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Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty.
Eur Spine J. 2017 01; 26(1):104-112.ES

Abstract

PURPOSE

Cervical sagittal balance has received increased attention as an important determinant of radiological and clinical outcomes. However, no prospective studies have compared the impact of cervical sagittal balance between anterior and posterior surgeries. We previously conducted a prospective study comparing anterior decompression with fusion (ADF) and laminoplasty (LAMP) for degenerative cervical myelopathy (DCM) and reported; however, analysis of cervical alignment within the concept of sagittal balance has yet to be performed, because that concept has recently been proposed. This study aimed to review this prospective cohort, specifically focusing on cervical sagittal balance.

METHODS

We prospectively performed ADF or LAMP for DCM patients based on the year of enrollment: ADF was performed in odd-numbered years and LAMP in even-numbered years. Cervical lateral X-ray images taken in the neutral standing position were evaluated preoperatively and at a 1-year follow-up. The radiographic measurements included the following: (1) CL (cervical lordosis: C2-7 lordotic angle), (2) CGH (center of gravity of the head)-C7 SVA (sagittal vertical axis), and (3) C7 slope. The clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score).

RESULTS

We analyzed the data for 66 patients (ADF n = 28, LAMP n = 38). While the CL and CGH-C7 SVA in the ADF were unchanged after the operation, those in the LAMP group worsened, especially in patients with preoperative cervical sagittal imbalance. The C7 slopes were not affected by the operation in either group. The postoperative decreases in the CL in the LAMP group correlated with the preoperative CGH-C7 SVA (r = 0.618, P < 0.01), but those in ADF group did not. In patients with preoperative cervical sagittal imbalance (CGH-C7 SVA ≥40 mm), the recovery rate of the C-JOA score in the ADF group was superior to that in the LAMP group (67.3 vs. 39.8 %). In contrast, for patients without cervical sagittal imbalance, the recovery rate of the C-JOA score showed no significant difference between the ADF and LAMP groups (64.5 vs. 58.7 %).

CONCLUSIONS

Postoperative cervical sagittal alignment and balance were maintained after ADF but deteriorated following LAMP, especially in patients with preoperative CGH-C7 SVA ≥40 mm. In these patients, neurological recovery after LAMP was unsatisfactory. LAMP is not suitable for degenerative cervical myelopathy patients with preoperative cervical sagittal imbalance.

Authors+Show Affiliations

Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi 5-11-5, Kawaguchi, Saitama, 332-8558, Japan. kenitiro1122@gmail.com.Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunky-Ku, Tokyo, 113-8519, Japan.Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunky-Ku, Tokyo, 113-8519, Japan.Department of Orthopedic Surgery, Saiseikai Kawaguchi General Hospital, Nishikawaguchi 5-11-5, Kawaguchi, Saitama, 332-8558, Japan.Department of Orthopedic Surgery, Yokohama City Minato Red Cross Hospital, Shinyamashita 3-12-1, Naka-ku, Yokohama, Kanagawa, 231-8682, Japan.Department of Orthopedic Surgery, Tokyo Medical and Dental University, Yushima 1-5-45, Bunky-Ku, Tokyo, 113-8519, Japan.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

27473211

Citation

Sakai, Kenichiro, et al. "Impact of the Surgical Treatment for Degenerative Cervical Myelopathy On the Preoperative Cervical Sagittal Balance: a Review of Prospective Comparative Cohort Between Anterior Decompression With Fusion and Laminoplasty." European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, vol. 26, no. 1, 2017, pp. 104-112.
Sakai K, Yoshii T, Hirai T, et al. Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. Eur Spine J. 2017;26(1):104-112.
Sakai, K., Yoshii, T., Hirai, T., Arai, Y., Shinomiya, K., & Okawa, A. (2017). Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. European Spine Journal : Official Publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 26(1), 104-112. https://doi.org/10.1007/s00586-016-4717-8
Sakai K, et al. Impact of the Surgical Treatment for Degenerative Cervical Myelopathy On the Preoperative Cervical Sagittal Balance: a Review of Prospective Comparative Cohort Between Anterior Decompression With Fusion and Laminoplasty. Eur Spine J. 2017;26(1):104-112. PubMed PMID: 27473211.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Impact of the surgical treatment for degenerative cervical myelopathy on the preoperative cervical sagittal balance: a review of prospective comparative cohort between anterior decompression with fusion and laminoplasty. AU - Sakai,Kenichiro, AU - Yoshii,Toshitaka, AU - Hirai,Takashi, AU - Arai,Yoshiyasu, AU - Shinomiya,Kenichi, AU - Okawa,Atsushi, Y1 - 2016/07/29/ PY - 2016/05/16/received PY - 2016/07/25/accepted PY - 2016/07/25/revised PY - 2016/7/31/pubmed PY - 2017/12/29/medline PY - 2016/7/31/entrez KW - Anterior decompression with fusion KW - Cervical sagittal balance KW - Cervical spondylotic myelopathy KW - Degenerative cervical myelopathy KW - Laminoplasty SP - 104 EP - 112 JF - European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society JO - Eur Spine J VL - 26 IS - 1 N2 - PURPOSE: Cervical sagittal balance has received increased attention as an important determinant of radiological and clinical outcomes. However, no prospective studies have compared the impact of cervical sagittal balance between anterior and posterior surgeries. We previously conducted a prospective study comparing anterior decompression with fusion (ADF) and laminoplasty (LAMP) for degenerative cervical myelopathy (DCM) and reported; however, analysis of cervical alignment within the concept of sagittal balance has yet to be performed, because that concept has recently been proposed. This study aimed to review this prospective cohort, specifically focusing on cervical sagittal balance. METHODS: We prospectively performed ADF or LAMP for DCM patients based on the year of enrollment: ADF was performed in odd-numbered years and LAMP in even-numbered years. Cervical lateral X-ray images taken in the neutral standing position were evaluated preoperatively and at a 1-year follow-up. The radiographic measurements included the following: (1) CL (cervical lordosis: C2-7 lordotic angle), (2) CGH (center of gravity of the head)-C7 SVA (sagittal vertical axis), and (3) C7 slope. The clinical results were evaluated using the Japanese Orthopedic Association scoring system for cervical myelopathy (C-JOA score). RESULTS: We analyzed the data for 66 patients (ADF n = 28, LAMP n = 38). While the CL and CGH-C7 SVA in the ADF were unchanged after the operation, those in the LAMP group worsened, especially in patients with preoperative cervical sagittal imbalance. The C7 slopes were not affected by the operation in either group. The postoperative decreases in the CL in the LAMP group correlated with the preoperative CGH-C7 SVA (r = 0.618, P < 0.01), but those in ADF group did not. In patients with preoperative cervical sagittal imbalance (CGH-C7 SVA ≥40 mm), the recovery rate of the C-JOA score in the ADF group was superior to that in the LAMP group (67.3 vs. 39.8 %). In contrast, for patients without cervical sagittal imbalance, the recovery rate of the C-JOA score showed no significant difference between the ADF and LAMP groups (64.5 vs. 58.7 %). CONCLUSIONS: Postoperative cervical sagittal alignment and balance were maintained after ADF but deteriorated following LAMP, especially in patients with preoperative CGH-C7 SVA ≥40 mm. In these patients, neurological recovery after LAMP was unsatisfactory. LAMP is not suitable for degenerative cervical myelopathy patients with preoperative cervical sagittal imbalance. SN - 1432-0932 UR - https://www.unboundmedicine.com/medline/citation/27473211/Impact_of_the_surgical_treatment_for_degenerative_cervical_myelopathy_on_the_preoperative_cervical_sagittal_balance:_a_review_of_prospective_comparative_cohort_between_anterior_decompression_with_fusion_and_laminoplasty_ L2 - https://doi.org/10.1007/s00586-016-4717-8 DB - PRIME DP - Unbound Medicine ER -