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Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy.
Spine (Phila Pa 1976). 2018 02 01; 43(3):E154-E162.S

Abstract

STUDY DESIGN

A prospective radiographic analysis of cervical spondylotic myelopathy (CSM).

OBJECTIVE

The aim of this study was to clarify the pathophysiology of CSM, and use the characteristic of global spinal alignment for determining the surgical strategy.

SUMMARY OF BACKGROUND DATA

Radiographic evaluation of CSM, in general, comprises cervical magnetic resonance imaging (MRI) and regional cervical radiography, which cannot distinguish between cervical hyperlodorsis with spinopelvic compensation and cervical lordorsis with normal global alignment.

METHODS

Our inclusion criteria were preoperative whole spine radiography and cervical MRI and health-related quality of life scores. Global spinal alignment was characterized by cervical lordosis (CL), C7 sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and knee flexion angle (KFA). Cervical alignment was characterized by O-C2, C2-4, C5-7, and C2-7 angles; cranial center of gravity (CCG) C7SVA; and C2-7 SVA. Responsible lesion determined using MRI was divided from C2/3 to C7/T1.

RESULTS

Eighty-eight surgically treated CSM patients with EOS full spine imaging were prospectively analyzed. There were 72 normal (Type 1; SVA <50 mm) and 16 positive (Type 2; SVA ≥50 mm) global balance patients. There were significant differences in age, T1S, KFA, T1S-CL, SVA, CCG-SVA, and C2-7 SVA between Type 1 and Type 2. C3/4 lesion was more common in Type 2 than in Type 1. There was a positive correlation between global sagittal, but not regional, balance, and responsible lesion. C3/4 lesion was more frequent in older, male, high SVA, large T1S-CL, large KFA, and large cranial lordosis (C2-4/C5-7 angle) patients.

CONCLUSION

This study indicates the necessity for global alignment evaluation, particularly in older CSM patients because of their compensation mechanism for global malalignment. Surgical strategy for cranial type CSM should be carefully selected considering global balance.

LEVEL OF EVIDENCE

4.

Authors+Show Affiliations

Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France.Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France.Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France.Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France.Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan.Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France.Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28542100

Citation

Yoshida, Go, et al. "Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy." Spine, vol. 43, no. 3, 2018, pp. E154-E162.
Yoshida G, Alzakri A, Pointillart V, et al. Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976). 2018;43(3):E154-E162.
Yoshida, G., Alzakri, A., Pointillart, V., Boissiere, L., Obeid, I., Matsuyama, Y., Vital, J. M., & Gille, O. (2018). Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy. Spine, 43(3), E154-E162. https://doi.org/10.1097/BRS.0000000000002253
Yoshida G, et al. Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy. Spine (Phila Pa 1976). 2018 02 1;43(3):E154-E162. PubMed PMID: 28542100.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy. AU - Yoshida,Go, AU - Alzakri,Abdulmajeed, AU - Pointillart,Vincent, AU - Boissiere,Louis, AU - Obeid,Ibrahim, AU - Matsuyama,Yukihiro, AU - Vital,Jean Marc, AU - Gille,Olivier, PY - 2017/5/26/pubmed PY - 2019/6/8/medline PY - 2017/5/26/entrez SP - E154 EP - E162 JF - Spine JO - Spine (Phila Pa 1976) VL - 43 IS - 3 N2 - STUDY DESIGN: A prospective radiographic analysis of cervical spondylotic myelopathy (CSM). OBJECTIVE: The aim of this study was to clarify the pathophysiology of CSM, and use the characteristic of global spinal alignment for determining the surgical strategy. SUMMARY OF BACKGROUND DATA: Radiographic evaluation of CSM, in general, comprises cervical magnetic resonance imaging (MRI) and regional cervical radiography, which cannot distinguish between cervical hyperlodorsis with spinopelvic compensation and cervical lordorsis with normal global alignment. METHODS: Our inclusion criteria were preoperative whole spine radiography and cervical MRI and health-related quality of life scores. Global spinal alignment was characterized by cervical lordosis (CL), C7 sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and knee flexion angle (KFA). Cervical alignment was characterized by O-C2, C2-4, C5-7, and C2-7 angles; cranial center of gravity (CCG) C7SVA; and C2-7 SVA. Responsible lesion determined using MRI was divided from C2/3 to C7/T1. RESULTS: Eighty-eight surgically treated CSM patients with EOS full spine imaging were prospectively analyzed. There were 72 normal (Type 1; SVA <50 mm) and 16 positive (Type 2; SVA ≥50 mm) global balance patients. There were significant differences in age, T1S, KFA, T1S-CL, SVA, CCG-SVA, and C2-7 SVA between Type 1 and Type 2. C3/4 lesion was more common in Type 2 than in Type 1. There was a positive correlation between global sagittal, but not regional, balance, and responsible lesion. C3/4 lesion was more frequent in older, male, high SVA, large T1S-CL, large KFA, and large cranial lordosis (C2-4/C5-7 angle) patients. CONCLUSION: This study indicates the necessity for global alignment evaluation, particularly in older CSM patients because of their compensation mechanism for global malalignment. Surgical strategy for cranial type CSM should be carefully selected considering global balance. LEVEL OF EVIDENCE: 4. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/28542100/Global_Spinal_Alignment_in_Patients_With_Cervical_Spondylotic_Myelopathy_ L2 - https://doi.org/10.1097/BRS.0000000000002253 DB - PRIME DP - Unbound Medicine ER -