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European Spine Journal

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01-09-2017 | Original Article

Effect of correction surgery for cervical kyphosis on compensatory mechanisms in overall spinopelvic sagittal alignment

Authors: Hiroshi Miyamoto, Kazuki Hashimoto, Terumasa Ikeda, Masao Akagi

Published in: European Spine Journal | Issue 9/2017

Abstract

Purpose

Progression of kyphotic deformity at the middle/lower cervical spine can cause difficulty with horizontal gaze, so compensation at other spinopelvic parts may occur. However, the precise mechanism remains unclear. The present study investigated the effect of correction surgery for cervical kyphosis on the compensatory mechanisms in overall spinopelvic sagittal alignment.

Methods

Forty-one patients, comprising 23 males and 18 females (mean age 67 years), underwent correction surgery for cervical kyphosis using the posterior screw–rod system. Spinopelvic lateral radiographs in the standing position were taken before and after surgery. C0–1 angle, C1–2 angle, clivo-axial angle (CAA), C2–7 angle, thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope were measured. Correlations between C2–7 angle and these parameters before surgery, and correlations between the correction angle of cervical kyphosis and postoperative changes of these parameters were evaluated.

Results

Negative correlations were found between the C2–7 angle and CAA (R = −0.640, p < 0.01), and C2–7 angle and C0–1 angle (R = −0.762, p < 0.001) before surgery. Negative correlations were found between the correction angle of C2–7 and change of CAA (R = −0.718, p < 0.001), and between the correction angle of C2–7 and change of C0–1 angle (R = −0.672, p < 0.01) after surgery.

Conclusions

The present study demonstrated that C0–1 angle and CAA are more important in the compensatory mechanism for kyphotic deformity at the middle/lower cervical spine compared to downward parameters. That is, to maintain horizontal gaze, lordosis increases at the cranio-cervical junction with greater kyphosis at the middle/lower cervical spine. Correction of cervical kyphosis in the middle/lower cervical spine resulted in normalization of the C0–1 angle and CAA because the compensatory mechanism at the cranio-cervical junction for obtaining horizontal gaze was no longer necessary after surgical intervention.

Mihara H, Ohnari K, Hachiya M, Kondo S, Yamada K (2000) Cervical myelopathy caused by C3–C4 spondylosis in elderly patients: a radiographic analysis of pathogenesis. Spine (Phila Pa 1976) 25(7):796–800CrossRef

Diebo BG, Varghese JJ, Lafage R, Schwab FJ, Lafage V (2015) Sagittal alignment of the spine: what do you need to know? Clin Neurol Neurosurg 139:295–301CrossRefPubMed

Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D et al (2012) Scoliosis research society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 37:1077–1082CrossRef

Yoshimoto H, Ito M, Abumi K, Kotani Y, Shono Y, Takada T, Minami A (2004) A retrospective radiographic analysis of subaxial sagittal alignment after posterior C1–C2 fusion. Spine (Phila Pa 1976) 29(2):175–181CrossRef

Inada T, Furuya T, Kamiya K, Ota M, Maki S, Suzuki T, Takahashi K, Yamazaki M, Aramomi M, Mannoji C, Koda M (2016) Postoperative increase in occiput-C2 angle negatively impacts subaxial lordosis after occipito-upper cervical posterior fusion surgery. Asian Spine J 10(4):744–747. doi:10.4184/asj.2016.10.4.744 (Epub 2016 Aug 16) CrossRefPubMedPubMedCentral

Lee DH, Ha JK, Chung JH, Hwang CJ, Lee CS, Cho JH (2016) A retrospective study to reveal the effect of surgical correction of cervical kyphosis on thoraco-lumbo-pelvic sagittal alignment. Eur Spine J 25(7):2286–2293CrossRefPubMed

Miyamoto H, Maeno K, Uno K, Kakutani K, Nishida K, Sumi M (2014) Outcomes of surgical intervention for cervical spondylotic myelopathy accompanying local kyphosis (comparison between laminoplasty alone and posterior reconstruction surgery using the screw-rod system). Eur Spine J 23(2):341–346CrossRefPubMed

Corbett JJ, Butler AB, Kaufman B (1976) ‘Sneeze syncope’, basilar invagination and Arnold–Chiari type I malformation. J Neurol Neurosurg Psychiatry 39(4):381–384CrossRefPubMedPubMedCentral

Horton WC, Brown CW, Bridwell KH, Glassman SD, Suk SI, Cha CW (2005) Is there an optimal patient stance for obtaining a lateral 36″ radiograph? A critical comparison of three techniques. Spine (Phila Pa 1976) 30:427–433CrossRef

10.

McRae DL, Barnum AS (1953) Occipitalization of the atlas. Am J Roentgenol Radium Ther Nucl Med 70(1):23–46PubMed

11.

Shimizu K, Nakamura M, Nishikawa Y, Hijikata S, Chiba K, Toyama Y (2005) Spinal kyphosis causes demyelination and neuronal loss in the spinal cord: a new model of kyphotic deformity using juvenile Japanese small game fowls. Spine (Phila Pa 1976) 30(21):2388–2392CrossRef

12.

Suda K, Abumi K, Ito M, Shono Y, Kaneda K, Fujiya M (2003) Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976) 28(12):1258–1262

13.

Suarez GA, Kelly JJ Jr (1992) The dropped head syndrome. Neurology 42:1625–1627CrossRefPubMed

14.

Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA et al (2012) The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery 71:662–669CrossRefPubMed

15.

Richman JD, Daniel TE, Anderson DD, Miller PL, Douglas RA (1995) Biomechanical evaluation of cervical spine stabilization methods using a porcine model. Spine (Phila Pa 1976) 20(20):2192–2197CrossRef

16.

Singh K, Vaccaro AR, Kim J, Lorenz EP, Lim TH, An HS (2003) Biomechanical comparison of cervical spine reconstructive techniques after a multilevel corpectomy of the cervical spine. Spine (Phila Pa 1976) 28(20):2352–2358CrossRef

Title: Effect of correction surgery for cervical kyphosis on compensatory mechanisms in overall spinopelvic sagittal alignment
Authors: Hiroshi Miyamoto
Kazuki Hashimoto
Terumasa Ikeda
Masao Akagi
Publication date: 01-09-2017
Publisher: Springer Berlin Heidelberg
Published in: European Spine Journal / Issue 9/2017
Print ISSN: 0940-6719
Electronic ISSN: 1432-0932
DOI: https://doi.org/10.1007/s00586-017-5106-7

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Effect of correction surgery for cervical kyphosis on compensatory mechanisms in overall spinopelvic sagittal alignment

Abstract

Purpose

Methods

Results

Conclusions

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Abstract

Purpose

Methods

Results

Conclusions

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