Abstract
Background:Previous studies on the correlation between cervical sagittal balance with improvement in quality of life showed significant results only for parameters of the anterior translation of the cervical spine (such as C2-C7 SVA).Objective:We test whether a new parameter, cervicothoracic lordosis, can predict clinical success in this type of surgery.Methods:The focused group involved patients who underwent surgical treatment of cervical degenerative disk disease by the posterior approach, due to myelopathy, radiculopathy or a combination of both. Neurologic deficit was measured before and after surgery with the Nurick Scale, postoperative quality of life, physical and mental components of SF-36 and NDI. Cervicothoracic lordosis and various sagittal balance parameters were also measured. Cervicothoracic lordosis was defined as the angle between: a) the line between the centroid of C2 and the centroid of C7; b) the line between the centroid of C7 and the centroid of T6. Correlations between postoperative quality of life and sagittal parameters were calculated.Results:Twenty-nine patients between 27 and 78 years old were evaluated. Surgery types were simple decompression (laminectomy or laminoforaminotomy) (3 patients), laminoplasty (4 patients) and laminectomy with fusion in 22 patients. Significant correlations were found for C2-C7 SVA and cervicothoracic lordosis. C2-C7 SVA correlated negatively with MCS (r=-0.445, p=0.026) and PCS (r=-0.405, p=0.045). Cervicothoracic lordosis correlated positively with MCS (r=0.554, p= 0.004) and PCS (r=0.462, p=0.020) and negatively with NDI (r=-0.416, p=0.031).Conclusion:The parameter cervicothoracic lordosis correlates with improvement of quality life after surgery for cervical degenerative disk disease by the posterior approach.
Highlights
The neurological improvement which is usually observed after cervical spinal cord decompression in cervical spondylotic myelopathy (CSM), may be accompanied by a lack of correspondent improvement in the quality of life [1], mostly due to continuing pain and its associated dysfunctions
We retrospectively evaluated the data of patients operated in our service in order to verify if a new, simple and intuitive cervical sagittal parameter, which was called cervicothoracic lordosis (CTL) could correlate with the quality of life after the surgical treatment of cervical degenerative disc disease (DDD) performed by the posterior approach and help define the surgical strategy
This study has evaluated the effect of cervical sagittal balance on the quality of life of the patients
Summary
The neurological improvement which is usually observed after cervical spinal cord decompression in cervical spondylotic myelopathy (CSM), may be accompanied by a lack of correspondent improvement in the quality of life [1], mostly due to continuing pain and its associated dysfunctions. The tremendous progress recently achieved in the understanding of spinopelvic balance –and the associated muscle energy expenditure to maintain posture– was able to improve the surgical planning process in this area and to offer correspondingly improved clinical results [4]. This progress led to a renewed interest on the study of cervical sagittal balance, aiming to offer the same benefits for cervical spine patients. Previous studies on the correlation between cervical sagittal balance with improvement in quality of life showed significant results only for parameters of the anterior translation of the cervical spine (such as C2-C7 SVA)
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