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Myelopathy and Spinal Deformity: Relevance of Spinal Alignment in Planning Surgical Intervention for Degenerative Cervical Myelopathy

Shamji, Mohammed F. MD, PhD, FRCSC*; Ames, Christopher P. MD; Smith, Justin S. MD, PhD; Rhee, John M. MD§; Chapman, Jens R. MD; Fehlings, Michael G. MD, PhD, FRCSC*

doi: 10.1097/BRS.0b013e3182a7f521
Influence of Spinal Deformity on Management and Outcome of Cervical Spondylotic Myelopathy

Surgical management of degenerative cervical myelopathy requires careful pathoanatomic consideration to select between various surgical options from both anterior and posterior approach. Hitherto, unexplored is the relevance of cervical deformity to the pathophysiology of such neurological disability, and whether correction of that deformity should be a surgical objective when planning for reconstruction after spinal cord decompression. Such correction could address both the static cord compression and the dynamic repetitive cord injury, while also restoring more normal biomechanics to the cervical spine. The articles in this focus issue's section on cervical spinal deformity reveal that cervical sagittal alignment is geometrically related to thoracolumbar spinal pelvic alignment and to T1 slope, and that it is further clinically correlated to regional disability and general health scores and to myelopathy severity. These conclusions are based on narrative reviews and a selection of primary research data, reflecting the nascency of this field. They further recommend for preoperative assessment of spinal alignment when significant deformity is suspected, and that correction of cervical kyphosis should be an objective when surgery is planned.

*Division of Neurosurgery, Toronto Western Hospital, Toronto, Ontario, Canada

UCSF Medical Center, Neurosurgery Clinic, San Francisco, CA

Department of Neurological Surgery, University of Virginia, Charlottesville, VA

§Department of Orthopaedic Surgery, Emory Spine Center, Atlanta, GA; and

UW Bone and Joint Center, Seattle, WA.

Address correspondence and reprint requests to Mohammed F. Shamji, MD, PhD, FRCSC, Toronto Western Hospital, Division of Neurosurgery, 399 Bathurst St, West Wing, 4th Flr, Room WW4-446, Toronto, Ontario, Canada M5T 2S8; E-mail:

Acknowledgment date: June 10, 2013. First revision date: July 17, 2013. Acceptance date: July 25, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

Supported by AOSpine North America, Inc. Analytic support for this work was provided by Spectrum Research, Inc., with funding from the AOSpine North America.

Relevant financial activities outside the submitted work: support for travel, board membership, consultancy, royalties, stock/stock options, grants/grants pending, provision of writing assistance, medicines, equipment, or administrative support, expert testimony, and payment for lectures.

© 2013 by Lippincott Williams & Wilkins