discrepancy during the assessment. Radiographic measurements included segmental ROM and overall cervical alignment. The segmental ROM of the index level was measured on standing dynamic lateral flexion/extension radiographs, obtained at 24-month follow-up examinations, using the Cobb angle method, which was the same as that previously reported on in the US FDA trials. 24 The change of segmental mobility (ΔROM) was defined as the differences between preoperative and postoperative segmental ROM (24-month postoperative value minus the preoperative value). Cervical alignment
Can segmental mobility be increased by cervical arthroplasty?
Hsuan-Kan Chang, Chih-Chang Chang, Tsung-Hsi Tu, Jau-Ching Wu, Wen-Cheng Huang, Li-Yu Fay, Peng-Yuan Chang, Ching-Lan Wu, and Henrich Cheng
Predicting postoperative coronal alignment for adult spinal deformity: do lower-extremity factors matter?
Nathan J. Lee, Michael Fields, Fthimnir M. Hassan, Scott L. Zuckerman, Alex S. Ha, Joseph M. Lombardi, Zeeshan M. Sardar, Ronald A. Lehman, and Lawrence G. Lenke
-extremity factors. To our knowledge, the influence of lower-extremity factors on coronal alignment has not yet been quantified. Methods Preoperative Radiographic Measurements All radiographic parameters, except those obtained intraoperatively, were measured with EOS imaging. In order to account for potential lower-extremity factors influencing coronal alignment, the following were assessed: LLD, PO, asymmetrical knee bending, and lower-extremity mechanical axis difference (MAD). LLD was measured as the difference in the anatomical lengths of the lower extremities
Is spinopelvic mismatch associated with increased disability at 2 years following short-segment lumbar fusions?
Devon LeFever, Philip K. Louie, Aiyush Bansal, Caroline Drolet, Venu M. Nemani, and Jean-Christophe Leveque
correction at the late postoperative time point. Statistical Analysis All analyses were conducted in R (version 4.1.3, R Foundation for Statistical Computing). Cases were retained for analysis if they had complete radiographic data and preoperative and 3-and 24-month postoperative ODI scores. To ensure that patients with complete data up to 24 months did not differ significantly from those with incomplete data up to 24 months, we compared preoperative and 3-month radiographic measurements between those with complete and incomplete 24-month data using independent
The importance of sagittal balance: how good is the evidence?
Peter D. Angevine and Paul C. McCormick
-plane deformity should be a key objective for every surgeon who performs spinal arthrodesis. We must be careful, nevertheless, not to approach the spine as a trigonometry problem and extrapolate associations between radiographic measurements and clinical outcomes without evidentiary support. Spine surgeons have accepted at face value the importance of sagittal alignment and the restoration of sagittal contour. Although these beliefs are widely held and a few studies seem to support the existence of a relationship between sagittal balance and clinical outcome, a review of the
Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress
Alexander A. Theologis, Tamir Ailon, Justin K. Scheer, Justin S. Smith, Christopher I. Shaffrey, Shay Bess, Munish Gupta, Eric O. Klineberg, Khaled Kebaish, Frank Schwab, Virginie Lafage, Douglas Burton, Robert Hart, Christopher P. Ames, and The International Spine Study Group
, radiographic measurements, and health-related quality of life (HRQOL) data (see below) were collected by patient-reported questionnaires and/or interviews with research coordinators and subsequently entered into the central database. Baseline demographic variables included age, sex, body mass index (BMI), Charlson Comorbidity Index (CCI), American Society of Anesthesiologists (ASA) physical status classification scores, history of prior spine surgery, and a clinical history of depression as self-reported by the patient. The current or past treatment for depression was not
Image-guided resection for thoracic ossification of the ligamentum flavum
Atsushi Seichi, Susumu Nakajima, Katsushi Takeshita, Tomoaki Kitagawa, Toru Akune, Hiroshi Kawaguchi, and Kozo Nakamura
facet joints at the surgically treated vertebrae were preserved ( Fig. 2A ). We also assessed the progression of postoperative kyphotic deformity and/or anterior vertebral slippage, on preoperative and follow-up lateral thoracic radiographs ( Fig. 2B and C ). Two cases were excluded from radiological evaluation; in these cases clear radiographs could not be obtained because the treated sites were at the cervicothoracic junction. Fig. 2. Radiographic measurements for the thoracic spine. A: The residual ratio of the lateral part of a facet joint on CT scans was
Posterior corrective surgery with a multilevel transforaminal lumbar interbody fusion and a rod rotation maneuver for patients with degenerative lumbar kyphoscoliosis
Akira Matsumura, Takashi Namikawa, Minori Kato, Tomonori Ozaki, Yusuke Hori, Noriaki Hidaka, and Hiroaki Nakamura
°). The L-Cobb angle was reduced to 20.3° at the PO time point and was maintained at 20.7° at the most recent follow-up. The overall correction rate was 66.4%. The PI-LL was reduced to 4.3° after surgery. The PT improved to 18.9° at the PO time point, which persisted throughout the follow-up. The SVA also improved to 27.6 mm at the PO time point, which persisted throughout the follow-up. Radiographic parameters are summarized in Tables 3 and 4 . TABLE 3. Postoperative and long-term follow-up changes to radiographic measurements made in the coronal plane
The rise and fall of the craniocervical junction relative to the hard palate: a lifetime story
Grant W. Mallory, Grigoriy Arutyunyan, Meghan E. Murphy, Kathryn M. Van Abel, Elvis Francois, Nicholas M. Wetjen, Jeremy L. Fogelson, Erin K. O'Brien, Michelle J. Clarke, Laurence J. Eckel, and Jamie J. Van Gompel
concomitantly underwent cervical CT and/or maxillofacial CT as part of their trauma workup. Those patients who had cervical or displaced facial/skull base fractures, a history of rheumatoid arthritis, or craniofacial anomalies were excluded. Additional exclusions were made if the available CT scans did not allow adequate visualization of the hard palate, opisthion, the C-1 ring, or the inferior endplate of C-2. Age, sex, and racial data were gathered for all patients meeting the inclusion criteria. Radiographic Measurements Methods previously described by McGregor 22
Treatment of craniocervical instability using a posterior-only approach
Report of 3 cases
Richard M. Young, Jonathan H. Sherman, Joshua J. Wind, Zachary Litvack, and Joseph O'Brien
the loss of ligamentous support structures commonly seen in rheumatoid 30 or psoriatic arthritis. Multiple radiographic measurements have been developed to quantify the degree of pathology at the craniocervical junction ( Table 1 ). 6 , 7 , 12 , 27 , 28 , 36 , 37 , 41 They all seek to address malalignment of the upper cervical spine with regard to the skull base ( Fig. 1 ). TABLE 1: Craniocervical junction measurements * Measure Description Abnormal Values Chamberlain's line 6 line drawn from edge of hard palate to opisthion
The impact of direct vertebral body derotation on the lumbar prominence in Lenke Type 5C curves
Steven W. Hwang, Ornella M. Dubaz, Robert Ames, Alex Rothkrug, Jeff S. Kimball, and Amer F. Samdani
average flexibility of 60%. At 2 years of follow-up, the mean lumbar curve was 14.0° ± 9.8° (70.1% correction, Figs. 1 and 2 ), and the thoracic curve was 13.4° ± 9.5° (60.5%). The remaining radiographic measurements are summarized in Table 2 . F ig . 1. Left: Preoperative standing posteroanterior radiograph showing a 46° thoracolumbar curve. Right: Postoperative standing radiograph obtained after surgical correction with DVBD, showing a 23° curve remaining. F ig . 2. Preoperative (left) and postoperative (right) lateral radiographs obtained