality ◽  
Health Related
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