Association of findings on preoperative extension lateral cervical radiography with osteotomy type, approach, and postoperative cervical alignment after cervical deformity surgery

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  • 1 Department of Orthopaedic Surgery, UC Davis Medical Center, Sacramento, California;
  • | 2 Hospital for Special Surgery, New York, New York;
  • | 3 Department of Orthopedics, Scripps Clinic, La Jolla, California;
  • | 4 Denver International Spine Center, Presbyterian St. Luke’s/Rocky Mountain Hospital for Children, Denver, Colorado;
  • | 5 Department of Orthopaedic Surgery, University of Kansas School of Medicine, Kansas City, Kansas;
  • | 6 Department of Neurosurgery, University of California, San Francisco, California;
  • | 7 Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;
  • | 8 Department of Orthopedic Surgery, NYU Langone Health, New York, New York; and
  • | 9 Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, Missouri
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OBJECTIVE

The authors’ objective was to determine whether preoperative lateral extension cervical spine radiography can be used to predict osteotomy type and postoperative alignment parameters after cervical spine deformity surgery.

METHODS

A total of 106 patients with cervical spine deformity were reviewed. Radiographic parameters on preoperative cervical neutral and extension lateral radiography were compared with 3-month postoperative radiographic alignment parameters. The parameters included T1 slope, C2 slope, C2–7 cervical lordosis, cervical sagittal vertical axis, and T1 slope minus cervical lordosis. Associations of radiographic parameters with osteotomy type and surgical approach were also assessed.

RESULTS

On extension lateral radiography, patients who underwent lower grade osteotomy had significantly lower T1 slope, T1 slope minus cervical lordosis, cervical sagittal vertical axis, and C2 slope. Patients who achieved more normal parameters on extension lateral radiography were more likely to undergo surgery via an anterior approach. Although baseline parameters were significantly different between neutral lateral and extension lateral radiographs, 3-month postoperative lateral and preoperative extension lateral radiographs were statistically similar for T1 slope minus cervical lordosis and C2 slope.

CONCLUSIONS

Radiographic parameters on preoperative extension lateral radiography were significantly associated with surgical approach and osteotomy grade and were similar to those on 3-month postoperative lateral radiography. These results demonstrated that extension lateral radiography is useful for preoperative planning and predicting postoperative alignment.

ABBREVIATIONS

C2S = C2 slope; CL = cervical lordosis; CSD = cervical spine deformity; cSVA = C2–7 sagittal vertical axis; ELXR = extension lateral radiography; T1S = T1 slope; T1S-CL = T1S minus CL.

Illustrations from Hubbe et al. (pp 160–163). Copyright Ioannis Vasilikos and Roberto Ferrarese. Published with permission.

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