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The effect of C2–3 disc angle on postoperative adverse events in cervical spondylotic myelopathy

Presented at the 2018 AANS/CNS Joint Section on Disorders of the Spine and Peripheral Nerves

Bryan S. Lee, Kevin M. Walsh, Daniel Lubelski, Konrad D. Knusel, Michael P. Steinmetz, Thomas E. Mroz, Richard P. Schlenk, Iain H. Kalfas, and Edward C. Benzel

segment disease (symptomatic adjacent segment degeneration with radiculopathy or myelopathy). Descriptive statistics were based on the preoperative and postoperative sagittal alignment as determined by the following independent variables: C2–7 Cobb angle, C2–7 sagittal vertical axis (SVA), C2–3 disc angle, and T1 slope. Radiographic angles were measured in a blinded fashion by chief and senior neurosurgery residents at the time of the data collection (B.S.L., K.M.W.). All radiographs were acquired in the standard fashion with the patient in the upright, standing

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David E. Gwinn, Christopher A. Iannotti, Edward C. Benzel, and Michael P. Steinmetz

A nalysis of cervical sagittal deformity in patients with cervical myelopathy requires a thorough clinical and radiographic evaluation to select the most appropriate surgical approach. Radiographic analysis of sagittal alignment is important to determine disease progression, to make decisions on the surgical approach, to follow interventions postoperatively, and to compare interventions for research purposes. Many of these radiographic parameters have been analyzed for reliability and reproducibility in both normal and diseased cohorts. 1 , 3 , 8 , 9 , 11

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Timothy A. Moore, Michael P. Steinmetz, and Paul A. Anderson

underwent surgery within 12 hours of their presentation to the hospital. One patient returned to the operating room 10 days after the initial procedure for incision and drainage of a superficial iliac crest wound infection. Follow-up intervals were 24 months in 5 patients, 18 months in 2 patients, and 12 months in 1. Postoperative lateral radiographs were obtained to ensure maintenance of the thoracolumbar reduction ( Fig. 2 ). F ig . 2. Postoperative lateral radiograph obtained 1 year postoperatively (same patient as Fig. 1 ) showing near-anatomical sagittal

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Rakesh D. Patel, Humberto G. Rosas, Michael P. Steinmetz, and Paul A. Anderson

= 41) were selected from a list of trauma patients who underwent CT for possible lumbar spine injury between 2005 and 2008. Measurements were performed only at L-4 and L-5. A helical 64-channel CT scanner was used for all patients (LS VCT 64, General Electric). The CT parameters included 1.25-mm slice thickness, 0.625-mm interval, 120 kV, 300 mAS (Smart mA/Auto mA range of 150–750), and a bone reconstruction algorithm (window width/window level of 3000/300). Inherent differences in the coronal and sagittal alignment of the lumbar spine, patient position within the

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John H. Shin, Michael P. Steinmetz, Edward C. Benzel, and Ajit A. Krishnaney

sagittal alignment and the occupying volume of the ossified mass are critical to selecting the best approach as correction of deformity may not always be feasible without significant morbidity. Cervical kyphosis may be the result of iatrogenic destabilization, trauma, degeneration, and systemic inflammatory diseases. However, it is most commonly observed after multilevel dorsal decompression, with rates of clinically significant kyphosis as high as 21%. 6 , 12 , 23 If a kyphotic deformity is present, a flexion moment is created with the head pitched forward relative

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Matthew J. Grosso, Roy Hwang, Thomas Mroz, Edward Benzel, and Michael P. Steinmetz

T he normal lordotic curvature of the cervical spine is critical to maintaining sagittal alignment and spinal balance. 9 , 17 , 18 The reversal of normal cervical curvature, as seen in kyphosis, can occur through a variety of mechanisms and can lead to mechanical pain, neurological dysfunction, and functional disabilities. 1 , 2 , 4 , 11 , 12 When patients present with sufficient symptomatic deformity, surgical intervention may be warranted. It is believed that the neurological symptoms seen in cervical kyphosis are a result of deformity

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Sina Pourtaheri, Akshay Sharma, Jason Savage, Iain Kalfas, Thomas E. Mroz, Edward Benzel, and Michael P. Steinmetz

intervertebral foramen associated with flexion-extension movement . Spine (Phila Pa 1976) 21 : 2412 – 2420 , 1996 10.1097/00007632-199611010-00002 8923625 18 Jang JS , Lee SH , Min JH , Maeng DH : Changes in sagittal alignment after restoration of lower lumbar lordosis in patients with degenerative flat back syndrome . J Neurosurg Spine 7 : 387 – 392 , 2007 10.3171/SPI-07/10/387 17933311 19 Kroenke K , Spitzer RL , Williams JB : The PHQ-9: validity of a brief depression severity measure . J Gen Intern Med 16 : 606 – 613 , 2001 11556941 10

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Syed K. Mehdi, Vincent J. Alentado, Bryan S. Lee, Thomas E. Mroz, Edward C. Benzel, and Michael P. Steinmetz

, 2012 28 Kimura I , Shingu H , Nasu Y : Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty . J Bone Joint Surg Br 77 : 956 – 961 , 1995 29 Lee CH , Jahng TA , Hyun SJ , Kim KJ , Kim HJ : Expansive laminoplasty versus laminectomy alone versus laminectomy and fusion for cervical ossification of the posterior longitudinal ligament: is there a difference in the clinical outcome and sagittal alignment? . Clin Spine Surg 29 : E9 – E15 , 2016 30 Lei T , Shen Y , Wang LF , Ding WY

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examined include presence of interbody fusion, rod diameter, rod material, age and preop sagittal alignment. Methods: A retrospective review of a multicenter, prospective ASD database was conducted. Inclusion criteria: age=18yr, ASD, no revisions between >6wk and <2yrs postop. Spinal pelvic parameters, thoracic kyphosis (TK:T2-T12) and lumbar lordosis (LL:L1-S1) were measured overall and within and outside of the instrumented segments. Changes for SVA, PT, PI-LL, TK, and LL between 6wks-2yrs postop were calculated. Of these pts, the amount of thoracic loss and TL

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surveys than NONOP (p<0.05). OP and NONOP had similar coronal alignment (p<0.05). OP had worse sagittal spinopelvic alignment for all measures than NONOP except cervical lordosis, TK and pelvic incidence (PI). OP had greater percentage of pure sagittal classification (type S; OP=23%, NON=14%; p<0.05). OP had worse grades for all modifier categories: PT (26% vs 16%), PI-lumbar lordosis mismatch (37% vs 21%) and global sagittal alignment (29% vs 9%), OP vs NONOP, respectively (p<0.05). Conclusion: Prospective analysis of OP vs NONOP treated ASD patients demonstrated