Artikel
Impact of regional and global sagittal balance on outcomes in cervical fusion surgery
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Autoren
-
Ehab Shiban
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Nicole Lange
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Anika Lamb
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Roxana Bettstetter
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Ann-Kathrin Jörger
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Jens Lehmberg
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
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Bernhard Meyer
- Technische Universität München, Klinikum rechts der Isar, Neurochirurgie, München, Deutschland
| Veröffentlicht: | 18. Juni 2018 |
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Gliederung
Text
Objective: Regional sagittal balance of the cervical spine has been associated with postoperative clinical outcome following cervical fusion. The relationship between regional and global sagittal balance and their influence on clinical outcome has not been clearly demonstrated so far.
Methods: A prospective observational study of 32 patients with cervical Myelopathy undergoing cervical fusion was performed. 30 (93%) and 2 (6%) patients had anterior and posterior surgery, respectively. Radiographic measurements were performed before and at one year follow up and included the following:
- 1.
- cervical segmental Lordosis
- 2.
- C2-C7 lordosis
- 3.
- C2-C7 sagittal vertical axis
- 4.
- center of gravity of head
- 5.
- T1-slope
- 6.
- Thoracic Kyphosis
- 7.
- Lumbar Lordosis
- 8.
- Pelvic Incidence
- 9.
- Pelvic tilt
- 10.
- Sacral Slope
Clinical outcome and health-related quality-of-life measures included neck disability index (NDI), modified Japanese orthopaedics association (mJOA) score, visual analog pain scale (VAS) for neck and for pain, and SF-12 physical component scores before and one year after surgery. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and clinical outcome.
Results: C2-C7 SVA negatively correlated with SF-12 PCS (r =-0.45, P=0.041). Cervical Lordosis positively correlated with SF-12 PCS (r = 437, P = 0.054). Otherwise there were no significant correlation between cervical or global alignment parameters and clinical outcome. Before surgery only T1-slope correlated the spinopelvic alignment parameters (r=0.558, p=0.001). However, at one year follow up segmental alignment, C2-plum line, C7 plum line, center of gravity of head, T1-slope and cervical Lordosis all correlated with the spinopelvic alignment parameters ( r=1.00 P<0.001).
Conclusion: Clinical outcome following cervical fusion is influenced by regional cervical alignment but not global sagittal alignment. Significant correlations were found between the cervical and the lumbosacral spine at one-year follow up. This may be due to inherent compensatory mechanisms to maintain global sagittal balance.
