Relationship Between Cervical Sagittal Alignment and Patient Outcomes After Anterior Cervical Fusion Surgery Involving 3 or More Levels

Jeon, Se-Il; Hyun, Seung-Jae; Han, Soonhung; Lee, Byoung Hun; Kim, Ki-Jeong; Jahng, Tae-Ahn; Kim, Hyun-Jib

doi:10.1016/j.wneu.2018.02.088

Cited by 21 publications

(17 citation statements)

References 16 publications

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“…Hyun et al [24] found that C2-C7 SVA greater than 43.5 mm was corresponded to severe NDI (> 25). Nevertheless, Jeon et al [3] and Kwon et al [25], which compared similar radiographic parameters with NDI and visual analog scale (VAS), reported that no cervical sagittal alignment parameters were significantly correlated with clinical outcomes after ACDF surgery with 3 levels and 2 levels, respectively, which are consistent with our results. It has to be noted though that these authors describe different surgical approaches.…”

Section: Discussionsupporting

confidence: 90%

“…Tang et al [23] and Hyun et al [24] reported on patients with posterior cervical fusion surgery. Jeon et al [3] and Kwon et al [25] reported on multilevel anterior fusion surgery of the cervical spine and demonstrated threshold values for C2-C7 SVA of 40 mm [23] and 43.5 mm [24] in contrast to the values that we reported in the majority of patients (mean value 20.6-22.5 mm).…”

Section: Discussioncontrasting

confidence: 86%

“…Surgical interventions that possibly interfere with sagittal alignment, like anterior discectomy, may influence ASD, irrespective of the presence of preoperative sagittal imbalance of the whole spine. In order to quantify cervical spine sagittal alignment, several radiographic parameters have been proposed, including C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA) and T1 slope [2,3]. It has to be realized though that these parameters also importantly influence each other [4,5].…”

Section: Introductionmentioning

confidence: 99%

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The association of cervical sagittal alignment with adjacent segment degeneration

et al. 2019

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Purpose Cervical spine surgery may affect sagittal alignment parameters and induce accelerated degeneration of the cervical spine. Cervical sagittal alignment parameters of surgical patients will be correlated with radiological adjacent segment degeneration (ASD) and with clinical outcome parameters. Methods Patients were analysed from two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF) and without intervertebral cage (ACD). C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis (SVA) and the occipito-cervical angle (OCI) were determined as cervical sagittal alignment parameters. Radiological ASD was scored by the combination of decrease in disc height and anterior osteophyte formation. Neck disability index (NDI), SF-36 PCS and MCS were evaluated as clinical outcomes. Results The cervical sagittal alignment parameters were comparable between the three treatment groups, both at baseline and at 2-year follow-up. Irrespective of surgical method, C2-C7 lordosis was found to increase from 11° to 13°, but the other parameters remained stable during follow-up. Only the OCI was demonstrated to be associated with the presence and positive progression of radiological ASD, both at baseline and at 2-year follow-up. NDI, SF-36 PCS and MCS were demonstrated not to be correlated with cervical sagittal alignment. Likewise, a correlation with the value or change of the OCI was absent. Conclusion OCI, an important factor to maintain horizontal gaze, was demonstrated to be associated with radiological ASD, suggesting that the occipito-cervical angle influences accelerated cervical degeneration. Since OCI did not change after surgery, degeneration of the cervical spine may be predicted by the value of OCI. NECK trial Dutch Trial Register Number NTR1289. PROCON trial Trial Register Number ISRCTN41681847.

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Section: Discussionsupporting

confidence: 90%

Section: Discussioncontrasting

confidence: 86%

Section: Introductionmentioning

confidence: 99%

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The association of cervical sagittal alignment with adjacent segment degeneration

et al. 2019

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“…T1 slope ≥40° has been associated with lower health-related quality-of-life measures in patients older than 50 years. 24 In contrast, Jeon et al 25 found no correlation between T1 slope and postoperative Neck Disability Index or visual analogue scale scores following anterior cervical discectomy and fusion (ACDF) involving 3 or more levels for cervical stenosis. High T1 slope has also been associated with negative radiographic outcomes following spinal surgery.…”

Section: Discussionmentioning

confidence: 99%

Can C7 Slope Be Used as a Substitute for T1 Slope? A Radiographic Analysis

Tang

Cheung

et al. 2019

Global Spine Journal

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Study Design: Retrospective radiographic study. Objectives: T1 slope is an important parameter of sagittal spinal balance. However, the T1 superior endplate can be difficult to visualize on radiographs due to overlying anatomical structures. C7 slope has been proposed as a potential substitute for T1 slope when the T1 superior endplate is not well visualized. The objective of this study was 2-fold: (1) to assess the correlation between C7 and T1 slopes on upright cervical spine radiographs and (2) to evaluate the interrater reliability of C7 slope. Methods: Cervical spine radiographs taken between December 2017 and June 2018 at a single institution were reviewed. Two observers measured upper C7 slope, lower C7 slope, and T1 slope. The correlations between upper and lower C7 slope and T1 slope were evaluated, and linear regression analyses were performed. Interrater reliability of C7 slope was also assessed. Results: In this cohort of 152 patients, there was a strong correlation between upper C7 slope and T1 slope ( r = 0.91, P < .001), as well as between lower C7 slope and T1 slope ( r = 0.90, P < .001). T1 slope could be estimated from the linear regression equation, T1 slope = 0.87 × C7 slope + 7, with an overall model fit of R 2 = 0.8. There was strong interrater reliability for upper (intraclass correlation coefficient [ICC] = 0.95, P < .001) and lower C7 slope (ICC = 0.96, P < .001). Conclusions: Both the upper and lower C7 slope are strongly correlated with T1 slope and can be used as a substitute to estimate T1 slope when the superior endplate of T1 is not well visualized.

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“…A previous study by Jeon et al19 included 33 patients who underwent three or more level ACDF for cervical stenosis, cervical degenerative disorder, or ossification of the posterior longitudinal ligament and concluded that multilevel ACDF did not significantly change the postoperative cervical alignment and thus may not significantly affect cervical alignment or clinical outcomes. A significant difference of their study from ours is the objective patients.…”

Section: Discussionmentioning

confidence: 99%

Is correction of segmental kyphosis necessary in single-level anterior cervical fusion surgery? An observational study

Sun

Bai

et al. 2018

TCRM

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BackgroundThis study was conducted to determine whether sagittal lordotic alignment and clinical outcomes could be improved by the correction of segmental kyphosis after single-level anterior cervical discectomy and fusion (ACDF) surgery.Patients and methodsWe retrospectively reviewed patients who underwent single-level ACDF surgery in our hospital between January 2014 and February 2017. Basic characteristics of patients included age at surgery, gender, diagnosis, duration of symptoms, and location of target level. Pre- and postoperative radiographs at the 6-month follow-up were used to evaluate the following parameters, such as segmental angle, C2–C7 angle, T1 slope, and C2–C7 sagittal vertical axis (SVA). Postoperative clinical outcomes were assessed by the Neck Disability Index and VAS. According to the segmental angle of postoperative radiographs, patients were divided into noncorrection group and correction group.ResultsA total of 181 patients (99 males and 82 females) were analyzed in our study. There were 32 patients in the noncorrection group and 149 patients in the correction group. There was no significant difference in demographic and clinical data between the two groups before surgery. However, patients in the correction group showed larger C2–C7 angle and lower C2–C7 SVA after surgery in comparison with those in the noncorrection group. Besides, changes in the segmental angle were positively correlated with changes in C2–C7 angle and negatively correlated with changes in C2–C7 SVA.ConclusionSurgical correction of segmental kyphosis in single-level cervical surgery contributed to balanced cervical alignment in comparison with those without satisfactory correction. However, we could not demonstrate that the correction of segmental alignment is associated with a better recovery in clinical outcomes.

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Relationship Between Cervical Sagittal Alignment and Patient Outcomes After Anterior Cervical Fusion Surgery Involving 3 or More Levels

Cited by 21 publications

References 16 publications

The association of cervical sagittal alignment with adjacent segment degeneration

The association of cervical sagittal alignment with adjacent segment degeneration

Can C7 Slope Be Used as a Substitute for T1 Slope? A Radiographic Analysis

Is correction of segmental kyphosis necessary in single-level anterior cervical fusion surgery? An observational study

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