A standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction

Abstract

Object Cervical spine osteotomies are powerful techniques to correct rigid cervical spine deformity. Many variations exist, however, and there is no current standardized system with which to describe and classify cervical osteotomies. This complicates the ability to compare outcomes across procedures and studies. The authors' objective was to establish a universal nomenclature for cervical spine osteotomies to provide a common language among spine surgeons. Methods A proposed nomenclature with 7 anatomical grades of increasing extent of bone/soft tissue resection and destabilization was designed. The highest grade of resection is termed the major osteotomy, and an approach modifier is used to denote the surgical approach(es), including anterior (A), posterior (P), anterior-posterior (AP), posterior-anterior (PA), anterior-posterior-anterior (APA), and posterior-anterior-posterior (PAP). For cases in which multiple grades of osteotomies were performed, the highest grade is termed the major osteotomy, and lower-grade osteotomies are termed minor osteotomies. The nomenclature was evaluated by 11 reviewers through 25 different radiographic clinical cases. The review was performed twice, separated by a minimum 1-week interval. Reliability was assessed using Fleiss kappa coefficients. Results The average intrarater reliability was classified as “almost perfect agreement” for the major osteotomy (0.89 [range 0.60–1.00]) and approach modifier (0.99 [0.95–1.00]); it was classified as “moderate agreement” for the minor osteotomy (0.73 [range 0.41–1.00]). The average interrater reliability for the 2 readings was the following: major osteotomy, 0.87 (“almost perfect agreement”); approach modifier, 0.99 (“almost perfect agreement”); and minor osteotomy, 0.55 (“moderate agreement”). Analysis of only major osteotomy plus approach modifier yielded a classification that was “almost perfect” with an average intrarater reliability of 0.90 (0.63–1.00) and an interrater reliability of 0.88 and 0.86 for the two reviews. Conclusions The proposed cervical spine osteotomy nomenclature provides the surgeon with a simple, standard description of the various cervical osteotomies. The reliability analysis demonstrated that this system is consistent and directly applicable. Future work will evaluate the relationship between this system and health-related quality of life metrics.

Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients

“…Therefore, our data suggest that the clinical advantages from surgical intervention were not affected by the location of the osteotomy. Our observed clinical benefits may be due to improvements in radiographic parameters of cervical alignment [19,20]. Cervical SVA directly correlates with NDI and SF-36 PCS scores [21,22].…”

Reliability assessment of a novel cervical spine deformity classification system

“…A reliability analysis demonstrated that this system is consistent and directly applicable. 4 As an initial step toward the long-term goal of developing a comprehensive classification for CSD, our objectives in the present study were to propose and validate an initial classification system for CSD that will have utility in reporting of treatment options and outcomes for affected patients.…”

“…46,49 In addition, Ames et al recently reported a standardized nomenclature for cervical spine soft-tissue release and osteotomy for deformity correction. 4 The proposed nomenclature includes 7 anatomical grades of increased extent of bone/soft tissue resection and destabilization, as well as a surgical approach modifier. A reliability analysis demonstrated that this system is consistent and directly applicable.…”

A controlled anterior sequential interbody dilation technique for correction of cervical kyphosis

“…With a posterior approach, particularly a combined anteroposterior approach, variations of posteriorly based osteotomies were used. 3 While osteotomies are extremely powerful techniques, they are not ideal in patients with mainly anterior thecal sac compression who do not require posterior fusion or in patients who cannot tolerate a prone position. Therefore, utilizing an anterior approach to cervical kyphosis correction may be beneficial.…”

“…Mainly, anterior decompression and spinal column reconstruction are not easily achieved via a posterior-only approach in the cervical spine, and a combined anteroposterior procedure is commonly needed when treating cervical deformity caused by an anterior element pathology. 3 A technique that allows direct access to anterior pathology, adequate decompression, and various extents of cervical kyphosis correction is ideal.…”