The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery.
Journal Article (Journal Article)
BACKGROUND: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion. OBJECTIVE: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion. METHODS: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = -0.43, P < .001 and r = -0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant. CONCLUSION: Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.
Full Text
Duke Authors
Cited Authors
- Tang, JA; Scheer, JK; Smith, JS; Deviren, V; Bess, S; Hart, RA; Lafage, V; Shaffrey, CI; Schwab, F; Ames, CP; ISSG,
Published Date
- September 2012
Published In
Volume / Issue
- 71 / 3
Start / End Page
- 662 - 669
PubMed ID
- 22653395
Electronic International Standard Serial Number (EISSN)
- 1524-4040
Digital Object Identifier (DOI)
- 10.1227/NEU.0b013e31826100c9
Language
- eng
Conference Location
- United States