The association between cervical focal kyphosis and myelopathy severity in patients with cervical spondylotic myelopathy before surgery

Wu, Bingxuan; Liu, Baoge; Sang, Dacheng; Cui, Wei; Wang, Dian

doi:10.1007/s00586-021-06771-x

Cited by 14 publications

(20 citation statements)

References 25 publications

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“…Experimental models of CSM have revealed that cervical kyphotic deformity is associated with demyelination, atrophy, and neuronal loss of the anterior horn, together with a decreased vascular supply of the anterior spinal cord [9,31]. Contrary to our results, a correlation between the CSM severity and the preoperative [32] or postoperative [33] local kyphotic deformity was found in recent studies.…”

Section: Discussioncontrasting

confidence: 99%

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

Janusz

Szmuda

Morasiewicz

et al. 2022

Neurol Neurochir Pol.

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Introduction.Retrospective study to assess correlation between the sagittal alignment of the cervical spine and the long-term outcomes of long cervical fusion due to cervical spondylotic myelopathy (CSM), with the emphasis on T1 slope minus cervical lordosis (T1S-CL).Summary of background data. Growing evidence shows that the sagittal profile can play a major role in the outcomes of treatment, but the role of its correction is yet to be established. Material and methods.We conducted a retrospective analysis of 54 patients treated for CSM from 2006 to 2012. The neck pain-related disability was measured using NDI, the myelopathy was measured with the mJOA and Nurick scales. Six years after the surgery, standardised X-ray measurements were obtained, including C2-C7 lordosis (CL), C2-C7 sagittal vertical alignment (SVAC2-C7), T1 slope (T1S), and T1S minus CL (T1S-CL). The patients were divided based on the T1S-CL into two groups, using the threshold value of 16.5 degrees. Results.A statistically significant improvement was noted in the mean NDI, mJOA, and median Nurick scale during the initial two years in both groups. The better aligned group had a better outcome measured with NDI at all follow-ups. The mJOA was significantly better in the better aligned group, but only preoperatively; at all follow-ups, the difference was not significant. T1S-CL had the strongest correlation with the NDI at the final follow-up.Conclusions. T1S-CL is an effective prognostic factor of the long term outcome after long cervical fusion in CSM treatment.

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Section: Discussioncontrasting

confidence: 99%

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

Janusz

Szmuda

Morasiewicz

et al. 2022

Neurol Neurochir Pol.

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“…Osteophytes at the posterior edge of the vertebral body are a common cause of cervical spondylotic spondylosis, and cervical spondylosis (CS) is caused by multiple segment cervical spine degeneration which is not uncommon in clinical practice [ 1 , 2 ]. For cervical spondylotic myelopathy (CSM) caused by multiple segment cervical spine degeneration, the compression of the spinal cord or nerve root is generally alleviated by direct anterior decompression or posterior indirect decompression, to achieve the purpose of improving the symptoms [ 3 ].…”

Section: Introductionmentioning

confidence: 99%

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Xia

Shi

Chen

et al. 2022

Journal of Healthcare Engineering

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Objective. To compare the clinical efficacy and safety of anterior cervical decompression and segmental fusion and posterior expansive canal plasty in the treatment of multisegment cervical myelopathy. Methods. Retrospective analysis was performed of 56 cases of multisegment cervical myelopathy patients admitted from July 2018 to June 2021, 32 male patients and 24 females, aged 56.9 ± 12.8 years with an average duration of 10.6 ± 3.2 years. All patients' preoperative imaging examination revealed multiple-segmented cervical disc herniation and had clinical manifestations of cervical myelopathy. Results. No neurovascular complications occurred in both groups, and 24 to 36 months of follow-up (mean 28.6 months) were obtained. The height of the cervical spondylosis segment was higher than that 2 weeks after surgery ( p < 0.05 ), and the curvature of the cervical spine was significantly lower than that before surgery. There was no statistical significance in the height of the anterior column and curvature of the cervical vertebra at 2 weeks after surgery and at the last follow-up ( p > 0.05 ). There were statistically significant differences in anterior curvature of the cervical spine between the two groups at 2 weeks after surgery and the last follow-up ( p < 0.05 ). Japanese Orthopaedic Association (JOA) scores in both groups recovered significantly after surgery. At 3 months and the last follow-up, the improvement rate of JOA score in the anterior approach group was significantly higher than that in the posterior approach group ( p < 0.05 ), and the improvement rate of JOA score in the anterior approach group was also better than that in the posterior approach group ( p < 0.05 ). Conclusion. This segmented anterior fusion procedure can effectively restore the anterior cervical column height and can significantly improve spinal cord function compared with posterior spinal canal enlargement plasty, thus could be considered an effective option for the treatment of multisegment cervical myelopathy.

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“…In the present study, there were no patients who developed the above surgery-related complications. Wu et al (2021) found that cervical focal kyphosis correlated with worse myelopathy symptoms, and the threshold cervical focal kyphosis for severe myelopathy symptoms is predicted to be at about 7 • . Progressive cervical kyphosis may result in cervical pain, which seriously decreases patients' quality of life.…”

Section: Intraoperative Consideration Of Anterior Decompression With ...mentioning

confidence: 97%

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

Wang

Zhang

et al. 2022

Front. Neurosci.

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Background contextCervical kyphosis is a common but potentially debilitating and challenging condition. There is controversy on the optimal surgical strategy for the treatment of kyphotic cervical spondylotic myelopathy (KCSM) using either anterior approach or posterior approach.IntroductionThe purpose of this study was to investigate the surgical efficacy of anterior decompression with fusion (ADF) vs. posterior decompression with fixation (PDF) for the treatment of KCSM, and to further analyze the changes of cervical spinal alignment parameters and axial symptoms (AS) severity after kyphotic correction.Materials and methodsWe retrospectively reviewed 117 patients with KCSM who had undergone ADF (58 patients) and PDF (59 patients) between January 2016 and December 2020. Cervical spinal alignment parameters, including curvature index (CI) and C2-7 Cobb angle, were measured on the PreOP and PostOP lateral radiographs. Recovery rate was calculated based on the Japanese Orthopedic Association (JOA) score. AS severity was quantified by Neck Disability Index (NDI). A P-value less than 0.05 was considered to be significant.ResultsThe patient mean age, gender, presenting symptoms and follow-up time were similar between the two groups (P > 0.05). However, there were statistically significant differences (P < 0.001) between the two groups regarding the operation levels, operating time and intraoperative blood loss. Analysis of PostOP follow-up data showed significant differences (P < 0.001) in CI, correction of CI, C2-7 Cobb angle, and NDI between the two groups, whereas no significant differences in JOA score (P = 0.16) and recovery rate (P = 0.14). There were significant differences (P < 0.001) in CI, C2-7 Cobb angle, JOA score, and NDI between PreOP and PostOP follow-up in each group. Correction of CI showed positive correlation with recovery of NDI in Group ADF (r = 0.51, P < 0.001), and in Group PDF (r = 0.45, P < 0.001).ConclusionSatisfied neurological improvement was obtained by ADF and PDF for patients with KCSM. Cervical kyphotic correction caused significant improvement of AS, and was more favorable with ADF than with PDF. Surgeons should pay full consideration of the merits and shortcomings of each approach when deciding on a surgical plan.

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The association between cervical focal kyphosis and myelopathy severity in patients with cervical spondylotic myelopathy before surgery

Cited by 14 publications

References 25 publications

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

Association of long-term outcome of long cervical fusion with sagittal balance: the significance of T1 slope minus cervical lordosis

Clinical Efficacy and Safety of Anterior Cervical Decompression versus Segmental Fusion and Posterior Expansive Canal Plasty in the Treatment of Multilevel Cervical Spondylotic Myelopathy

Cervical alignment and clinical outcome of anterior decompression with fusion vs. posterior decompression with fixation in kyphotic cervical spondylotic myelopathy

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