Preoperative cervical sagittal alignment parameters and their impacts on myelopathy in patients with cervical spondylotic myelopathy: a retrospective study.

Wei Yuan,Zhuxi Huang,Haitao Zhu,Yue Zhu,Lei Pei,Cui Cui

doi:10.7717/peerj.4027

Abstract

BackgroundCervical sagittal alignment plays an important role in the pathogenesis of cervical spondylotic myelopathy (CSM), but there are limited studies on the cervical sagittal parameters in CSM patients and their correlations with myelopathy. The aim of this study is to investigate the correlations among the preoperative cervical sagittal alignment parameters and their correlations with the development of myelopathy in patients with CSM.MethodsWe retrospectively collected 212 patients with CSM who underwent surgical interventions. Gender, age, modified Japanese Orthopedic Association score (mJOA), cervical lordosis (CL), C2–C7 sagittal vertical axis (C2–C7 SVA), T1 slope (T1S), neck tilt (NT) and thoracic inlet angle (TIA) were collected before operation. Interobserver and intraobserver reliability were calculated for all measurements (intraclass correlation coefficient, ICC). Data were analyzed with Pearson and Spearman correlation tests and multiple linear regression analysis.ResultsA total of 212 patients with CSM were included in this study (male: 136, female: 76) with an average age of 54.5 ± 10.1 years old. Intraobserver and interobserver reliability for all included radiographic parameters presented good to excellent agreement (ICC > 0.7). No significant differences in demographic and radiological parameters have been observed between males and females (P > 0.05). We found statistically significant correlations among the following parameters: age with CL (r = 0.135, P = 0.049), age with T1S (r = 0.222, P = 0.001), CL with T1S (r = 0.291, P < 0.001), CL with C2-C7 SVA (r = − 0.395, P < 0.001), mJOA with age (r = − 0.274, P < 0.001), mJOA with C2–C7 SVA (r = − 0.219, P < 0.001) and mJOA with T1S(r = − 0.171, p = 0.013). Linear regression analysis showed that C2–C7 SVA was the predictor of CL (adjusted R2 = 0.152, P < 0.001) and multiple linear regression showed that age combined with C2–C7 SVA was a sensitive predictor of mJOA (adjusted R2 = 0.106, P < 0.001).DiscussionThere were significant correlations among certain preoperative cervical sagittal parameters in CSM patients. CL was the only predictor of C2–C7 SVA. Age combined with C2–C7 SVA could predict the severity of myelopathy.

Highlights

Cervical spondylotic myelopathy (CSM) is a degenerative disease and the most common cause of neurological dysfunctions in the world (Klineberg, 2010; Smith et al, 2013)
The current study aims to investigate the preoperative cervical sagittal parameters in cervical spondylotic myelopathy (CSM), their intercorrelations and correlations between these parameters and myelopathy, which can demonstrate the clinical implications of cervical sagittal alignment in CSM patients
When examining the correlations among the parameters, we found statistically significant correlations among the following variables (Table 4): age with cervical lordosis (CL) (r = 0.135, P = 0.05), age with T1 slope (T1S) (r = 0.222, P = 0.001), CL with T1S (r = 0.291, P < 0.001), CL with C2–C7 SVA (r = −0.395, P < 0.001), modified Japanese Orthopedic Association score (mJOA) with age Linear regression analysis on C2–C7 SVA was conducted with CL, and multiple linear regression on mJOA was conducted with age and C2–C7 SVA

Summary

Introduction

Cervical spondylotic myelopathy (CSM) is a degenerative disease and the most common cause of neurological dysfunctions in the world (Klineberg, 2010; Smith et al, 2013). Abnormalities of the cervical sagittal alignment, in return, could contribute to spinal cord dysfunction through several mechanisms, including direct compression, repeated flexion/extension injury and vascular compromise (Ames et al, 2013b; Smith et al, 2013). These findings highlight the importance of cervical sagittal alignment in the pathogenesis of CSM. The aim of this study is to investigate the correlations among the preoperative cervical sagittal alignment parameters and their correlations with the development of myelopathy in patients with CSM. Age combined with C2–C7 SVA could predict the severity of myelopathy

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