Original ArticleIs It Possible To Evaluate the Ideal Cervical Alignment for Each Patient Needing Surgery? An Easy Rule To Determine the Appropriate Cervical Lordosis in Preoperative Planning
Introduction
In the last decade, many studies elucidated the relationship between sagittal alignment and the quality of life after spinal surgery.1, 2, 3, 4, 5, 6, 7, 8 In the past few years, a considerable amount of literature has been published regarding cervical spine alignment and the relationships among different cervical parameters.9, 10, 11, 12, 13 Despite the extensive research, there is still a lack of certainty regarding the optimal amount of cervical lordosis needed to achieve postoperative success. Because of these unclear indications, surgeons usually strive to correct cervical kyphosis to attain an angle as close as possible to neutral.14 Traditionally, the C-7 sagittal vertical axis (SVA) is used to measure sagittal alignment of the thoracolumbar spine.15 Thus, current research on cervical spine is trying to adopt similar parameters.16 More specifically, the C-2 plumb line, chin brow vertical angle, and T1 slope (T1 SL) are increasingly being used.17, 18 To evaluate the effect of cervical alignment in respect to the overall sagittal spine alignment, we use 3-foot spine radiographs.
Moreover, few studies report the relationship between radiographic parameters of the cervical spine and the surgical clinical outcome. Accordingly, the effects of these cervical radiographic measurements on the outcome scores are not nearly as well defined as the global and pelvic parameters are in thoracolumbar deformities.3, 19, 20, 21 Similarly, there are few studies1, 2, 4 of cervical alignment parameters (mostly represented by lordosis between C-2 and C-7) related to postoperative clinical outcomes; they all show weak statistical correlations.
Section snippets
Objectives
Few studies have evaluated the relationship between standing cervical sagittal alignment and postoperative clinical scores for patients without cervical kyphosis receiving single and multilevel anterior cervical fusion. Therefore, our goal is to gain a better understanding of the following parameters:
- 1.
Evaluate the relationship between sagittal alignment of the cervical spine and patient-reported postoperative clinical scores following single and multilevel anterior cervical fusion.
- 2.
Identify the
Material and Methods
A series of 70 patients who were admitted to our center from 2013 through 2014 for anterior cervical discectomy and fusion were identified retrospectively. Every patient had follow-up within at least 1 year. The population in this study had several diagnoses, such as spondylosis, disc herniation with radiculopathy, and myeloradiculopathy. We excluded from this study all patients with posterior or combined approaches. Among the excluded patients were 4 patients with cervical kyphosis greater
Demographic Data
The study included 70 patients (55 with cervical radiographs including T1). The patient's ages did not significantly differ among the 3 groups. The average age was 52 years (range, 31–81 years). Thirty-one patients (45%) were male, and 39 patients (55%) were female. Most of the patients had one level pathology (n = 38; 54%) followed by two levels (n = 22; 31%), and three levels (n = 11; 15%; Table 2).
Two patients reported postoperative dysphagia that resolved within 3 weeks postoperatively. In
Discussion
Simply obtaining a better sagittal alignment was not the endpoint of our study. Because there is no agreement in the literature regarding what the correct cervical sagittal alignment should be, we opted not to divide our groups according to the alignment itself. Accordingly, the patients were separated based on their clinical postoperative scores. Once separated, we tried to find a correlation between the sagittal alignment and an easy indication to help understand what the ideal alignment
Conclusions
As we learned from thoracolumbar spine surgery, we cannot exclude the sagittal parameter when planning spinal surgery. We know that the spinopelvic parameter is more defined and widely used than the aforementioned correlations. The spinopelvic parameters are studied and used mostly on patients with preexisting sagittal imbalance and deformity, thus strongly correlating with the quality of life.1, 3, 10, 31 In our study, there was a strong correlation between C2-C7 SVA, CL/C7 SL, C7 SL, and T1
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The Short-Term to Midterm Follow-Up of Patients with Hirayama Disease After Anterior Cervical Discectomy and Fusion
2021, World NeurosurgeryCitation Excerpt :A high T1S had been associated with postoperative cervical kyphosis.25 Ajello et al.27 found that patients with postoperative SVA of 24 ± 10 mm were more likely to have better outcomes than those with SVA of 38 mm. Hung et al.28 reported that improving CL and decreasing SVA could have a better curative effect.
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Conflict of interest statement: The authors declare that the article content was composed in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.