The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery

Jessica A. Tang, Justin K. Scheer, Justin S. Smith, Vedat Deviren, Shay Bess, Robert Hart, Virginie Lafage, Christopher I. Shaffrey, Frank Schwab, Christopher P. Ames

Research output: Contribution to journalArticle

186 Citations (Scopus)

Abstract

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-oflife scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = 20.43, P , .001 and r = 20.36, 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.

Original languageEnglish (US)
Pages (from-to)662-669
Number of pages8
JournalNeurosurgery
Volume76
DOIs
StatePublished - Mar 26 2015

Fingerprint

Lordosis
Neck
Kyphosis
Spinal Cord Diseases
Gravitation
Pain Measurement
Pathologic Constriction
Spine
Head
Quality of Life
Pain
Health

Keywords

  • Cervical fusion
  • Cervical spine
  • HRQOL
  • Radiographic parameters
  • Sagittal alignment
  • Spinal deformity

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Tang, J. A., Scheer, J. K., Smith, J. S., Deviren, V., Bess, S., Hart, R., ... Ames, C. P. (2015). The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 76, 662-669. https://doi.org/10.1227/NEU.0b013e31826100c9

The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. / Tang, Jessica A.; Scheer, Justin K.; Smith, Justin S.; Deviren, Vedat; Bess, Shay; Hart, Robert; Lafage, Virginie; Shaffrey, Christopher I.; Schwab, Frank; Ames, Christopher P.

In: Neurosurgery, Vol. 76, 26.03.2015, p. 662-669.

Research output: Contribution to journalArticle

Tang, JA, Scheer, JK, Smith, JS, Deviren, V, Bess, S, Hart, R, Lafage, V, Shaffrey, CI, Schwab, F & Ames, CP 2015, 'The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery', Neurosurgery, vol. 76, pp. 662-669. https://doi.org/10.1227/NEU.0b013e31826100c9
Tang, Jessica A. ; Scheer, Justin K. ; Smith, Justin S. ; Deviren, Vedat ; Bess, Shay ; Hart, Robert ; Lafage, Virginie ; Shaffrey, Christopher I. ; Schwab, Frank ; Ames, Christopher P. / The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. In: Neurosurgery. 2015 ; Vol. 76. pp. 662-669.
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abstract = "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-oflife scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = 20.43, P , .001 and r = 20.36, 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.",
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AU - Scheer, Justin K.

AU - Smith, Justin S.

AU - Deviren, Vedat

AU - Bess, Shay

AU - Hart, Robert

AU - Lafage, Virginie

AU - Shaffrey, Christopher I.

AU - Schwab, Frank

AU - Ames, Christopher P.

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N2 - 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-oflife scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = 20.43, P , .001 and r = 20.36, 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.

AB - 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-oflife scores. RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = 20.43, P , .001 and r = 20.36, 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.

KW - Cervical fusion

KW - Cervical spine

KW - HRQOL

KW - Radiographic parameters

KW - Sagittal alignment

KW - Spinal deformity

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