Abstract
BackgroundTo analyze the impact of spino cranial angle (SCA) on alteration of cervical alignment after multi-level anterior cervical discectomy fusion (ACDF) and explore the relationship between SCA and health-related quality of life (HRQOL) scores.Material and methodsIn total, 49 patients following multi-level ACDF for multi-level cervical spondylotic myelopathy (MCSM) with more than 2 years follow-up period were enrolled. Radiographic data including SCA were measured. Receiver operating characteristics (ROC) curve analysis was applied to confirm the optimal cut-off values of SCA for predicting sagittal balance. Patients were divided into two groups on the basis of the cut-off value of preoperative SCA. Correlation coefficients were analyzed between SCA and HRQOL scores.ResultsOptimal cut-off values for predicting sagittal balance was SCA of 88.6°. Patients with higher SCA, no matter preoperatively, postoperatively and at follow-up, got lower T1-Slope (T1s), C2–C7 lordosis angle (CA) and higher △SCA (pre vs post: p = 0.036, pre vs F/U: p = 0.022). Simultaneously, pre-SCA, post-SCA, and F/U-SCA in the high SCA group were positively correlated with the pre-NDI, post-NDI, and F/U-NDI scores respectively (pre: p < 0.001, post: p = 0.015, F/U: p = 0.003). However, no correlation was performed in the low SCA group.ConclusionAn excessive SCA can be considered to cause poorer clinical outcomes at preoperative and better correction after surgery. The SCA could be used as a new reference value to determine sagittal balance parameters of the cervical spine and to assess the quality of life.
Highlights
Multi-level cervical spondylotic myelopathy (MCSM) refers to a common type of cervical spondylosis with multiple ( ≥ 3) segments, which is often caused by the compression of degenerated facet joints, disks, hypertrophic or ossificated ligamentum flavum and other pathological changes [1]
The purpose of our research is to explore the connection between spino cranial angle (SCA) and health-related quality of life (HRQOL) scores and to explore the impact of anterior cervical discectomy fusion (ACDF) on sagittal parameters, we divided SCA into two categories based on the SCA cut-off value to infer a new reference value to determine cervical sagittal balance and to assess the quality of clinical outcomes
Receiver operating characteristics (ROC) curve analysis and cut-off value We used T1s minus CA (T1sCA) to assess cervical alignment (T1sCA ≤ 20°, sagittal balance; > 20°, sagittal imbalance), and the result of ROC curve analysis for cervical sagittal balance showed that preoperative SCA of 88.6° was confirmed as optimal cut-off value
Summary
Multi-level cervical spondylotic myelopathy (MCSM) refers to a common type of cervical spondylosis with multiple ( ≥ 3) segments, which is often caused by the compression of degenerated facet joints, disks, hypertrophic or ossificated ligamentum flavum and other pathological changes [1]. Multi-level anterior cervical discectomy and fusion (ACDF), as an idiomatic procedure for treating MCSM, can directly achieve the decompression of spinal cord and the correction of kyphosis to a large extent [2]. According to previous literatures [3, 4], changes of sagittal parameters may be associated with the quality of life of patients. Ling, F.P., et al [5] reported the three most important sagittal balance parameters: T1-Slope (T1s), C2–C7 sagittal vertical axis (cSVA), spino cranial angle (SCA), which will be the focus of future research. To analyze the impact of spino cranial angle (SCA) on alteration of cervical alignment after multi-level anterior cervical discectomy fusion (ACDF) and explore the relationship between SCA and health-related quality of life (HRQOL) scores
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