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Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis.
Spine (Phila Pa 1976). 2016 Apr; 41(7):E396-402.S

Abstract

STUDY DESIGN

Retrospective study.

OBJECTIVE

To assess the relationship between sagittal alignment of the cervical spine and patient-reported health-related quality-of-life scores following multilevel posterior cervical fusion, and to explore whether an analogous relationship exists in the cervical spine using T1 slope minus C2-C7 lordosis (T1S-CL).

SUMMARY OF BACKGROUND DATA

A recent study demonstrated that, similar to the thoracolumbar spine, the severity of disability increases with sagittal malalignment following cervical reconstruction surgery.

METHODS

From 2007 to 2013, 38 consecutive patients underwent multilevel posterior cervical fusion for cervical stenosis, myelopathy, and deformities. Radiographic measurements included C0-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, and T1S-CL. Pearson correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life.

RESULTS

C2-C7 SVA positively correlated with neck disability index (NDI) scores (r = 0.495). C2-C7 lordosis (P = 0.001) and T1S-CL (P = 0.002) changes correlated with NDI score changes after surgery. For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of 50 mm, beyond which correlations were most significant. The T1S-CL also correlated positively with C2-C7 SVA and NDI scores (r = 0.871 and r = 0.470, respectively). Results of the regression analysis indicated that a C2-C7 SVA value of 50 mm corresponded to a T1S-CL value of 26.1°.

CONCLUSION

This study showed that disability of the neck increased with cervical sagittal malalignment following surgical reconstruction and a greater T1S-CL mismatch was associated with a greater degree of cervical malalignment. Specifically, a mismatch greater than 26.1° corresponded to positive cervical sagittal malalignment, defined as C2-C7 SVA greater than 50 mm.

LEVEL OF EVIDENCE

3.

Authors+Show Affiliations

Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Gyeonggi, South Korea.No affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

26583469

Citation

Hyun, Seung-Jae, et al. "Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis." Spine, vol. 41, no. 7, 2016, pp. E396-402.
Hyun SJ, Kim KJ, Jahng TA, et al. Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. Spine (Phila Pa 1976). 2016;41(7):E396-402.
Hyun, S. J., Kim, K. J., Jahng, T. A., & Kim, H. J. (2016). Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. Spine, 41(7), E396-402. https://doi.org/10.1097/BRS.0000000000001264
Hyun SJ, et al. Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. Spine (Phila Pa 1976). 2016;41(7):E396-402. PubMed PMID: 26583469.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Relationship Between T1 Slope and Cervical Alignment Following Multilevel Posterior Cervical Fusion Surgery: Impact of T1 Slope Minus Cervical Lordosis. AU - Hyun,Seung-Jae, AU - Kim,Ki-Jeong, AU - Jahng,Tae-Ahn, AU - Kim,Hyun-Jib, PY - 2015/11/20/entrez PY - 2015/11/20/pubmed PY - 2016/12/29/medline SP - E396 EP - 402 JF - Spine JO - Spine (Phila Pa 1976) VL - 41 IS - 7 N2 - STUDY DESIGN: Retrospective study. OBJECTIVE: To assess the relationship between sagittal alignment of the cervical spine and patient-reported health-related quality-of-life scores following multilevel posterior cervical fusion, and to explore whether an analogous relationship exists in the cervical spine using T1 slope minus C2-C7 lordosis (T1S-CL). SUMMARY OF BACKGROUND DATA: A recent study demonstrated that, similar to the thoracolumbar spine, the severity of disability increases with sagittal malalignment following cervical reconstruction surgery. METHODS: From 2007 to 2013, 38 consecutive patients underwent multilevel posterior cervical fusion for cervical stenosis, myelopathy, and deformities. Radiographic measurements included C0-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), T1 slope, and T1S-CL. Pearson correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life. RESULTS: C2-C7 SVA positively correlated with neck disability index (NDI) scores (r = 0.495). C2-C7 lordosis (P = 0.001) and T1S-CL (P = 0.002) changes correlated with NDI score changes after surgery. For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of 50 mm, beyond which correlations were most significant. The T1S-CL also correlated positively with C2-C7 SVA and NDI scores (r = 0.871 and r = 0.470, respectively). Results of the regression analysis indicated that a C2-C7 SVA value of 50 mm corresponded to a T1S-CL value of 26.1°. CONCLUSION: This study showed that disability of the neck increased with cervical sagittal malalignment following surgical reconstruction and a greater T1S-CL mismatch was associated with a greater degree of cervical malalignment. Specifically, a mismatch greater than 26.1° corresponded to positive cervical sagittal malalignment, defined as C2-C7 SVA greater than 50 mm. LEVEL OF EVIDENCE: 3. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/26583469/Relationship_Between_T1_Slope_and_Cervical_Alignment_Following_Multilevel_Posterior_Cervical_Fusion_Surgery:_Impact_of_T1_Slope_Minus_Cervical_Lordosis_ L2 - https://doi.org/10.1097/BRS.0000000000001264 DB - PRIME DP - Unbound Medicine ER -