Correlation analysis between C<sub>7</sub> slope and cervical sagittal parameters in short segment anterior cervical discectomy with fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

MA Junfeng ^1,2 , CHENG Zhaojun ³ , JIANG Zehua ² , YUAN Jianjun ² , WANG Wei ¹ , LONG Mingxing ¹ ,  ZHANG Xueli ²

1. Graduate School of Tianjin Medical University, Tianjin, 300070, P.R.China;
2. Department of Spinal Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China;
3. Tianjin Universtity of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;

Corresponding author：

ZHANG Xueli, Email: zxlspine@163.com

Keywords：

Anterior cervical discectomy with fusion; cervical sagittal parameter; C₇ slope

DOI：

10.7507/1002-1892.201901065

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Objective To elucidate the relationship between preoperative C₇ slope (C₇S) and sagittal parameters in anterior cervical discectomy with fusion (ACDF) by imaging. Methods A retrospective analysis of 54 patients (24 males and 30 females) with ACDF for cervical spondylosis between January 2012 and January 2017 was performed. The age ranged from 23 to 71 years (mean, 46.6 years). There were 29 cases of cervical spondylotic radiculopathy and 25 cases of cervical spondylotic myelopathy. The disease duration ranged from 3 to 48 months, with an average of 16.8 months. In the 55 patients, 44 were single-segment ACDF and 10 were double-segment ACDF. Sagittal parameters of cervical spine were measured on cervical X-ray films before operation and at last follow-up, including C_2-7 Cobb angle, C_2-7 sagittal vertical axis (C_2-7 SVA), C₇S, and segment Cobb angle (SCobb), and the changes of C_2-7 Cobb angle (the difference between the last follow-up and the preoperative angle) were calculated. Pearson correlation was used to analyze the correlation between the parameters before operation and at last follow-up. According to the preoperative median value of C₇S (15°), the patients were divided into group A (C₇S<15°) and group B (C₇S≥15°). The sagittal parameters before and after operation were compared between the two groups. Results All the 54 patients were followed up 6-45 months (mean, 15.5 months). At last follow-up, C₇S, C_2-7 Cobb angle, C_2-7 SVA, and SCobb angle were significantly improved when compared with preoperative values (P<0.05). Correlation analysis showed that the preoperative C₇S and SCobb angles were significantly correlated with C_2-7 Cobb angle and C_2-7 SVA (P<0.05), but there was no significant correlation between C₇S and SCobb angle (r=0.049, P=0.724). There was a significant correlation between C₇S, C_2-7 Cobb angle, and SCobb angle at last follow-up (P<0.05), but there was no significant correlation between C₇S and SCobb angles and C_2-7 SVA (P>0.05). According to the median value of preoperative C₇S, 28 patients in group A had C₇S of (11.82±3.60)°, while 26 patients in group B had C₇S of (20.77±4.09)°. There was no significant difference in gender and age between the two groups (P>0.05). The preoperative C_2-7 Cobb angle and C_2-7 SVA in group A were significantly lower than those in group B (P<0.05). There was no significant difference between preoperative SCobb angle and group B (t=0.234, P=0.816). There were no significant differences in C_2-7 Cobb angle, C_2-7 SVA, and SCobb angle between group A and group B at last follow-up (P>0.05). However, the change of C_2-7 Cobb angle in group A was significantly higher than that in group B (t=2.321, P=0.024). Conclusion Preoperative C₇S≥15° group has more physiological lordosis before operation, but its postoperative cervical curvature changes less, while ACDF is more conducive to correct the preoperative C₇S<15 ° cervical curvature.

Citation： MA Junfeng, CHENG Zhaojun, JIANG Zehua, YUAN Jianjun, WANG Wei, LONG Mingxing, ZHANG Xueli. Correlation analysis between C₇ slope and cervical sagittal parameters in short segment anterior cervical discectomy with fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2019, 33(7): 877-882. doi: 10.7507/1002-1892.201901065 Copy

1.	Kim JT, Lee HJ, Choi DY, et al. Sequential alignment change of the cervical spine after anterior cervical discectomy and fusion in the lower cervical spine. Eur Spine J, 2016, 25(7): 2223-2232.
2.	刘涛, 邱水强, 黄宇峰, 等. 颈前路椎间融合术后矢状位参数变化与临床疗效的相关性研究. 中华骨科杂志, 2018, 38(2): 79-85.
3.	刘蔚, 唐鹏宇, 罗勇骏, 等. 前路手术对颈椎椎间盘突出症患者颈椎矢状位参数的影响. 脊柱外科杂志, 2017, 15(3): 167-170.
4.	刘涛, 李浩曦, 黄宇峰, 等. 下颈椎前路减压融合术后颈椎矢状位平衡的变化. 中国脊柱脊髓杂志, 2018, 28(6): 496-502.
5.	周思宇, 孙卓然, 李危石. 矢状位平衡影像学评价之争议与现状. 中国修复重建外科杂志, 2018, 32(11): 1365-1370.
6.	杨洋, 黎庆初, 朱召银, 等. 双节段前路颈椎自锁式融合器融合术后矢状位影像学参数的变化. 中国脊柱脊髓杂志, 2016, 26(2): 116-123.
7.	Kim B, Yoon DH, Ha Y, et al. Relationship between T₁ slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J, 2016, 16(2): 219-225.
8.	福嘉欣, 江毅, 江汉, 等. T₁ 斜坡角度与颈后路单开门椎管扩大成形术后颈椎曲度变化关系的探讨. 中国矫形外科杂志, 2015, 23(15): 1360-1364.
9.	解放, 凃志鹏, 龚克, 等. 零切迹椎间融合器行单节段颈前路减压融合术后 T₁ 倾斜角与融合器沉降的关系研究. 骨科, 2018, 9(3): 206-211.
10.	张黎龙, 程招军, 崔子健, 等. MRI 测量脊髓型颈椎病患者矢状位参数相关性分析. 中国修复重建外科杂志, 2017, 31(4): 451-454.
11.	程招军, 彭兵, 任志帅, 等. 脊髓型颈椎病患者颈椎 MRI 与 X 线片矢状位参数的对比分析. 中国脊柱脊髓杂志, 2016, 26(7): 591-595.
12.	Park JH, Cho CB, Song JH, et al. T₁ slope and cervical sagittal alignment on cervical CT radiographs of asymptomatic persons. J Korean Neurosurg Soc, 2013, 53(6): 356-359.
13.	Tamai K, Buser Z, Paholpak P, et al. Can C₇ slope substitute the T₁ slope?: an analysis using cervical radiographs and kinematic MRIs. Spine (Phila Pa 1976), 2018, 43(7): 520-525.
14.	Núñez-Pereira S, Hitzl W, Bullmann V, et al. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine, 2015, 23(1): 16-23.
15.	王治栋, 朱若夫, 杨惠林, 等. 前路减压椎间桥形融合器 ROI-C 置入治疗连续双节段脊髓型颈椎病的疗效对比. 中国脊柱脊髓杂志, 2016, 26(2): 124-130.
16.	Weng C, Wang J, Tuchman A, et al. Influence of T₁ slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976), 2016, 41(3): 185-190.
17.	Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2015, 76(Suppl 1): S14-S21.
18.	林圣荣, 周非非, 孙宇, 等. 颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化. 中华医学杂志, 2014, 94(35): 2726-2730.
19.	Miyazaki M, Ishihara T, Notani N, et al. Relationship of T1 slope with loss of lordosis and surgical outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament. Clin Neurol Neurosurg, 2018, 164: 19-24.
20.	Knott PT, Mardjetko SM, Techy F. The use of the T₁ sagittal angle in predicting overall sagittal balance of the spine. Spine J, 2010, 10(11): 994-998.
21.	Gillis CC, Kaszuba MC, Traynelis VC. Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion. J Neurosurg Spine, 2016, 25(4): 421-429.
22.	Basques BA, Louie PK, Mormol J, et al. Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes. Eur Spine J, 2018, 27(11): 2745-2753.

1. Kim JT, Lee HJ, Choi DY, et al. Sequential alignment change of the cervical spine after anterior cervical discectomy and fusion in the lower cervical spine. Eur Spine J, 2016, 25(7): 2223-2232.
2. 刘涛, 邱水强, 黄宇峰, 等. 颈前路椎间融合术后矢状位参数变化与临床疗效的相关性研究. 中华骨科杂志, 2018, 38(2): 79-85.
3. 刘蔚, 唐鹏宇, 罗勇骏, 等. 前路手术对颈椎椎间盘突出症患者颈椎矢状位参数的影响. 脊柱外科杂志, 2017, 15(3): 167-170.
4. 刘涛, 李浩曦, 黄宇峰, 等. 下颈椎前路减压融合术后颈椎矢状位平衡的变化. 中国脊柱脊髓杂志, 2018, 28(6): 496-502.
5. 周思宇, 孙卓然, 李危石. 矢状位平衡影像学评价之争议与现状. 中国修复重建外科杂志, 2018, 32(11): 1365-1370.
6. 杨洋, 黎庆初, 朱召银, 等. 双节段前路颈椎自锁式融合器融合术后矢状位影像学参数的变化. 中国脊柱脊髓杂志, 2016, 26(2): 116-123.
7. Kim B, Yoon DH, Ha Y, et al. Relationship between T₁ slope and loss of lordosis after laminoplasty in patients with cervical ossification of the posterior longitudinal ligament. Spine J, 2016, 16(2): 219-225.
8. 福嘉欣, 江毅, 江汉, 等. T₁ 斜坡角度与颈后路单开门椎管扩大成形术后颈椎曲度变化关系的探讨. 中国矫形外科杂志, 2015, 23(15): 1360-1364.
9. 解放, 凃志鹏, 龚克, 等. 零切迹椎间融合器行单节段颈前路减压融合术后 T₁ 倾斜角与融合器沉降的关系研究. 骨科, 2018, 9(3): 206-211.
10. 张黎龙, 程招军, 崔子健, 等. MRI 测量脊髓型颈椎病患者矢状位参数相关性分析. 中国修复重建外科杂志, 2017, 31(4): 451-454.
11. 程招军, 彭兵, 任志帅, 等. 脊髓型颈椎病患者颈椎 MRI 与 X 线片矢状位参数的对比分析. 中国脊柱脊髓杂志, 2016, 26(7): 591-595.
12. Park JH, Cho CB, Song JH, et al. T₁ slope and cervical sagittal alignment on cervical CT radiographs of asymptomatic persons. J Korean Neurosurg Soc, 2013, 53(6): 356-359.
13. Tamai K, Buser Z, Paholpak P, et al. Can C₇ slope substitute the T₁ slope?: an analysis using cervical radiographs and kinematic MRIs. Spine (Phila Pa 1976), 2018, 43(7): 520-525.
14. Núñez-Pereira S, Hitzl W, Bullmann V, et al. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine, 2015, 23(1): 16-23.
15. 王治栋, 朱若夫, 杨惠林, 等. 前路减压椎间桥形融合器 ROI-C 置入治疗连续双节段脊髓型颈椎病的疗效对比. 中国脊柱脊髓杂志, 2016, 26(2): 124-130.
16. Weng C, Wang J, Tuchman A, et al. Influence of T₁ slope on the cervical sagittal balance in degenerative cervical spine: an analysis using kinematic MRI. Spine (Phila Pa 1976), 2016, 41(3): 185-190.
17. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2015, 76(Suppl 1): S14-S21.
18. 林圣荣, 周非非, 孙宇, 等. 颈后路单开门椎管扩大椎板成形术后颈椎矢状面平衡的变化. 中华医学杂志, 2014, 94(35): 2726-2730.
19. Miyazaki M, Ishihara T, Notani N, et al. Relationship of T1 slope with loss of lordosis and surgical outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament. Clin Neurol Neurosurg, 2018, 164: 19-24.
20. Knott PT, Mardjetko SM, Techy F. The use of the T₁ sagittal angle in predicting overall sagittal balance of the spine. Spine J, 2010, 10(11): 994-998.
21. Gillis CC, Kaszuba MC, Traynelis VC. Cervical radiographic parameters in 1- and 2-level anterior cervical discectomy and fusion. J Neurosurg Spine, 2016, 25(4): 421-429.
22. Basques BA, Louie PK, Mormol J, et al. Multi- versus single-level anterior cervical discectomy and fusion: comparing sagittal alignment, early adjacent segment degeneration, and clinical outcomes. Eur Spine J, 2018, 27(11): 2745-2753.

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Correlation analysis between C₇ slope and cervical sagittal parameters in short segment anterior cervical discectomy with fusion

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Correlation analysis between C7 slope and cervical sagittal parameters in short segment anterior cervical discectomy with fusion

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Correlation analysis between C₇ slope and cervical sagittal parameters in short segment anterior cervical discectomy with fusion