Evaluation of changes in cervical sagittal balance and clinical parameters in patients undergoing two-level anterior cervical discectomy and fusion

Abstract Background To analyze the impact of spino cranial angle (SCA) on alteration of cervical alignment after multi-level anterior cervical discectomy fusion (ACDF) and explore the relationship between SCA and health-related quality of life (HRQOL) scores. Material and methods In total, 49 patients following multi-level ACDF for multi-level cervical spondylotic myelopathy (MCSM) with more than 2 years follow-up period were enrolled. Radiographic data including SCA were measured. Receiver operating characteristics (ROC) curve analysis was applied to confirm the optimal cut-off values of SCA for predicting sagittal balance. Patients were divided into two groups on the basis of the cut-off value of preoperative SCA. Correlation coefficients were analyzed between SCA and HRQOL scores. Results Optimal cut-off values for predicting sagittal balance was SCA of 88.6°. Patients with higher SCA, no matter preoperatively, postoperatively and at follow-up, got lower T1-Slope (T1s), C2–C7 lordosis angle (CA) and higher △SCA (pre vs post: p = 0.036, pre vs F/U: p = 0.022). Simultaneously, pre-SCA, post-SCA, and F/U-SCA in the high SCA group were positively correlated with the pre-NDI, post-NDI, and F/U-NDI scores respectively (pre: p < 0.001, post: p = 0.015, F/U: p = 0.003). However, no correlation was performed in the low SCA group. Conclusion An excessive SCA can be considered to cause poorer clinical outcomes at preoperative and better correction after surgery. The SCA could be used as a new reference value to determine sagittal balance parameters of the cervical spine and to assess the quality of life.

Download Full-text

The Relationship Between Preoperative Cervical Sagittal Balance and Clinical Outcome of Patients With Hirayama Disease Treated With Anterior Cervical Discectomy and Fusion

Neurospine ◽

10.14245/ns.2142564.282 ◽

2021 ◽

Vol 18 (3) ◽

pp. 618-627

Author(s):

Xiao Lu ◽

Guang-Yu Xu ◽

Cong Nie ◽

Yu Xuan Zhang ◽

Jian Song ◽

...

Keyword(s):

Logistic Regression ◽

Cobb Angle ◽

Clinical Outcomes ◽

Roc Curve ◽

Sagittal Balance ◽

Postoperative Outcome ◽

Anterior Cervical Discectomy ◽

Hirayama Disease ◽

Cervical Sagittal Balance ◽

The Relationship

Objective: Anterior cervical discectomy and fusion (ACDF) is a common surgical method used to treat patients with Hirayama disease. And sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical diseases, but their relationships with ACDF-treated Hirayama disease outcomes remain unknown. The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcomes in ACDF-treated Hirayama disease patients.Methods: Eighty patients with Hirayama disease treated by ACDF were reviewed retrospectively. Six cervical sagittal balance parameters were collected including Cobb angle, T1 slope, C1–7 sagittal vertical axis (SVA), C2–7 SVA, center of gravity of the head (CGH)-C7 SVA, range of motion. The recovery outcomes of the patients were divided into 2 groups by Odom score and the differences in recovery between the 2 groups were confirmed by electromyography. The correlation between imaging parameters and postoperative outcome was evaluated with logistic regression. The receiver operating characteristic (ROC) curve and area under the ROC curve (AUC) were used to evaluate the significant result of logistic regression and the optimal diagnostic value.Results: Only 2 parameters, Cobb angle and CGH-C7 SVA, showed statistical correlation with the postoperative outcome assessment by logistic regression. AUC of Cobb angle and CGH-C7 SVA were 0.559 and 0.702 respectively. The optimal predictive threshold was 1.50° and 5.40 mm, respectively.Conclusion: A larger Cobb angle and smaller CGH-C7 SVA seemed to correlate with a better postoperative outcome. These 2 factors could be used to predict the outcome of surgical treatment of Hirayama disease preoperatively.

Download Full-text