Journal of Korean Neurosurgical Society

  • 제64권6호
  • /
  • Pages.913-921
  • /
  • 2021
  • /
  • 2005-3711(pISSN)
  • /
  • 1598-7876(eISSN)
대한신경외과학회 (The Korean Neurosurgical Society)
권호 표지
DOI QR코드

DOI QR Code

Analyzing the Significance of T1 Slope minus Cervical Lordosis in Patients with Anterior Cervical Discectomy and Fusion Surgery

  • Lee, Ho Jin (Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea) ;
  • You, Soon Tae (Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea) ;
  • Sung, Jae Hoon (Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea) ;
  • Kim, Il Sup (Department of Neurosurgery, St. Vincent Hospital, College of Medicine, The Catholic University of Korea) ;
  • Hong, Jae Taek (Department of Neurosurgery, Eunpyeong St. Mary's Hospital, College of Medicine, The Catholic University of Korea)
  • 투고 : 2021.01.13
  • 심사 : 2021.03.03
  • 발행 : 2021.11.01
PDF 다운로드
⟨ 이전 논문 다음 논문 ⟩

초록

Objective : Accurate measurement of T1 slope (a component of T1s minus cervical lordosis [CL]) is often constrained by anatomical limitations. In this situation, efforts should be made to find the exact meaning of T1s-CL and whether there are any alternatives to it. Methods : We enrolled 117 patients who received two-level anterior cervical discectomy and fusion (ACDF). Occipital slope, C2 slope (C2s), C7 slope (C7s), T1, O-C2 angle (O-C2A), C2-7 angle (C2-7A), O-C7 angle (O-C7A), T1s-CL, C7-T1 angle (C7-T1A), and C2-7 sagittal vertical axis were measured. We determined 16° (T1s-CL) as the reference point for dividing subjects into the mismatch group and the balance group, and a comparative analysis was performed. Results : The mean value of C7-T1A was constantly maintained within 2.6° peri-operatively. In addition, C2s and T1s-CL showed the same absolute change (Δ|0.8|°). The mean values of T1s-CL of the mismatch and balance groups were 23.0° and 7.6°, respectively. The five factors with the largest differences between the two groups were as follows : C2s (Δ13.3°), T1s-CL (Δ15.4°), O-C2A (Δ8.7°), C2-7A (Δ14.7°), and segmental angle (Δ7.9°) before surgery. Only four factors showed statistically significant change between the two groups after ACDF : T1s-CL (Δ4.0° vs. Δ0.2°), C2s (Δ3.2° vs. Δ0.7°), O-C2A (Δ2.6° vs. Δ1.3°), C2-7A (Δ6.3° vs. Δ1.3°). A very strong correlation between T1s-CL and C2s was also found (r=|0.88-0.96|). Conclusion : C2s itself may be the essential key to represent T1s-CL. The amounts and directions of change of these two factors (T1s-CL and C2s) were also almost identical. The above phenomenon was re-confirmed once again through the correlation analysis.

키워드

참고문헌

  1. Ajello M, Marengo N, Pilloni G, Penner F, Vercelli G, Pecoraro F, et al. : Is it possible to evaluate the ideal cervical alignment for each patient needing surgery? An easy rule to determine the appropriate crvical lordosis in preoperative planning. World Neurosurg 97 : 471-478, 2017 https://doi.org/10.1016/j.wneu.2016.09.110
  2. Diebo BG, Challier V, Henry JK, Oren JH, Spiegel MA, Vira S, et al. : Predicting cervical alignment required to maintain horizontal gaze based on global spinal alignment. Spine (Phila Pa 1976) 41 : 1795-1800, 2016 https://doi.org/10.1097/BRS.0000000000001698
  3. Gillis CC, Kaszuba MC, Traynelis VC : Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion. J Neurosurg Spine 25 : 421-429, 2016 https://doi.org/10.3171/2016.2.SPINE151056
  4. Ha Y, Schwab F, Lafage V, Mundis G, Shaffrey C, Smith J, et al. : Reciprocal changes in cervical spine alignment after corrective thoracolumbar deformity surgery. Eur Spine J 23 : 552-559, 2014 https://doi.org/10.1007/s00586-013-2953-8
  5. Hyun SJ, Kim KJ, Jahng TA, Kim HJ : Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery: impact of T1 slope minus cervical lordosis. Spine (Phila Pa 1976) 41 : E396-E402, 2016 https://doi.org/10.1097/BRS.0000000000001264
  6. Jenkins LA, Capen DA, Zigler JE, Nelson RW, Nagelberg S : Cervical spine fusions for trauma. A long-term radiographic and clinical evaluation. Orthop Rev Suppl : 13-19, 1994
  7. Kawakami M, Tamaki T, Yoshida M, Hayashi N, Ando M, Yamada H : Axial symptoms and cervical alignments after cervical anterior spinal fusion for patients with cervical myelopathy. J Spinal Disord 12 : 50-56, 1999 https://doi.org/10.1097/00002517-199902000-00008
  8. Kim HJ, Choi BW, Park J, Pesenti S, Lafage V : Anterior cervical discectomy and fusion can restore cervical sagittal alignment in degenerative cervical disease. Eur J Orthop Surg Traumatol 29 : 767-774, 2019 https://doi.org/10.1007/s00590-019-02386-7
  9. Kim JH, Park JY, Yi S, Kim KH, Kuh SU, Chin DK, et al. : Anterior cervical discectomy and fusion alters whole-spine sagittal alignment. Yonsei Med J 56 : 1060-1070, 2015 https://doi.org/10.3349/ymj.2015.56.4.1060
  10. Kim JT, Lee HJ, Choi DY, Shin MH, Hong JT : Sequential alignment change of the cervical spine after anterior cervical discectomy and fusion in the lower cervical spine. Eur Spine J 25 : 2223-2232, 2016 https://doi.org/10.1007/s00586-016-4401-z
  11. Kwon WK, Kim PS, Ahn SY, Song JY, Kim JH, Park YK, et al. : Analysis of associating factors with C2-7 sagittal vertical axis after two-level anterior cervical fusion: comparison between plate augmentation and standalone cages. Spine (Phila Pa 1976) 42 : 318-325, 2017 https://doi.org/10.1097/BRS.0000000000001776
  12. Lan Z, Huang Y, Xu W : Relationship between T1 slope minus C2-7 lordosis and cervical alignment parameters after adjacent 2-level anterior cervical diskectomy and fusion of lower cervical spine. World Neurosurg 122 : e1195-e1201, 2019 https://doi.org/10.1016/j.wneu.2018.11.016
  13. Lau D, DiGiorgio AM, Chan AK, Dalle Ore CL, Virk MS, Chou D, et al. : Applicability of cervical sagittal vertical axis, cervical lordosis, and T1 slope on pain and disability outcomes after anterior cervical discectomy and fusion in patients without deformity. J Neurosurg Spine 18 : 1-8, 2019 https://doi.org/10.3171/2012.9.SPINE12335
  14. Lee HJ, Kim JH, Kim IS, Hong JT : Physiologic cervical alignment change between whole spine radiographs and normal standing cervical radiographs. World Neurosurg 122 : e1222-e1227, 2019 https://doi.org/10.1016/j.wneu.2018.11.019
  15. Lee SH, Son ES, Seo EM, Suk KS, Kim KT : Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J 15 : 705-712, 2015 https://doi.org/10.1016/j.spinee.2013.06.059
  16. Ling FP, Chevillotte T, Leglise A, Thompson W, Bouthors C, Le Huec JC : Which parameters are relevant in sagittal balance analysis of the cervical spine? A literature review. Eur Spine J 27 : 8-15, 2018 https://doi.org/10.1007/s00586-018-5462-y
  17. Naderi S, Ozgen S, Pamir MN, Ozek MM, Erzen C : Cervical spondylotic myelopathy: surgical results and factors affecting prognosis. Neurosurgery 43 : 43-49, discussion 49-50, 1998 https://doi.org/10.1097/00006123-199807000-00028
  18. Oe S, Togawa D, Nakai K, Yamada T, Arima H, Banno T, et al. : The influence of age and sex on cervical spinal alignment among volunteers aged over 50. Spine (Phila Pa 1976) 40 : 1487-1494, 2015 https://doi.org/10.1097/BRS.0000000000001071
  19. Smith JS, Shaffrey CI, Lafage V, Blondel B, Schwab F, Hostin R, et al. : Spontaneous improvement of cervical alignment after correction of global sagittal balance following pedicle subtraction osteotomy. J Neurosurg Spine 17 : 300-307, 2012 https://doi.org/10.3171/2012.6.SPINE1250
  20. Song KJ, Taghavi CE, Lee KB, Song JH, Eun JP : The efficacy of plate construct augmentation versus cage alone in anterior cervical fusion. Spine (Phila Pa 1976) 34 : 2886-2892, 2009 https://doi.org/10.1097/BRS.0b013e3181b64f2c
  21. Staub BN, Lafage R, Kim HJ, Shaffrey CI, Mundis GM, Hostin R, et al. : Cervical mismatch: the normative value of T1 slope minus cervical lordosis and its ability to predict ideal cervical lordosis. J Neurosurg Spine 30 : 31-37, 2018
  22. Tamai K, Buser Z, Paholpak P, Sessumpun K, Nakamura H, Wang JC : Can C7 slope substitute the T1 slope?: an analysis using cervical radiographs and kinematic MRIs. Spine (Phila Pa 1976) 43 : 520-525, 2018 https://doi.org/10.1097/BRS.0000000000002371
  23. Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, et al. : The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 76 Suppl 1 : S14-S21; discussion S21, 2015 https://doi.org/10.1227/01.neu.0000462074.66077.2b
  24. Villavicencio AT, Babuska JM, Ashton A, Busch E, Roeca C, Nelson EL, et al. : Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery 68 : 1309-1316; discussion 1316, 2011 https://doi.org/10.1227/NEU.0b013e31820b51f3
  25. Wang Q, Wang XT, Zhu L, Wei YX : Thoracic inlet parameters for degenerative cervical spondylolisthesis imaging measurement. Med Sci Monit 24 : 2025-2030, 2018 https://doi.org/10.12659/MSM.907073
  26. Weng C, Wang J, Tuchman A, Wang J, Fu C, Hsieh PC, et al. : Influence of T1 slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976) 41 : 185-190, 2016 https://doi.org/10.1097/BRS.0000000000001353