Tag: Radiographic parameters

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Radiographic Risk Factors for Adjacent Segment Disease Following Anterior Cervical Discectomy and Fusion (ACDF): A Systematic Review and Meta-Analysis

Global Spine Journal 2024, Vol. 14(7) 2183–2200

Study Design: Systematic review and meta-analysis.

Objectives: To assess the radiographic risk factors for adjacent segment disease (ASD) following anterior cervical discectomy and fusion (ACDF) for degenerative cervical spine pathologies.

Methods: PubMed, Embase and the Cochrane Library databases were searched up to December 2023. The primary inclusion criteria were degenerative spinal conditions treated with ACDF, comparing radiological parameters in patients with and without postoperative ASD. The radiographic parameters included intervertebral disc height, cervical sagittal alignment, sagittal segmental alignment, range of motion, segmental height, T1 slope, sagittal vertical axis (SVA), thoracic inlet angle (TIA), and plate to disc distance (PPD). Risk of bias was assessed for all studies. The Cochrane Review Manager was utilized to perform the meta-analysis.

Results: From 7044 articles, 13 retrospective studies were included in the final analysis. Three studies had “not serious” bias and the other 10 studies had serious or very serious bias. The total number of patients in the included studies was 1799 patients. Five studies included single-level ACDF, 2 studies included multi-level ACDF, and 6 studies included single or multi-level ACDF. On meta-analysis, the significant risk factors associated with ASD development were reduced postoperative cervical lordosis (mean difference [MD] = 3.35°, P = .002), reduced last-follow-up cervical lordosis (MD = À3.02°, P = .0003), increased preoperative to postoperative cervical sagittal alignment change (MD = À3.68°, P = .03), and the presence of developmental cervical canal stenosis (Odds ratio [OR] = 4.17, P < .001).

Conclusions: Decreased postoperative cervical lordosis, greater change in cervical sagittal alignment and developmental cervical canal stenosis were associated with an increased risk of ASD following ACDF.

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

Neurosurgery 71:662–669, 2012

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-oflife 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.

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