Risk factor analysis of postoperative kyphotic change in subaxial cervical alignment after upper cervical fixation

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OBJECTIVE

Little is known about the risk factors for postoperative subaxial cervical kyphosis following craniovertebral junction (CVJ) fixation. The object of this study was to evaluate postoperative changes in cervical alignment and to identify the risk factors for postoperative kyphotic change in the subaxial cervical spine after CVJ fixation.

METHODS

One hundred fifteen patients were retrospectively analyzed for postoperative subaxial kyphosis after CVJ fixation. Relations between subaxial kyphosis and radiological risk factors, including segmental angles and ranges of motion (ROMs) at C0–1, C1–2, and C2–7, and clinical factors, such as age, sex, etiology, occipital fixation, extensor muscle resection at C2, additional C1–2 posterior wiring, and subaxial laminoplasty, were investigated. Univariate and multivariate logistic regression analyses were conducted to identify the risk factors for postoperative kyphotic changes in the subaxial cervical spine.

RESULTS

The C2–7 angle change was more than −10° in 30 (26.1%) of the 115 patients. Risk factor analysis showed CVJ fixation combined with subaxial laminoplasty (OR 9.336, 95% CI 1.484–58.734, p = 0.017) and a small ROM at the C0–1 segment (OR 0.836, 95% CI 0.757–0.923, p < 0.01) were related to postoperative subaxial kyphotic change. On the other hand, age, sex, resection of the C2 extensor muscle, rheumatoid arthritis, additional C1–2 posterior wiring, and postoperative segmental angles were not risk factors for postoperative subaxial kyphosis

CONCLUSIONS

Subaxial alignment change is not uncommon after CVJ fixation. Muscle detachment at the C2 spinous process was not a risk factor of kyphotic change. The study findings suggest that a small ROM at the C0–1 segment with or without occipital fixation and combined subaxial laminoplasty are risk factors for subaxial kyphotic change.

ABBREVIATIONS CVJ = craniovertebral junction; ICC = intraclass correlation coefficient; OA = osteoarthritis; RA = rheumatoid arthritis; ROM = range of motion.

Article Information

Correspondence Jae Taek Hong: Eunpyeong St. Mary’s Hospital, The Catholic University of Korea, Seoul, Korea. jatagi15@gmail.com.

INCLUDE WHEN CITING Published online April 26, 2019; DOI: 10.3171/2019.2.SPINE18982.

Disclosures The authors report no conflict of interest concerning the materials or methods used in this study or the findings specified in this paper.

© AANS, except where prohibited by US copyright law.

Headings

Figures

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    Lateral preoperative (A) and 1-year postoperative (B) radiographs from a kyphosis group patient. C2–7 angles varied from −12° preoperatively to 15° at 1 year postoperatively.

  • View in gallery

    A: Intraoperative photograph showing the semispinalis cervicis muscle (arrows) attached to the C2 spinous process (C2 muscle-sparing technique). B: Intraoperative photograph showing C2 muscle resection (arrows) around the C2 spinous process because of additional posterior wiring fixation. Figure is available in color online only.

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    Intraoperative photograph showing wide dissection of the deep extensor muscles in a case of C1–2 posterior fixation combined with subaxial laminoplasty. Figure is available in color online only.

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