Sagittal range of motion after extensive cervical fusion

Abstract

Background contextComplicated cervical spine revision and deformity correction surgeries are becoming increasingly common. These challenging operations often necessitate fusion of the entire cervical spine. Patients frequently express concern over the likely loss of range of motion (ROM) of the neck postoperatively. However, we are aware of no study that specifically examines the sagittal cervical ROM after extensive cervical fusion. PurposeTo characterize sagittal ROM after extensive cervical fusion. Study designRetrospective case series. Patient sampleThirty patients were included. Outcome measuresRadiographs at final follow-up were measured for cervical ROM by the occipitocervical and cervicosternal angles with the neck in full flexion and extension. MethodsThe surgical and medical records at one tertiary referral academic institution were used to identify adults who had undergone extensive cervical fusion between 1996 and 2008. An “extensive cervical fusion” entailed an upper instrumented vertebra proximal to C3 and lower instrumented vertebra distal to C7. Radiographs at final follow-up were measured for cervical ROM by the occipitocervical and cervicosternal angles with the neck in full flexion and extension. ResultsThe average age at surgery was 58.3±10.0 years. The surgical levels were occiput–T1 (one patient), occiput–T4 (one patient), occiput–T6 (one patient), C1–T1 (one patient), C1–T2 (one patient), C2–T1 (nine patients), C2–T2 (eight patients), C2–T3 (six patients), and C2–T4 (two patients). Twenty-seven of the procedures were revisions. The other surgical indications were chin-on-chest deformity (one patient), cervical scoliosis (one patient), and multilevel cervical myelopathy (one patient). The mean follow-up period was 34.5±30.9 months (range, 6–154 months). The mean cervical ROM values by the occipitocervical and cervicosternal angles were 29.5±11.0° and 7.5±5.0°, respectively. The mean total cervical ROM value was 34.1±14.7°. ConclusionsA substantial degree of sagittal ROM can be maintained after extensive surgical fusion of the cervical spine.