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.	劉濤, 邱水強, 黃宇峰, 等. 頸前路椎間融合術后矢狀位參數變化與臨床療效的相關性研究. 中華骨科雜志, 2018, 38(2): 79-85.
3.	劉蔚, 唐鵬宇, 羅勇駿, 等. 前路手術對頸椎椎間盤突出癥患者頸椎矢狀位參數的影響. 脊柱外科雜志, 2017, 15(3): 167-170.
4.	劉濤, 李浩曦, 黃宇峰, 等. 下頸椎前路減壓融合術后頸椎矢狀位平衡的變化. 中國脊柱脊髓雜志, 2018, 28(6): 496-502.
5.	周思宇, 孫卓然, 李危石. 矢狀位平衡影像學評價之爭議與現狀. 中國修復重建外科雜志, 2018, 32(11): 1365-1370.
6.	楊洋, 黎慶初, 朱召銀, 等. 雙節段前路頸椎自鎖式融合器融合術后矢狀位影像學參數的變化. 中國脊柱脊髓雜志, 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, 江漢, 等. T₁ 斜坡角度與頸后路單開門椎管擴大成形術后頸椎曲度變化關系的探討. 中國矯形外科雜志, 2015, 23(15): 1360-1364.
9.	解放, 凃志鵬, 龔克, 等. 零切跡椎間融合器行單節段頸前路減壓融合術后 T₁ 傾斜角與融合器沉降的關系研究. 骨科, 2018, 9(3): 206-211.
10.	張黎龍, 程招軍, 崔子健, 等. MRI 測量脊髓型頸椎病患者矢狀位參數相關性分析. 中國修復重建外科雜志, 2017, 31(4): 451-454.
11.	程招軍, 彭兵, 任志帥, 等. 脊髓型頸椎病患者頸椎 MRI 與 X 線片矢狀位參數的對比分析. 中國脊柱脊髓雜志, 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.	Nú?ez-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.	王治棟, 朱若夫, 楊惠林, 等. 前路減壓椎間橋形融合器 ROI-C 置入治療連續雙節段脊髓型頸椎病的療效對比. 中國脊柱脊髓雜志, 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.	林圣榮, 周非非, 孫宇, 等. 頸后路單開門椎管擴大椎板成形術后頸椎矢狀面平衡的變化. 中華醫學雜志, 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. 劉濤, 邱水強, 黃宇峰, 等. 頸前路椎間融合術后矢狀位參數變化與臨床療效的相關性研究. 中華骨科雜志, 2018, 38(2): 79-85.
3. 劉蔚, 唐鵬宇, 羅勇駿, 等. 前路手術對頸椎椎間盤突出癥患者頸椎矢狀位參數的影響. 脊柱外科雜志, 2017, 15(3): 167-170.
4. 劉濤, 李浩曦, 黃宇峰, 等. 下頸椎前路減壓融合術后頸椎矢狀位平衡的變化. 中國脊柱脊髓雜志, 2018, 28(6): 496-502.
5. 周思宇, 孫卓然, 李危石. 矢狀位平衡影像學評價之爭議與現狀. 中國修復重建外科雜志, 2018, 32(11): 1365-1370.
6. 楊洋, 黎慶初, 朱召銀, 等. 雙節段前路頸椎自鎖式融合器融合術后矢狀位影像學參數的變化. 中國脊柱脊髓雜志, 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, 江漢, 等. T₁ 斜坡角度與頸后路單開門椎管擴大成形術后頸椎曲度變化關系的探討. 中國矯形外科雜志, 2015, 23(15): 1360-1364.
9. 解放, 凃志鵬, 龔克, 等. 零切跡椎間融合器行單節段頸前路減壓融合術后 T₁ 傾斜角與融合器沉降的關系研究. 骨科, 2018, 9(3): 206-211.
10. 張黎龍, 程招軍, 崔子健, 等. MRI 測量脊髓型頸椎病患者矢狀位參數相關性分析. 中國修復重建外科雜志, 2017, 31(4): 451-454.
11. 程招軍, 彭兵, 任志帥, 等. 脊髓型頸椎病患者頸椎 MRI 與 X 線片矢狀位參數的對比分析. 中國脊柱脊髓雜志, 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. Nú?ez-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. 王治棟, 朱若夫, 楊惠林, 等. 前路減壓椎間橋形融合器 ROI-C 置入治療連續雙節段脊髓型頸椎病的療效對比. 中國脊柱脊髓雜志, 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. 林圣榮, 周非非, 孫宇, 等. 頸后路單開門椎管擴大椎板成形術后頸椎矢狀面平衡的變化. 中華醫學雜志, 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