Xiaoyu Yang1, Ronald H M A Bartels2, Roland Donk3, Mark P Arts4, Caroline M W Goedmakers5, Carmen L A Vleggeert-Lankamp5. 1. J11-R-83: Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. X.Yang@lumc.nl. 2. Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands. 3. Department of Orthopaedic Surgery, Via Sana Clinics, Mill, The Netherlands. 4. Department of Neurosurgery, Haaglanden Medical Centre, The Hague, The Netherlands. 5. J11-R-83: Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands.
Abstract
PURPOSE:Cervical spine surgery may affect sagittal alignment parameters and induce accelerated degeneration of the cervical spine. Cervical sagittal alignment parameters of surgical patients will be correlated with radiological adjacent segment degeneration (ASD) and with clinical outcome parameters. METHODS: Patients were analysed from two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF) and without intervertebral cage (ACD). C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis (SVA) and the occipito-cervical angle (OCI) were determined as cervical sagittal alignment parameters. Radiological ASD was scored by the combination of decrease in disc height and anterior osteophyte formation. Neck disability index (NDI), SF-36 PCS and MCS were evaluated as clinical outcomes. RESULTS: The cervical sagittal alignment parameters were comparable between the three treatment groups, both at baseline and at 2-year follow-up. Irrespective of surgical method, C2-C7 lordosis was found to increase from 11° to 13°, but the other parameters remained stable during follow-up. Only the OCI was demonstrated to be associated with the presence and positive progression of radiological ASD, both at baseline and at 2-year follow-up. NDI, SF-36 PCS and MCS were demonstrated not to be correlated with cervical sagittal alignment. Likewise, a correlation with the value or change of the OCI was absent. CONCLUSION: OCI, an important factor to maintain horizontal gaze, was demonstrated to be associated with radiological ASD, suggesting that the occipito-cervical angle influences accelerated cervical degeneration. Since OCI did not change after surgery, degeneration of the cervical spine may be predicted by the value of OCI. NECK TRIAL: Dutch Trial Register Number NTR1289. PROCON TRIAL: Trial Register Number ISRCTN41681847. These slides can be retrieved under Electronic Supplementary Material.
RCT Entities:
PURPOSE: Cervical spine surgery may affect sagittal alignment parameters and induce accelerated degeneration of the cervical spine. Cervical sagittal alignment parameters of surgical patients will be correlated with radiological adjacent segment degeneration (ASD) and with clinical outcome parameters. METHODS:Patients were analysed from two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF) and without intervertebral cage (ACD). C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis (SVA) and the occipito-cervical angle (OCI) were determined as cervical sagittal alignment parameters. Radiological ASD was scored by the combination of decrease in disc height and anterior osteophyte formation. Neck disability index (NDI), SF-36 PCS and MCS were evaluated as clinical outcomes. RESULTS: The cervical sagittal alignment parameters were comparable between the three treatment groups, both at baseline and at 2-year follow-up. Irrespective of surgical method, C2-C7 lordosis was found to increase from 11° to 13°, but the other parameters remained stable during follow-up. Only the OCI was demonstrated to be associated with the presence and positive progression of radiological ASD, both at baseline and at 2-year follow-up. NDI, SF-36 PCS and MCS were demonstrated not to be correlated with cervical sagittal alignment. Likewise, a correlation with the value or change of the OCI was absent. CONCLUSION: OCI, an important factor to maintain horizontal gaze, was demonstrated to be associated with radiological ASD, suggesting that the occipito-cervical angle influences accelerated cervical degeneration. Since OCI did not change after surgery, degeneration of the cervical spine may be predicted by the value of OCI. NECK TRIAL: Dutch Trial Register Number NTR1289. PROCON TRIAL: Trial Register Number ISRCTN41681847. These slides can be retrieved under Electronic Supplementary Material.
Authors: Rick C Sasso; Newton H Metcalf; John A Hipp; Nicholas D Wharton; Paul A Anderson Journal: Spine (Phila Pa 1976) Date: 2011-06 Impact factor: 3.468
Authors: Christopher P Ames; Benjamin Blondel; Justin K Scheer; Frank J Schwab; Jean-Charles Le Huec; Eric M Massicotte; Alpesh A Patel; Vincent C Traynelis; Han Jo Kim; Christopher I Shaffrey; Justin S Smith; Virginie Lafage Journal: Spine (Phila Pa 1976) Date: 2013-10-15 Impact factor: 3.468
Authors: Justin K Scheer; Jessica A Tang; Justin S Smith; Frank L Acosta; Themistocles S Protopsaltis; Benjamin Blondel; Shay Bess; Christopher I Shaffrey; Vedat Deviren; Virginie Lafage; Frank Schwab; Christopher P Ames Journal: J Neurosurg Spine Date: 2013-06-14