Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity

2020 ◽  
Vol 32 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Darryl Lau ◽  
Anthony M. DiGiorgio ◽  
Andrew K. Chan ◽  
Cecilia L. Dalle Ore ◽  
Michael S. Virk ◽  
...  
Keyword(s):  
Vertical Axis ◽  
Anterior Cervical Discectomy ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Significant Linear Trend ◽  
Cervical Discectomy ◽  
T1 Slope ◽  
Significant Difference ◽  
Vas Scores

OBJECTIVEUnderstanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes.METHODSConsecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used.RESULTSA total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0–55 mm), 10.4° (range −6.0° to 44°), and 28.3° (range 14.0°–51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p < 0.001) and 12 months (p < 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p < 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p < 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data.CONCLUSIONSACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.

T1 slope minus cervical lordosis in multilevel anterior cervical discectomy and fusion with or without plate: a mean 6-year follow up

2020 ◽  
Author(s):  
Rile Ge ◽  
Peng Yang ◽  
Xin Liu ◽  
Bingtao Wen
Keyword(s):  
Neck Disability Index ◽  
Anterior Cervical Discectomy ◽  
Adjacent Segment ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Cervical Discectomy ◽  
Cervical Alignment ◽  
Japanese Orthopedic Association ◽  
T1 Slope

Abstract Purpose Cervical alignment between self-locked cage (SLC) and anterior cage-with-plate (ACP) system was debatable, especially in multilevel anterior cervical discectomy and fusion (ACDF). T1 slope minus C2-C7 cervical lordosis (T1S-CL) was critical for cervical-balance while without identified threshold. Thus the study was to compare sagittal alignment between SLC and ACP on 3-level ACDF and to identify the threshold of T1S-CL in 3-level ACDF. Methods 45 patients of 3-level SLC and 28 cases of 3-level ACP with well-matched demographics were retrospectively enrolled with 6.1-year follow-up. Cervical alignment paramters were CL, C2-C7 sagittal vertical axis (C2-C7 SVA), T1S and T1S-CL, as well as adjacent segment degeneration (ASD), obtained on X-ray. Neck disability index (NDI) and Japanese Orthopedic Association (JOA) score were recorded for evaluating quality of life (QOL). NDI of 20 was difined as the cutoff of QOL. Threshold of T1S-CL was determined by both linear and logistic regression model. Result CL, C2-C7 SVA and T1S were insignificant at baseline and all parameters were indifferent at last (P ˃0.05). CL and T1S improved at last in both groups (P < 0.05). The incidence of ASD was comparable between groups (P ˃0.05). Both groups acquired inprovement on NDI and JOA (P < 0.001). There were close correlation among alignment paramters and between parameters and NDI at final follow-up. C2-C7 SVA was independent risk factor for NDI and two regression models predicted C2-C7 SVA with a cutoff of 29.2 mm, corresponded to the threshold on T1S-CL of 20.7°. Conclusions It is comparable on alignment reconstruction between SLC and ACP system. The cutoff on C2-C7 SVA with 29.2 mm corresponds to a thershold of T1S-CL with 20.7° in multilevel ACDF.

scholarly journals 324 The Applicability of Cervical Sagittal Vertical Axis, Lordosis, and T1-slope on Pain and Disability Outcomes After Anterior Cervical Discectomy and Fusion

Neurosurgery ◽  
2018 ◽  
Vol 65 (CN_suppl_1) ◽  
pp. 130-131
Author(s):  
Darryl Lau ◽  
Anthony Digorgio ◽  
Andrew K.H Chan ◽  
Michael S Virk ◽  
Dean Chou ◽  
...  
Keyword(s):  
Vertical Axis ◽  
Anterior Cervical Discectomy ◽  
Sagittal Vertical Axis ◽  
Cervical Discectomy ◽  
T1 Slope

scholarly journals Differences in Demographic and Radiographic Characteristics between Patients with Visible and Invisible T1 Slopes on Lateral Cervical Radiographic Images

2022 ◽  
Vol 11 (2) ◽  
pp. 411
Author(s):  
Sadayuki Ito ◽  
Hiroaki Nakashima ◽  
Akiyuki Matsumoto ◽  
Kei Ando ◽  
Masaaki Machino ◽  
...  
Keyword(s):  
Pilot Study ◽  
Surgical Planning ◽  
Vertical Axis ◽  
Sagittal Vertical Axis ◽  
Radiographic Images ◽  
T1 Slope ◽  
Group I ◽  
Significant Difference ◽  
The Mean ◽  
Flexion And Extension

Introduction: The T1 slope is important for cervical surgical planning, and it may be invisible on radiographic images. The prevalence of T1 invisible cases and the differences in demographic and radiographic characteristics between patients whose T1 slopes are visible or invisible remains unexplored. Methods: This pilot study aimed to evaluate the differences in these characteristics between outpatients whose T1 slopes were visible or invisible on radiographic images. Patients (n = 60) who underwent cervical radiography, whose T1 slope was confirmed clearly, were divided into the visible (V) group and invisible (I) group. The following radiographic parameters were measured: (1) C2-7 sagittal vertical axis (SVA), (2) C2-7 angle in neutral, flexion, and extension positions. Results: Based on the T1 slope visibility, 46.7% of patients were included in group I. The I group had significantly larger C2-7 SVA than the V group for males (p < 0.05). The C2-7 SVA tended to be larger in the I group, without significant difference for females (p = 0.362). Discussion: The mean C2-7 angle in neutral and flexion positions was not significantly different between the V and I groups for either sex. The mean C2-7 angle in the extension position was greater in the V group. The T1 slope was invisible in males with high C2-7 SVA.

scholarly journals Anterior cervical discectomy and fusion performed using structural allograft or polyetheretherketone: pseudarthrosis and revision surgery rates with minimum 2-year follow-up

2020 ◽  
Vol 32 (4) ◽  
pp. 562-569
Author(s):  
Minghao Wang ◽  
Dean Chou ◽  
Chih-Chang Chang ◽  
Ankit Hirpara ◽  
Yilin Liu ◽  
...  
Keyword(s):  
Revision Surgery ◽  
Plate Fixation ◽  
Anterior Cervical Discectomy ◽  
Anterior Plate ◽  
Cervical Discectomy ◽  
Posterior Surgery ◽  
Structural Allograft ◽  
Significant Difference ◽  
Surgery Rates

OBJECTIVEBoth structural allograft and PEEK have been used for anterior cervical discectomy and fusion (ACDF). There are reports that PEEK has a higher pseudarthrosis rate than structural allograft. The authors compared pseudarthrosis, revision, subsidence, and loss of lordosis rates in patients with PEEK and structural allograft.METHODSThe authors performed a retrospective review of patients who were treated with ACDF at their hospital between 2005 and 2017. Inclusion criteria were adult patients with either PEEK or structural allograft, anterior plate fixation, and a minimum 2-year follow-up. Exclusion criteria were hybrid PEEK and allograft cases, additional posterior surgery, adjacent corpectomies, infection, tumor, stand-alone or integrated screw and cage devices, bone morphogenetic protein use, or lack of a minimum 2-year follow-up. Demographic variables, number of treated levels, interbody type (PEEK cage vs structural allograft), graft packing material, pseudarthrosis rates, revision surgery rates, subsidence, and cervical lordosis changes were collected. These data were analyzed by Pearson’s chi-square test (or Fisher’s exact test, according to the sample size and expected value) and Student t-test.RESULTSA total of 168 patients (264 levels total, mean follow-up time 39.5 ± 24.0 months) were analyzed. Sixty-one patients had PEEK, and 107 patients had structural allograft. Pseudarthrosis rates for 1-level fusions were 5.4% (PEEK) and 3.4% (allograft) (p > 0.05); 2-level fusions were 7.1% (PEEK) and 8.1% (allograft) (p > 0.05); and ≥ 3-level fusions were 10% (PEEK) and 11.1% (allograft) (p > 0.05). There was no statistical difference in the subsidence magnitude between PEEK and allograft in 1-, 2-, and ≥ 3-level ACDF (p > 0.05). Postoperative lordosis loss was not different between cohorts for 1- and 2-level surgeries.CONCLUSIONSIn 1- and 2-level ACDF with plating involving the same number of fusion levels, there was no statistically significant difference in the pseudarthrosis rate, revision surgery rate, subsidence, and lordosis loss between PEEK cages and structural allograft.

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 Comparison study of clinical outcomes and sagittal alignment improvement between anterior and posterior fusion techniques for multilevel cervical spondylotic myelopathy

2021 ◽  
Vol 29 (1) ◽  
pp. 230949902098817
Author(s):  
Hui Liu ◽  
Xiang Li ◽  
Jianru Wang ◽  
Zemin Li ◽  
Zihao Li ◽  
...  
Keyword(s):  
Clinical Outcomes ◽  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Anterior Cervical Discectomy ◽  
Sagittal Vertical Axis ◽  
Cervical Discectomy ◽  
Cervical Corpectomy ◽  
C7 Slope ◽  
Anterior Cervical Corpectomy

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.

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

2020 ◽  
Vol 33 (3) ◽  
pp. 307-315 ◽  
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.

scholarly journals Influence of complete uncinate process removal on 2-year assessment of radiologic outcomes: subsidence and sagittal balance in patients receiving one-level anterior cervical discectomy and fusion

2019 ◽  
Author(s):  
Sung Hyun Noh ◽  
Jeong Yoon Park ◽  
Sung Uk Kuh ◽  
Dong Kyu Chin ◽  
Keun Su Kim ◽  
...  
Keyword(s):  
Vertical Axis ◽  
Cervical Radiculopathy ◽  
Uncinate Process ◽  
Foraminal Stenosis ◽  
Sagittal Vertical Axis ◽  
Arm Pain ◽  
T1 Slope ◽  
Cervical Sagittal Alignment ◽  
Post Operation

Abstract Background: Many patients who appealed cervical radiculopathy have stenosis of neural foramens because of cumulative osteophyte or uncovertebral joint hypertrophy. For cervical foraminal stenosis, complete UPR conducted concurrently with ACDF. The aim of this study was to evaluate the clinical and radiological consequences of complete uncinate process resection (UPR) during anterior discectomy and fusion (ACDF) versus those seen with ACDF without UPR. Methods: In total, 105 patients who underwent one-level ACDF with a cage-and-plate construct between 2011 and 2015 were retrospectively reviewed. Among them, 37 underwent ACDF with complete UPR, and 68 underwent ACDF without UPR. Radiographic parameters of disc height, C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA), center of the sellar turcica–C7 SVA (St-SVA), spinocranial angle (SCA), and fusion rate were measured on plain radiographs at pre-operation, immediately post-operation, and during the follow-up period (median follow-up duration: 37.7 ± 10.5 months). Results: Improvement in Visual analogue scale (VAS) score for arm pain was significantly better in the ACDF with complete UPR group immediately post-operation. Fusion rates, C2–C7 lordosis, T1 slope, and C2–C7 SVA after single-level ACDF were not significantly different between the two groups (p>0.05). Subsidence occurred in 23 patients (ACDF with complete UPR: 14 cases [37%] versus ACDF without UPR: 9 cases [13%]; p < 0.05). Conclusions: Cervical sagittal alignment after ACDF with complete UPR is not significantly different from that achieved with ACDF without UPR. However, subsidence occurred more frequently after ACDF with complete UPR than after ACDF without UPR, although there was no clinical impact. More precise and careful selection of patients is needed when deciding on additional complete UPR.

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