The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

Neurosurgery. 2015 Mar;76 Suppl 1:S14-21; discussion S21. doi: 10.1227/01.neu.0000462074.66077.2b.

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-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.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Cervical Vertebrae*
  • Female
  • Humans
  • Kyphosis / diagnostic imaging
  • Kyphosis / surgery*
  • Male
  • Middle Aged
  • Posture*
  • Predictive Value of Tests
  • Quality of Life
  • Radiography
  • Retrospective Studies
  • Spinal Cord Diseases / diagnostic imaging
  • Spinal Cord Diseases / surgery*
  • Spinal Fusion / methods*
  • Spinal Stenosis / diagnostic imaging
  • Spinal Stenosis / surgery*
  • Treatment Outcome
  • Young Adult