Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

Kim, Seok Woo; Jang, Seung Bo; Lee, Hyung Min; Lee, Jeong‐Hwan; Lee, Min Uk; Kim, Jeong Woo; Yee, Jae Sung

doi:10.3390/jcm9030713

“…Previous studies showed that cervical sagittal alignment plays an important role in the clinical outcomes of laminoplasty. If the patient's lordotic alignment of the cervical spine is well maintained, the outcome of the surgery is always good [ 4 ]. On the other hand, the straight or kyphotic curvature of the cervical spine is not recommended as a good indication for laminoplasty because the laminoplasty may not create enough posterior migration of the spinal cord.…”

Section: Introductionmentioning

confidence: 99%

Analysis of Cervical Spine Alignment Change after Modified Kurokawa Cervical Laminoplasty in the Patients with Cervical Myelopathy and Straight Cervical Spine

Cui

¹

,

Wei

²

,

Liu

³

et al. 2021

BioMed Research International

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Laminoplasty is widely used to decompress the spinal cord in patients with multilevel cervical lesions. Straight cervical alignment may not be a good candidate for laminoplasty because of postoperation progression of kyphosis and loss of cervical spine range of motion (ROM). However, clinical outcomes of laminoplasty did not show a strong and consistent effect based on cervical sagittal alignment. Moreover, the kyphosis progression and ROM change after operation for the patients with preoperative strange cervical alignment are still unclear. This study is to evaluate the change of cervical alignment and ROM in patients with straight cervical alignment after modified Kurokawa cervical laminoplasty. Thirty patients with multiple-level cervical spondylosis (CSM) and straight cervical alignment were included. All patients underwent laminoplasty with the reconstruction of the spinous process-ligament-muscular complex (SPLMC). The modified JOA score was analyzed for clinical assessment. The change of cervical alignment, ROM, T1 slope, and intervertebral disc space Cobb angle were analyzed for radiological assessment. The average JOA score at preoperative and 2 years follow-up were 7.8 ± 1.4 and 13.6 ± 2.1 , respectively. The recovery ratio was 63%. At the 2 years follow-up, there were 18 patients who acquired lordotic cervical alignment. 10 patients remained as straight cervical curve, and 2 patients’ cervical alignment developed mild kyphosis. 28 out of 30 patients showed improvement of cervical alignment. The cervical alignment was improved from 1.29 ± 10.04 ° preoperative to 9.58 ± 8.65 ° postoperative. However, the ROM decreased from 36.8 ± 18.92 preoperative to 25.08 ± 12.10 ° postoperative. A positive correlation was found between the C2/4 angle change and cervical alignment change, T1 slope and cervical alignment, cervical alignment, and neutral position flexion reserved ROM. A negative correlation was found between the C1/2 angle change and cervical alignment change. Laminoplasty with a reconstruction of SPLMC followed by appropriate postoperative muscle exercises may be an encouraging way to maintain or improve physiological alignment and prevent postoperation kyphosis deformity at 2 years follow-up.

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“…In previous studies, the Cobb angle method was typically used for assessment of CSA. However, this method does not allow for precise assessment of the segmental deformities [ 3 – 6 ]. Owing to the segmental deformities, results of Cobb angle method for assessment of cervical alignment may be misleading, especially in patients with cervical kyphosis (CK).…”

Section: Introductionmentioning

confidence: 99%

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Li

¹

,

Zhang

²

,

Shen

³

2020

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Background Cervical sagittal alignment (CSA) is closely related with cervical disk degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK. Methods Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analog scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP. Results Patients who complained of ANP were categorized as ANP group (VAS score ≥ 3; n = 92), while those without ANP were categorized as non-ANP group (VAS score < 3; n = 171). There was no significant between-group difference with respect to age (P = 0.196), gender (P = 0.516), TIA (P = 0.139), NT (P = 0.676), CK type (P = 0.533), cranial tilt (P = 0.332), cervical tilt (P = 0.585), or cervical disk degeneration (P = 0.695). The T1 slope and C2-7 SVA in the ANP group were significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [ odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P = 0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P = 0.028) were identified as risk factors for ANP. Conclusions Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

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“…However, this method does not allow for precise assessment of the segmental deformities [3][4][5][6] . Owing to the segmental deformities, results of Cobb angle method for assessment of cervical alignment may be misleading, especially in patients with cervical kyphosis (CK).…”

Section: Introductionmentioning

confidence: 99%

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Li

¹

,

Zhang

²

,

Shen

³

2020

Preprint

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Background: Cervical sagittal alignment (CSA) is closely related with cervical disc degeneration and impacts the spinal function, especially in the setting of cervical kyphosis (CK). In this study, we evaluated the influence of cervical sagittal parameters on the development of axial neck pain (ANP) in patients with CK.Methods: Data pertaining to 263 patients with CK who visited the outpatient department of our hospital between January 2012 and December 2018 were retrospective analyzed. The most common symptoms of ANP were neck pain, stiffness, or dullness. Visual analogue scale (VAS) was used to evaluate ANP. The following radiographic parameters were evaluated: CK types, C2-7 sagittal vertical axis (SVA), thoracic inlet angle (TIA), T1 slope, neck tilt (NT), cranial tilt, and cervical tilt. Sagittal alignment of CK was classified into 2 types: global and regional type. Multivariate logistic regression analysis was performed to identify risk factors for ANP.Results: Patients who complained of ANP were categorized as ANP group (VAS score≥3; n=92), while those without ANP were categorized as non-ANP group (VAS score<3; n=171). There was no significant between-group difference with respect to age (P=0.196), gender (P=0.516), TIA (P=0.139), NT (P=0.676), CK type (P=0.533), cranial tilt (P=0.332), cervical tilt (P=0.585), or cervical disc degeneration (P=0.695). The T1 slope and C2-7 SVA in the ANP group was significantly greater than that in the non-ANP group (P < 0.05). On multivariate logistic regression, C2-7 SVA [odds ratio (OR) 2.318, 95% confidence interval 1.373–4.651, P=0.003) and T1 slope (OR 2.563, 95% CI 1.186–4.669, P=0.028) were identified as risk factors for ANP.Conclusions: Our findings suggest a significant effect of cervical sagittal parameters on the occurrence of ANP in patients with CK. Greater T1 slope and larger C2-7 SVA may lead to the development of neck pain.

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Analysis of Cervical Spine Alignment and its Relationship with Other Spinopelvic Parameters after Laminoplasty in Patients with Degenerative Cervical Myelopathy

Cited by 13 publications

References 15 publications

Analysis of Cervical Spine Alignment Change after Modified Kurokawa Cervical Laminoplasty in the Patients with Cervical Myelopathy and Straight Cervical Spine

Analysis of Cervical Spine Alignment Change after Modified Kurokawa Cervical Laminoplasty in the Patients with Cervical Myelopathy and Straight Cervical Spine

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

Impact of cervical sagittal parameters on axial neck pain in patients with cervical kyphosis

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