TY - JOUR
T1 - Complications of Poor Cervical Alignment in Patients Undergoing Posterior Cervicothoracic Laminectomy and Fusion
AU - Kennamer, Brooke T.
AU - Arginteanu, Marc S.
AU - Moore, Frank M.
AU - Steinberger, Alfred A.
AU - Yao, Kevin C.
AU - Gologorsky, Yakov
N1 - Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2019/2
Y1 - 2019/2
N2 - Objective: This study sought to determine whether a relationship exists between caudal instrumented level and revision rates, neck disability index scores, and cervical alignment in patients undergoing multilevel posterior cervical fusion. Methods: This study examined a dataset of all patients undergoing posterior cervical decompression and fusion at ≥3 levels, terminating between C4 and T4, between January 2010 and December 2015, with at least 12 months of clinical follow-up. Patients were separated into cohorts based on caudal level of the fusion: C6 (or more cranial), C7, T1, or T2 (or more caudal). Revision rate, neck disability index score, sagittal vertical axis, T1 slope, and cervical lordosis were recorded. Linear regression and multivariate analysis were performed to identify independent predictors of patient outcomes and disparities between ending constructs in the cervical and the thoracic spine. Results: The overall revision rate was 10.8% (n = 24). No statistically significant difference in the revision rate was identified between fusions terminating at C6 or cranial, C7, T1, or T2 and caudal (P = 0.74). Revision correlated strongly with increased sagittal vertical axis (P = 0.002) and T1 slope (P = 0.04). Increased neck disability index score correlated with revision rate (P = 0.01), cervical kyphosis (P < 0.001), and increased sagittal vertical axis (P = 0.04). Conclusions: This study suggests that constructs terminating in the proximal thoracic spine have similar revision rates, postoperative neck disability index scores, and radiographic measurements as those terminating in the cervical spine. Poor cervical alignment, as evidenced by increased sagittal vertical axis, cervical kyphosis and T1 slope, predicts need for revision and of poorer clinical outcomes.
AB - Objective: This study sought to determine whether a relationship exists between caudal instrumented level and revision rates, neck disability index scores, and cervical alignment in patients undergoing multilevel posterior cervical fusion. Methods: This study examined a dataset of all patients undergoing posterior cervical decompression and fusion at ≥3 levels, terminating between C4 and T4, between January 2010 and December 2015, with at least 12 months of clinical follow-up. Patients were separated into cohorts based on caudal level of the fusion: C6 (or more cranial), C7, T1, or T2 (or more caudal). Revision rate, neck disability index score, sagittal vertical axis, T1 slope, and cervical lordosis were recorded. Linear regression and multivariate analysis were performed to identify independent predictors of patient outcomes and disparities between ending constructs in the cervical and the thoracic spine. Results: The overall revision rate was 10.8% (n = 24). No statistically significant difference in the revision rate was identified between fusions terminating at C6 or cranial, C7, T1, or T2 and caudal (P = 0.74). Revision correlated strongly with increased sagittal vertical axis (P = 0.002) and T1 slope (P = 0.04). Increased neck disability index score correlated with revision rate (P = 0.01), cervical kyphosis (P < 0.001), and increased sagittal vertical axis (P = 0.04). Conclusions: This study suggests that constructs terminating in the proximal thoracic spine have similar revision rates, postoperative neck disability index scores, and radiographic measurements as those terminating in the cervical spine. Poor cervical alignment, as evidenced by increased sagittal vertical axis, cervical kyphosis and T1 slope, predicts need for revision and of poorer clinical outcomes.
KW - Cervical kyphosis
KW - Cervicothoracic fusion
KW - Cervicothoracic junction
KW - Multilevel posterior cervical fusion
KW - Posterior cervical fusion
KW - Sagittal vertical axis
UR - http://www.scopus.com/inward/record.url?scp=85056309703&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.10.062
DO - 10.1016/j.wneu.2018.10.062
M3 - Article
C2 - 30342267
AN - SCOPUS:85056309703
SN - 1878-8750
VL - 122
SP - e408-e414
JO - World Neurosurgery
JF - World Neurosurgery
ER -