Assessment of T1 Slope Minus Cervical Lordosis and C2-7 Sagittal Vertical Axis Criteria of a Cervical Spine Deformity Classification System Using Long-Term Follow-up Data After Multilevel Posterior Cervical Fusion Surgery

2018 ◽  
Vol 16 (1) ◽  
pp. 20-26 ◽  
Author(s):  
Seung-Jae Hyun ◽  
Sanghyun Han ◽  
Ki-Jeong Kim ◽  
Tae-Ahn Jahng ◽  
Hyun-Jib Kim
Keyword(s):  
Vertical Axis ◽  
Spine Deformity ◽  
Cervical Fusion ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Fusion Surgery ◽  
Long Term Follow Up ◽  
Posterior Cervical Fusion

Posterior Cervical Fusion Using Cervical Interfacet Spacers in Patients With Symptomatic Cervical Pseudarthrosis

Neurosurgery ◽  
2015 ◽  
Vol 78 (5) ◽  
pp. 661-668 ◽  
Author(s):  
Manish K. Kasliwal ◽  
Jacquelyn A. Corley ◽  
Vincent C. Traynelis
Keyword(s):  
Neck Pain ◽  
Outcome Measures ◽  
Vertical Axis ◽  
Mean Difference ◽  
Cervical Fusion ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Arm Pain ◽  
Vas Score ◽  
Posterior Cervical Fusion

Abstract BACKGROUND: Posterior cervical fusion with cervical interfacet spacer (CIS) is a novel allograft technology offering the potential to provide indirect neuroforaminal decompression while simultaneously enhancing fusion by placing the allograft in compression. OBJECTIVE: To analyze the clinical and radiological outcomes after posterior cervical fusion with CIS in patients with symptomatic anterior cervical pseudarthroses. METHODS: Medical records of patients who underwent posterior cervical fusion with CIS for symptomatic pseudarthrosis after anterior cervical diskectomy and fusion were reviewed. Standardized outcome measures such as visual analog scale (VAS) score for neck and arm pain, Neck Disability Index (NDI), and upright lateral cervical radiographs were reviewed. RESULTS: There were 19 patients with symptomatic cervical pseudarthrosis. Preoperative symptoms included refractory neck or arm pain. The average follow-up was 20 months (range, 12-56 months). There was improvement in VAS score for neck pain (P < .004), radicular arm pain (P < .007), and NDI score (P < .06) after surgery, with 83%, 72%, and 67% of patients showing improvement in their VAS neck pain, VAS arm pain, and NDI scores, respectively. Fusion rate was high, with fusion occurring at all levels treated for pseudarthrosis. There was a small improvement in cervical lordosis (mean difference, 2 ± 5.17°; P = .09) and slight worsening of C2-7 sagittal vertical axis after surgery (mean difference, 1.89 ± 7.87 mm; P = .43). CONCLUSION: CIS provides an important fusion technique, allowing placement of an allograft in compression for posterior cervical fusion in patients with anterior cervical pseudarthroses. Although there was improvement in clinical outcome measures after surgery, placement of CIS had no clinically significant impact on cervical lordosis and C2-7 sagittal vertical axis.

Halifax interlaminar clamp for posterior cervical fusion: a long-term follow-up review

1993 ◽  
Vol 78 (5) ◽  
pp. 702-708 ◽  
Author(s):  
E. Francois Aldrich ◽  
Peter B. Weber ◽  
Wayne N. Crow
Keyword(s):  
Fusion Rate ◽  
Cervical Fusion ◽  
Content Type ◽  
Long Term Follow Up ◽  
Risk Patients ◽  
Cause Of Failure ◽  
Posterior Cervical Fusion ◽  
Lost To Follow Up

✓ Fifty consecutive patients requiring posterior cervical fusion for various pathologies were treated with Halifax interlaminar clamps for internal spinal fixation. Fusion involved the C1–2 level in 17 cases, the C1–3 level in one, and the lower cervical area (C2–7) in 32. No patient was lost to follow-up review, which varied from 6 to 40 months (average 21 months). Fusion failed in five patients, three at the C1–2 level, one at the C1–3 level, and one at the C2–3 level. Screw loosening was the cause of failure in four patients, and in one the arch of C-1 fractured. No other complications occurred. Because of the lack of complications, avoidance of the hazards of sublaminar instrumentation, and an excellent fusion rate, this technique is highly recommended for posterior cervical fusion in the lower cervical spine. Atlantoaxial arthrodesis was achieved in only 14 (82%) of 17 patients, however, which might be due to the higher mobility at this multiaxial level. Improved results in this region may be possible by using a new modified interlaminar clamp, by performing adequate bone fusions, and by postoperative external halo immobilization in high-risk patients.

scholarly journals Long-term results after the one-stage posterior-only surgical correction of thoraco-lumbar kyphoscoliosis in congenital spine deformity caused by two ipsilateral hemi-vertebrae

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Xuhong Xue ◽  
Sheng Zhao ◽  
Feng Miao ◽  
Kai Li ◽  
Bin Zhao
Keyword(s):  
Sagittal Plane ◽  
Vertical Axis ◽  
Surgical Correction ◽  
Neurological Injury ◽  
Long Term Results ◽  
Spine Deformity ◽  
Sagittal Vertical Axis ◽  
The Mean

Abstract Background Two ipsilateral hemivertebrae is less common and presents severe growth imbalance caused by the vertebral anomalies. However, there is a paucity of reports regarding to two ipsilateral thoracolumbar hemivertebrae. The purpose of present study is to evaluate the long-term outcomes of the posterior surgical correction of thoraco-lumbar spine deformity caused by two ipsilateral hemivertebrae. Methods From 2006 to 2014, a total of 14 consecutive pediatric patients with congenital thoraco-lumbar hemivertebrae were treated by posterior excision of hemivertebrae with short segment fusion. The following parameters were measured: coronal major curvature, cranial and caudal compensatory curvature, segmental kyphosis, lumbar lordosis, trunk shift, apical vertebra translation and sagittal vertical axis. These results were compared and evaluated in preoperatively, immediately postoperatively and at the final follow-up. All patients had a minimum of 5 years follow-up. Results The mean age at surgery was 11.1 ± 4.8 years (2yos to 17yos). The mean follow-up period was 80.2 ± 19.4 months (60mons to 117mons). There was a mean improvement of 74.2% in the coronal major curve from a mean angle of 64.1° before surgery to 15.8° at the final follow-up. The cranial and caudal curves improved of 69.8 and 69.0% from 25.6° to 7.7°, 26.9 to 8.2, respectively. The mean thoraco-lumbar kyphosis was 59.9° before and 13.6° after surgery, 20.8° at the final follow-up. Alignment in the coronal and sagittal plane was either maintained or improved within normal values in all patients. Conclusions Good correction and spinal balance can be achieved by posterior-only hemivertebrectomy in patients with thoracolumbar kyphocsoliosis caused by two ipsilateral hemivertebra. The complication of neurological injury is low but a technically demanding procedure. More attention should be paid in residual curve progression after surgery.

scholarly journals Long-term effects of the Chêneau brace on coronal and sagittal alignment in adolescent idiopathic scoliosis

2015 ◽  
Vol 23 (4) ◽  
pp. 505-509 ◽  
Author(s):  
Ming-Qiao Fang ◽  
Chong Wang ◽  
Guang-Heng Xiang ◽  
Chao Lou ◽  
Nai-Feng Tian ◽  
...  
Keyword(s):  
Adolescent Idiopathic Scoliosis ◽  
Idiopathic Scoliosis ◽  
Sagittal Alignment ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Long Term Effects ◽  
Sagittal Vertical Axis ◽  
Pelvic Parameters

OBJECT The aim of the present study was to retrospectively evaluate progressive correction of coronal and sagittal alignment and pelvic parameters in patients treated with a Chêneau brace. METHODS Thirty-two patients with adolescent idiopathic scoliosis (AIS) were assessed before initiation of bracing treatment and at the final follow-up. Each patient underwent radiological examinations, and coronal, sagittal, and pelvic parameters were measured. RESULTS No statistically significant modification of the Cobb angle was noted. The pelvic incidence remained unchanged in 59% of the cases and increased in 28% of the cases. The sacral slope decreased in 34% of the cases but remained unchanged in 50%. Thoracic kyphosis and lumbar lordosis were significantly decreased, whereas the sagittal vertical axis was significantly increased from a mean of -44.0 to -30.2 mm (p = 0.02). The mean pelvic tilt increased significantly from 4.5° to 8.3° (p = 0.002). CONCLUSIONS The Chêneau brace can be useful for preventing curvature progression in patients with AIS. However, the results of this study reveal high variability in the effect of brace treatment on sagittal and pelvic alignment. Treatment with the Chêneau brace may also influence sagittal global balance.

Association of findings on preoperative extension lateral cervical radiography with osteotomy type, approach, and postoperative cervical alignment after cervical deformity surgery

2021 ◽  
pp. 1-6
Author(s):  
Hai V. Le ◽  
Joseph B. Wick ◽  
Renaud Lafage ◽  
Gregory M. Mundis ◽  
Robert K. Eastlack ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Surgical Approach ◽  
Vertical Axis ◽  
Spine Deformity ◽  
Lower Grade ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
T1 Slope ◽  
Radiographic Parameters ◽  
Cervical Spine Radiography

OBJECTIVE The authors’ objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery. METHODS A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2–7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed. RESULTS On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope. CONCLUSIONS Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

scholarly journals Improvement in cervical lordosis and sagittal alignment after vertebral body sliding osteotomy in patients with cervical spondylotic myelopathy and kyphosis

2020 ◽  
Vol 33 (3) ◽  
pp. 307-315 ◽  
Author(s):  
Dong-Ho Lee ◽  
Choon Sung Lee ◽  
Chang Ju Hwang ◽  
Jae Hwan Cho ◽  
Jae-Woo Park ◽  
...  
Keyword(s):  
Vertebral Body ◽  
Cervical Spondylotic Myelopathy ◽  
Sagittal Alignment ◽  
Japanese Orthopaedic Association ◽  
Vertical Axis ◽  
Sacral Slope ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Segmental Lordosis

OBJECTIVEVertebral body sliding osteotomy (VBSO) is a safe, novel technique for anterior decompression in patients with multilevel cervical spondylotic myelopathy. Another advantage of VBSO may be the restoration of cervical lordosis through multilevel anterior cervical discectomy and fusion (ACDF) above and below the osteotomy level. This study aimed to evaluate the improvement and maintenance of cervical lordosis and sagittal alignment after VBSO.METHODSA total of 65 patients were included; 34 patients had undergone VBSO, and 31 had undergone anterior cervical corpectomy and fusion (ACCF). Preoperative, postoperative, and final follow-up radiographs were used to evaluate the improvements in cervical lordosis and sagittal alignment after VBSO. C0–2 lordosis, C2–7 lordosis, segmental lordosis, C2–7 sagittal vertical axis (SVA), T1 slope, thoracic kyphosis, lumbar lordosis, sacral slope, pelvic tilt, and Japanese Orthopaedic Association scores were measured. Subgroup analysis was performed between 15 patients with 1-level VBSO and 19 patients with 2-level VBSO. Patients with 1-level VBSO were compared to patients who had undergone 1-level ACCF.RESULTSC0–2 lordosis (41.3° ± 7.1°), C2–7 lordosis (7.1° ± 12.8°), segmental lordosis (3.1° ± 9.2°), and C2–7 SVA (21.5 ± 11.7 mm) showed significant improvements at the final follow-up (39.3° ± 7.2°, 13° ± 9.9°, 15.2° ± 8.5°, and 18.4 ± 7.9 mm, respectively) after VBSO (p = 0.049, p < 0.001, p < 0.001, and p = 0.038, respectively). The postoperative segmental lordosis was significantly larger in 2-level VBSO (18.8° ± 11.6°) than 1-level VBSO (10.3° ± 5.5°, p = 0.014). The final segmental lordosis was larger in the 1-level VBSO (12.5° ± 6.2°) than the 1-level ACCF (7.2° ± 7.6°, p = 0.023). Segmental lordosis increased postoperatively (p < 0.001) and was maintained until the final follow-up (p = 0.062) after VBSO. However, the postoperatively improved segmental lordosis (p < 0.001) decreased at the final follow-up (p = 0.045) after ACCF.CONCLUSIONSNot only C2–7 lordosis and segmental lordosis, but also C0–2 lordosis and C2–7 SVA improved at the final follow-up after VBSO. VBSO improves segmental cervical lordosis markedly through multiple ACDFs above and below the VBSO level, and a preserved vertebral body may provide more structural support.

Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity

2020 ◽  
Vol 32 (1) ◽  
pp. 23-30 ◽  
Author(s):  
Darryl Lau ◽  
Anthony M. DiGiorgio ◽  
Andrew K. Chan ◽  
Cecilia L. Dalle Ore ◽  
Michael S. Virk ◽  
...  
Keyword(s):  
Vertical Axis ◽  
Anterior Cervical Discectomy ◽  
Cervical Lordosis ◽  
Sagittal Vertical Axis ◽  
Significant Linear Trend ◽  
Cervical Discectomy ◽  
T1 Slope ◽  
Significant Difference ◽  
Vas Scores

OBJECTIVEUnderstanding what influences pain and disability following anterior cervical discectomy and fusion (ACDF) in patients with degenerative cervical spine disease is critical. This study examines the timing of clinical improvement and identifies factors (including spinal alignment) associated with worse outcomes.METHODSConsecutive adult patients were enrolled in a prospective outcomes database from two academic centers participating in the Quality Outcomes Database from 2013 to 2016. Demographics, surgical details, radiographic data, arm and neck pain (visual analog scale [VAS] scores), and disability (Neck Disability Index [NDI] and EQ-5D scores) were reviewed. Multivariate analysis was used.RESULTSA total of 186 patients were included, and 48.4% were male. Their mean age was 55.4 years, and 45.7% had myelopathy. Preoperative cervical sagittal vertical axis (cSVA), cervical lordosis (CL), and T1 slope values were 24.9 mm (range 0–55 mm), 10.4° (range −6.0° to 44°), and 28.3° (range 14.0°–51.0°), respectively. ACDF was performed at 1, 2, and 3 levels in 47.8%, 42.0%, and 10.2% of patients, respectively. Preoperative neck and arm VAS scores were 5.7 and 5.4, respectively. NDI and EQ-5D scores were 22.1 and 0.5, respectively. There was significant improvement in all outcomes at 3 months (p < 0.001) and 12 months (p < 0.001). At 3 months, neck VAS (3.0), arm VAS (2.2), NDI (12.7), and EQ-5D (0.7) scores were improved, and at 12 months, neck VAS (2.8), arm VAS (2.3), NDI (11.7), and EQ-5D (0.8) score improvements were sustained. Improvements occurred within the first 3-month period; there was no significant difference in outcomes between the 3-month and 12-month mark. There was no correlation among cSVA, CL, or T1 slope with any outcome endpoint. The most consistent independent preoperative factors associated with worse outcomes were high neck and arm VAS scores and a severe NDI result (p < 0.001). Similar findings were seen with worse NDI and EQ-5D scores (p < 0.001). A significant linear trend of worse NDI and EQ-5D scores at 3 and 12 months was associated with worse baseline scores. Of the 186 patients, 171 (91.9%) had 3-month follow-up data, and 162 (87.1%) had 12-month follow-up data.CONCLUSIONSACDF is effective in improving pain and disability, and improvement occurs within 3 months of surgery. cSVA, CL, and T1 slope do not appear to influence outcomes following ACDF surgery in the population with degenerative cervical disease. Therefore, in patients with relatively normal cervical parameters, augmenting alignment or lordosis is likely unnecessary. Worse preoperative pain and disability were independently associated with worse outcomes.

scholarly journals Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study

2020 ◽  
Author(s):  
Seung-Kook Kim ◽  
Ogeil Mubarak Elbashier ◽  
Su-chan Lee ◽  
Woo-jin Choi
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Expandable Cage ◽  
Cage Group

Abstract Background: Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods: Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results: In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48±11.10 versus 81.43±13.75, P=.00028), lower rate of PJK (10.1% versus 22.5%, P=.03), and restoration of local angle (4.66±3.76 versus 2.03±1.16, P=.000079) than the control group. However, sagittal balance (0.01±2.57 versus 0.50 ±2.10, P=.07) was not restored, and weakness showed higher rate of subsidence (16.31% versus 4.85 %, P=.0018), pseudoarthrosis (9.92% versus 2.42%, P=.02), cage, and retropulsion (3.55% versus 0, P=.01) than the control group.Conclusions: Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.

scholarly journals Can posterior stand-alone expandable cages safely restore lumbar lordosis? A minimum 5-year follow-up study

2020 ◽  
Vol 15 (1) ◽  
Author(s):  
Seung-Kook Kim ◽  
Ogeil Mubarak Elbashier ◽  
Su-chan Lee ◽  
Woo-Jin Choi
Keyword(s):  
Sagittal Balance ◽  
Lumbar Lordosis ◽  
Vertical Axis ◽  
Control Group ◽  
Sacral Slope ◽  
Sagittal Vertical Axis ◽  
Expandable Cage ◽  
Cage Group

Abstract Background Lumbar lordosis (LL) can be restored, and screw-related complications may be avoided with the stand-alone expandable cage method. However, the long-term spinopelvic changes and safety remain unknown. We aimed to elucidate the long-term radiologic outcomes and safety of this technique. Methods Data from patients who underwent multi-level stand-alone expandable cage fusion and 80 patients who underwent screw-assisted fusion between February 2007 and December 2012, with at least 5 years of follow-up, were retrospectively analyzed. Segmental angle and translation, short and whole LL, pelvic incidence, pelvic tilt, sacral slope (SS), sagittal vertical axis, thoracic kyphosis, and presence of subsidence, pseudoarthrosis, retropulsion, cage breakage, proximal junctional kyphosis (PJK), and screw malposition were assessed. The relationship between local, lumbar, and spinopelvic effects was investigated. The implant failure rate was considered a measure of procedure effectiveness and safety. Results In total, 69 cases were included in the stand-alone expandable cage group and 150 cases in the control group. The stand-alone group showed shorter operative time (58.48 ± 11.10 vs 81.43 ± 13.75, P = .00028), lower rate of PJK (10.1% vs 22.5%, P = .03), and restoration of local angle (4.66 ± 3.76 vs 2.03 ± 1.16, P = .000079) than the control group. However, sagittal balance (0.01 ± 2.57 vs 0.50 ± 2.10, P = .07) was not restored, and weakness showed higher rate of subsidence (16.31% vs 4.85%, P = .0018), pseudoarthrosis (9.92% vs 2.42%, P = .02), cage, and retropulsion (3.55% vs 0, P = .01) than the control group. Conclusions Stand-alone expandable cage fusion can restore local lordosis; however, global sagittal balance was not restored. Furthermore, implant safety has not yet been proven.

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