Quality of Life in Adult Patients Receiving Cervical Fusion for Fresh Subaxial Cervical Injury: The Role of Associated Spinal Cord Injury

Abstract

Purpose. To study postoperative Health-Related Quality of Life (HRQOL) after instrumented fusion for fresh subaxial cervical trauma and the effect of spinal cord injury (SCI). Methods. From a total of 65 patients, 17 (26%) patients suffered on admission from SCI. Twenty-five patients underwent anterior, 25 posterior, and 15 circumferential cervical surgery for a single cervical injury. Sagittal roentgenographic parameters were measured in 65 age-matched asymptomatic controls and in patients on admission, eight months postoperatively and at final follow-up (lower C2-C7 curvature, cervical sagittal vertical axis (cSVA), spinocranial angle (SCA), T1-slope, neck tilt (NT), thorax inlet angle (TIA), cervical tilt (CT), cranial tilt (CrT), and occiput–C2 angle (C0-C2)). In the last evaluation, SCI patients were compared with their counterparts without SCI using national validated HRQOL instruments (SF-36 and neck disability index (NDI)). Results. Fusion included an average of 3 vertebrae (range 2-4 vertebrae). All 65 patients were followed for an average of 5.5 years, (range 3-7 years) postoperatively. In the last evaluation, 10 (15.4%) patients with incomplete SCI improved postoperatively at 1-2 grades. At the last observation, patients with SCI showed poorer HRQOL scores than their counterparts without SCI. In particular, each SF-36 domain score was correlated with SCA, T1-slope, cSVA, and CT. At baseline, patients showed higher NT, CrT, and C0-C2 angle than controls. Eight months postoperatively, cSVA, NT, TIA, and cranial tilt (CrT) were increased in patients. In the last observation, there was difference in the sagittal roentgenographic parameters between patients with SCI compared to those without SCI. Patients aged ≥55 years had postoperatively increased cSVA, NT, and CrT compared to their younger counterparts. Conclusion. At the final observation, HRQOL scores were lower in patients with SCI than in their non-SCI counterparts, obviously because of the associated neurologic impairment. SF-36 scores correlated with several sagittal roentgenographic parameters. These correlations should be taken in consideration by spine surgeons when performing cervical spine surgery for fresh cervical spine injuries.

Cervical Sagittal Alignment and Related Factor Analysis and Prediction Model in Patients Undergoing Revision Surgery After Anterior Cervical Fusion

“…We also found a negative correlation of C0-C2 relative to CL in both groups postoperatively. Similar result has been reported by other authors as follows: A study was done by Korovessis et al 23 to investigate HLQOL after instrumentation fusion after subaxial cervical trauma, and the authors found that C0-C2 had a negative correlation with CL in patients who underwent fusion surgery relative to the control health individual. A study by Nojiri et al 24 in asymptomatic health individual established the standard values of upper and lower cervical regions, and the authors found notable negative correlations between C0-C2 and CL.…”

Effect of cervical brace on postoperative axial symptoms in patients with Anterior Cervical Discectomy and Fusion

“…a1 was negative if the cervical spine was anteriorly convex in hyper exion and a2 was negative if the cervical spine was deformed and retro exed in hyperextension. ROM = a1 + a2 [11]. We measured and recorded the patient's cervical mobility preoperatively, and at 1 and 3 months of discharge, through the patient's cervical hyperextension hyper exion slices at each follow-up visit.The quality of life was measured by the SF-36 (quality of life assessment scale) scores,The SF-36 scale includes 8 dimensions, with a total of 36 items.…”

Verletzungen der subaxialen Halswirbelsäule

“…Die Behandlungsergebnisse nach HWS-Verletzungen hängen im Wesentlichen vom Grad der neurologischen Verletzung ab [69]: Verständlicherweise hat eine Rückenmarkverletzung einen starken negativen Einfluss auf die Lebensqualität [69].…”

“…Ohne Rückenmarkverletzung berichten 81% der Patienten über ein exzellentes oder gutes Ergebnis nach >5 Jahren [69,70]. Die Rückkehr in den alten Beruf gelingt ebenfalls etwa 84% [70].…”

“…20% der Fälle zu verzeichnen [71]. Nach > 5 Jahren liegt der SF-36-Schmerzindex zwischen 72/ 100 und 95/100 [69,70]. sind vor allem bei spontan reponierten, rein ligamentären Verletzungen zu erwarten.…”