Correlation analysis between preoperative C<sub>2</sub> slope and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENG Zhaojun ^1,2 , GONG Yan ¹ , GAN Yanchi ³ , HE Jiahui ⁴ , LIANG De ¹ , REN Hui ⁵ ,  JIANG Xiaobing ⁵

1. Minimally Invasive Spinal Surgery, the First Affiliated Hospital of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
2. Postdoctoral Research Station of Guangzhou University of Chinese Medicine, Guangzhou Guangdong, 510405, P. R. China;
3. Department of Joint Orthopedics, Ruikang Hospital Affiliated to Guangxi University of Traditional Chinese Medicine, Nanning Guangxi, 530012, P. R. China;
4. Department of Orthopedics, the Affiliated Hospital of Traditional Chinese Medicine of Guangzhou Medical University, Guangzhou Guangdong, 510170, P. R. China;
5. Department of Spinal Surgery, the Second Affiliated Hospital of Guangzhou Medical University, Guangzhou Guangdong, 510260, P. R. China;

Corresponding?author：

JIANG Xiaobing, Email: spinedrjxb@sina.com

Keywords：

C₂ slope; anterior cervical discectomy and fusion; cervical spondylotic myelopathy; sagittal parameter

DOI：

10.7507/1002-1892.202409010

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Objective To investigate correlation between preoperative C₂ slope (C2S) and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion (ACDF), with the aim of providing reliable indicators for predicting effectiveness. Methods One hundred and eighteen patients with cervical spondylotic myelopathy, who received short-segment ACDF between January 2018 and December 2022 and met the selection criteria, were enrolled in the study. There were 46 males and 72 females, aged from 26 to 80 years, with a mean age of 53.6 years. The operative duration was (127.6±33.46) minutes and the intraoperative blood loss was (34.75±30.40) mL. All patients were followed up 2 years. The pre- and post-operative Neck Disability Index (NDI), Japanese Orthopaedic Association (JOA) score, and visual analogue scale (VAS) score for pain were recorded. Based on the anteroposterior and lateral cervical X-ray films, the sagittal parameters of the cervical spine were measured [C₂-C₇ Cobb angle, C₀-C₂ Cobb angle, T₁ slope, C2S, sagittal segmental angle (SSA) of the surgical segment, and average surgical disc height (ASDH) of the surgical segment]. Statistical analyses were performed to assess the differences in these indicators between pre- and post-operation, as well as the correlations between the preoperative C2S and the JOA score, NDI, and VAS score at 2 years after operation. The patients were allocated into group A (C2S >11.73°) and group B (C2S≤ 11.73°) according to the median value of the preoperative C2S (11.73°). The JOA score, NDI, and VAS score before operation and at 2 years after operation, as well as the differences between pre- and post-operative values (change values), were compared between the two groups. Results The T₁ slope, C₂-C₇ Cobb angle, C₀-C₂ Cobb angle, SSA, and ASDH at immediate after operation and JOA score, NDI, and VAS score at 2 years after operation significantly improved in 118 patients when compared with preoperative ones (P<0.05). Pearson correlation analysis showed that preoperative C2S was not correlated with JOA score and NDI at 2 years after operation (P>0.05), but negatively correlated with VAS score (P<0.05). There were 59 patients with preoperative C2S>11.73° (group A) and 59 with C2S≤11.73° (group B). There was no significant difference in preoperative JOA score, NDI, and VAS score between the two groups (P>0.05). There were significant differences in VAS score at 2 year after operation and the change value between the two groups (P<0.05); there was no significant difference in the JOA score and NDI (P>0.05). Conclusion Patients with cervical spondylotic myelopathy and a higher preoperative C2S exhibited superior long-term pain relief and effectiveness following short-segment ACDF.

Citation： CHENG Zhaojun, GONG Yan, GAN Yanchi, HE Jiahui, LIANG De, REN Hui, JIANG Xiaobing. Correlation analysis between preoperative C₂ slope and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion. Chinese Journal of Reparative and Reconstructive Surgery, 2025, 39(3): 341-345. doi: 10.7507/1002-1892.202409010 Copy

1.	Khan AF, Mohammadi E, Haynes G, et al. Evaluating tissue injury in cervical spondylotic myelopathy with spinal cord MRI: a systematic review. Eur Spine J, 2024, 33(1): 133-154.
2.	Kapetanakis S, Thomaidis T, Charitoudis G, et al. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg, 2017, 3(3): 312-322.
3.	Spanos SL, Siasios ID, Dimopoulos VG, et al. Correlation of clinical and radiological outcome after anterior cervical discectomy and fusion with a polyetheretherketone cage. J Clin Med Res, 2018, 10(3): 268-276.
4.	Ames CP, Blondel B, Scheer JK, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(22 Suppl 1): S149-160.
5.	Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine, 2013, 19(2): 141-159.
6.	Park MS, Moon SH, Lee HM, et al. The effect of age on cervical sagittal alignment: normative data on 100 asymptomatic subjects. Spine (Phila Pa 1976), 2013, 38(8): E458-E463.
7.	Iyer S, Nemani VM, Nguyen J, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine (Phila Pa 1976), 2016, 41(5): 371-377.
8.	Villavicencio AT, Babuska JM, Ashton A, et al. Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery, 2011, 68(5): 1309-1316.
9.	Protopsaltis TS, Ramchandran S, Tishelman JC, et al. The importance of C₂ slope, a singular marker of cervical deformity, correlates with patient-reported outcomes. Spine (Phila Pa 1976), 2020, 45(3): 184-192.
10.	吳炳軒, 劉寶戈, 崔維, 等. C₂及C₇傾斜角與退變性頸椎節段后凸矢狀位力線及臨床功能相關性研究. 中國脊柱脊髓雜志, 2021, 31(12): 1098-1105.
11.	程招軍, 彭兵, 張黎龍, 等. 術前MRI中T₁傾斜角與單開門椎管擴大成形術后生理曲度丟失的相關性分析. 中國修復重建外科雜志, 2018, 32(1): 64-68.
12.	Yin M, Xu C, Ma J, et al. A bibliometric analysis and visualization of current research trends in the treatment of cervical spondylotic myelopathy. Global Spine J, 2021, 11(6): 988-998.
13.	Park S, Jeong G, Hwang CJ, et al. Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy. Spine J, 2024, 24(12): 2253-2263.
14.	Yang X, Bartels RHMA, Donk R, et al. The association of cervical sagittal alignment with adjacent segment degeneration. Eur Spine J, 2020, 29(11): 2655-2664.
15.	Passias PG, Alas H, Lafage R, et al. Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? J Craniovertebr Junction Spine, 2019, 10(3): 152-159.
16.	Lin T, Chen P, Wang Z, et al. Does cervical sagittal balance affect the preoperative neck disability index in patients with cervical myelopathy? Clin Spine Surg, 2020, 33(1): E21-E25.
17.	Kim N, Suk KS, Kwon JW, et al. Clinical significance of the C₂ slope after multilevel cervical spine fusion. J Neurosurg Spine, 2022, 38(1): 24-30.
18.	Divi SN, Bronson WH, Canseco JA, et al. How do C₂ tilt and C₂ slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion? Spine J, 2021, 21(4): 578-585.

1. Khan AF, Mohammadi E, Haynes G, et al. Evaluating tissue injury in cervical spondylotic myelopathy with spinal cord MRI: a systematic review. Eur Spine J, 2024, 33(1): 133-154.
2. Kapetanakis S, Thomaidis T, Charitoudis G, et al. Single anterior cervical discectomy and fusion (ACDF) using self- locking stand-alone polyetheretherketone (PEEK) cage: evaluation of pain and health-related quality of life. J Spine Surg, 2017, 3(3): 312-322.
3. Spanos SL, Siasios ID, Dimopoulos VG, et al. Correlation of clinical and radiological outcome after anterior cervical discectomy and fusion with a polyetheretherketone cage. J Clin Med Res, 2018, 10(3): 268-276.
4. Ames CP, Blondel B, Scheer JK, et al. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(22 Suppl 1): S149-160.
5. Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine, 2013, 19(2): 141-159.
6. Park MS, Moon SH, Lee HM, et al. The effect of age on cervical sagittal alignment: normative data on 100 asymptomatic subjects. Spine (Phila Pa 1976), 2013, 38(8): E458-E463.
7. Iyer S, Nemani VM, Nguyen J, et al. Impact of cervical sagittal alignment parameters on neck disability. Spine (Phila Pa 1976), 2016, 41(5): 371-377.
8. Villavicencio AT, Babuska JM, Ashton A, et al. Prospective, randomized, double-blind clinical study evaluating the correlation of clinical outcomes and cervical sagittal alignment. Neurosurgery, 2011, 68(5): 1309-1316.
9. Protopsaltis TS, Ramchandran S, Tishelman JC, et al. The importance of C₂ slope, a singular marker of cervical deformity, correlates with patient-reported outcomes. Spine (Phila Pa 1976), 2020, 45(3): 184-192.
10. 吳炳軒, 劉寶戈, 崔維, 等. C₂及C₇傾斜角與退變性頸椎節段后凸矢狀位力線及臨床功能相關性研究. 中國脊柱脊髓雜志, 2021, 31(12): 1098-1105.
11. 程招軍, 彭兵, 張黎龍, 等. 術前MRI中T₁傾斜角與單開門椎管擴大成形術后生理曲度丟失的相關性分析. 中國修復重建外科雜志, 2018, 32(1): 64-68.
12. Yin M, Xu C, Ma J, et al. A bibliometric analysis and visualization of current research trends in the treatment of cervical spondylotic myelopathy. Global Spine J, 2021, 11(6): 988-998.
13. Park S, Jeong G, Hwang CJ, et al. Laminoplasty with foraminotomy versus anterior cervical discectomy and fusion for cervical myeloradiculopathy. Spine J, 2024, 24(12): 2253-2263.
14. Yang X, Bartels RHMA, Donk R, et al. The association of cervical sagittal alignment with adjacent segment degeneration. Eur Spine J, 2020, 29(11): 2655-2664.
15. Passias PG, Alas H, Lafage R, et al. Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? J Craniovertebr Junction Spine, 2019, 10(3): 152-159.
16. Lin T, Chen P, Wang Z, et al. Does cervical sagittal balance affect the preoperative neck disability index in patients with cervical myelopathy? Clin Spine Surg, 2020, 33(1): E21-E25.
17. Kim N, Suk KS, Kwon JW, et al. Clinical significance of the C₂ slope after multilevel cervical spine fusion. J Neurosurg Spine, 2022, 38(1): 24-30.
18. Divi SN, Bronson WH, Canseco JA, et al. How do C₂ tilt and C₂ slope correlate with patient reported outcomes in patients after anterior cervical discectomy and fusion? Spine J, 2021, 21(4): 578-585.

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Correlation analysis between preoperative C₂ slope and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion

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Correlation analysis between preoperative C2 slope and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion

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Correlation analysis between preoperative C₂ slope and effectiveness at 2 years after short-segment anterior cervical discectomy and fusion