Skip Navigation LinksHome > September 2012 - Volume 71 - Issue 3 > The Impact of Standing Regional Cervical Sagittal Alignment...
Neurosurgery:
doi: 10.1227/NEU.0b013e31826100c9
Research-Human-Clinical Studies

The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

Tang, Jessica A. BS*; Scheer, Justin K. BS; Smith, Justin S. MD, PhD**; Deviren, Vedat MD§; Bess, Shay MD; Hart, Robert A. MD; Lafage, Virginie PhD#; Shaffrey, Christopher I. MD**; Schwab, Frank MD#; Ames, Christopher P. MD*; the ISSG

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Abstract

BACKGROUND: Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.

OBJECTIVE: To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.

METHODS: From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.

RESULTS: Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = −0.43, P < .001 and r = −0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.

CONCLUSION: Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.

ABBREVIATIONS: CGH, center of gravity of head

HRQOL, health-related quality-of-life

NDI, neck disability index

PCSz, physical composite score

SVA, sagittal vertical axis

VAS, visual analog scale

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