Background: For laminectomy and posterior spinal fusion (LPSF) surgery for cervical spondylotic myelopathy (CSM), the evidence is unclear as to whether fusions should cross the cervicothoracic junction (CTJ).
Objective: To compare LPSF outcomes between those with and without lower instrumented vertebrae (LIV) crossing the CTJ.
Methods: A consecutive series of adults undergoing LPSF for CSM from 2012 to 2018 with a minimum of 12-mo follow-up were identified. LPSF with subaxial upper instrumented vertebrae and LIV between C6 and T2 were included. Clinical and radiographic outcomes were compared.
Results: A total of 79 patients were included: 46 crossed the CTJ (crossed-CTJ) and 33 did not. The mean follow-up was 22.2 mo (minimum: 12 mo). Crossed-CTJ had higher preoperative C2-7 sagittal vertical axis (cSVA) (33.3 ± 16.0 vs 23.8 ± 12.4 mm, P = .01) but similar preoperative cervical lordosis (CL) and CL minus T1-slope (CL minus T1-slope) (P > .05, both comparisons). The overall reoperation rate was 3.8% (crossed-CTJ: 2.2% vs not-crossed: 6.1%, P = .37). In adjusted analyses, crossed-CTJ was associated with superior cSVA (β = -9.7; P = .002), CL (β = 6.2; P = .04), and CL minus T1-slope (β = -6.6; P = .04), but longer operative times (β = 46.3; P = .001). Crossed- and not-crossed CTJ achieved similar postoperative patient-reported outcomes [Visual Analog Scale (VAS) neck pain, VAS arm pain, Nurick Grade, Modified Japanese Orthopedic Association Scale, Neck Disability Index, and EuroQol-5D] in adjusted multivariable analyses (adjusted P > .05). For the entire cohort, higher postoperative CL was associated with lower postoperative arm pain (adjusted Pearson's r -0.1, P = .02). No postoperative cervical radiographic parameters were associated with neck pain (P > .05).
Conclusion: Subaxial LPSF for CSM that crossed the CTJ were associated with superior radiographic outcomes for cSVA, CL, and CL minus T1-slope, but longer operative times. There were no differences in neck pain or reoperation rate.
Download full-text PDF |
Source |
---|---|
http://dx.doi.org/10.1093/neuros/nyaa241 | DOI Listing |
J Neurosurg Spine
January 2025
6Presbyterian St. Lukes Medical Center, Denver, Colorado.
Objective: Malalignment following cervical spine deformity (CSD) surgery can negatively impact outcomes and increase complications. Despite the growing ability to plan alignment, it remains unclear whether preoperative goals are achieved with surgery. The objective of this study was to assess how good surgeons are at achieving their preoperative goal alignment following CSD surgery.
View Article and Find Full Text PDFGlobal Spine J
September 2024
Department of Spine, Guangdong Provincial People's Hospital (Guangdong Academy of Medical Sciences) Southern Medical University, Guangzhou, China.
Study Design: A retrospective study.
Objectives: To explore the relationship between K-line tilt and short-term surgical outcomes following laminoplasty in patients with multilevel degenerative cervical myelopathy (DCM), and to evaluate the potential of K-line tilt as a reliable preoperative predictor.
Methods: A retrospective analysis was performed for 125 consecutive patients who underwent laminoplasty for multilevel DCM.
World Neurosurg
October 2024
Department of Spine Surgery, The First Affiliated Hospital of Guangxi Medical University, Nanning, Guangxi Zhuang Autonomous Region, PR China. Electronic address:
Objective: To investigate the effect of age and sex on odontoid parameters and their relationships with cervical sagittal alignment in children.
Methods: A total of 155 Chinese children without cervical symptoms were divided into groups by age: 3-12 years (87 participants), 13-18 years (68 participants), and sex: male (91 participants) and female (64 participants). Lateral plain radiographs of the whole spine were analyzed for (1) odontoid parameters: odontoid incidence (OI), odontoid tilt, and C2 slope (C2S); and (2) cervical sagittal parameters: C0-2, C2-3, C2-4, C2-5, C2-6, and C2-7 angles (cervical lordosis [CL]), T1 slope (T1S), and T1S minus CL (T1S-CL).
Clin Neurol Neurosurg
October 2024
Department of Physical Medicine and Rehabilitation, Biruni University Faculty of Medicine, Istanbul, Turkiye. Electronic address:
J Spine Surg
March 2024
Department of Orthopaedics, School of Medicine, University of Phayao, Phayao, Thailand.
Enter search terms and have AI summaries delivered each week - change queries or unsubscribe any time!