Abstract
BackgroundAnterior cervical discectomy and fusion (ACDF) is widely used in the treatment of cervical degenerative disease; however, the variation of cervical sagittal alignment changes after ACDF has been rarely explored. The purpose of this study is to determine the relationship between changes of cervical sagittal alignment after ACDF and spino-pelvic sagittal alignment under Roussouly classification.MethodsA cohort of 133 Chinese cervical spondylotic patients who received ACDF from 2011 to 2012 was recruited. All patients were categorized with Roussouly Classification. Lateral X-ray images of global spine were obtained, and preoperative and postoperative parameters were measured and analyzed, including C2–C7 angles (C2–C7), C0–C7 angles (C0–C7), external auditory meatus (EAM) tilt, sacral slope (SS), thoracic kyphosis (TK), lumbar lordosis (LL), spinal sacral angles (SSA), Superior adjacent inter-vertebral angle (SAIV), inferior adjacent inter-vertebral angle (IAIV) and et al. The Wilcoxon signed-rank test was used for intragroup comparisons preoperatively and at postoperative 48 months.ResultsAmong the parameters, C2–C7 and C0–C7 showed significant increase, while EAM TK, and IAIV decreased significantly. In type I, EAM and TK decreased significantly, however SS showed a significant increase; in type II, TK showed a significant decrease, but SSA showed a significant increase; in type III, a significant increase of C0–C7 was observed with a significant decrease in EAM, nevertheless, LL, SS and SSA showed significant decreases; and in type IV, C2–C7 showed a significant increase and EAM decreased significantly. The percentage of lordotic alignment in cervical spine increased, which was presenting in type I, III and IV. Nevertheless, the amount of patients with straight cervical alignment increased in type II.ConclusionThe backward movement of head occurs is the compensatory mechanism in cervical sagittal alignment modifications after ACDF. The compensatory alteration of spino-pelvic sagittal alignment varied in different Roussouly type.
Highlights
Anterior cervical discectomy and fusion (ACDF) is widely used in the treatment of cervical degenerative disease; the variation of cervical sagittal alignment changes after ACDF has been rarely explored
The patients were divided into 4 groups with Roussouly classification, and intergroup comparisons of preoperative factors revealed that there was no significant difference among groups including age, gender or operation levels (Table 1)
The amount of patients with lordotic cervical alignment increased in the 4-year follow-up, which echoed the results of Yung et al, who reported that the number of patients with a lordotic alignment increased from 14 (31%) to 30 (67%) after surgery in the ACDF group [13]
Summary
Anterior cervical discectomy and fusion (ACDF) is widely used in the treatment of cervical degenerative disease; the variation of cervical sagittal alignment changes after ACDF has been rarely explored. The purpose of this study is to determine the relationship between changes of cervical sagittal alignment after ACDF and spino-pelvic sagittal alignment under Roussouly classification. Yu et al reported the relationship between cervical spine and the global spine alignment in asymptomatic subjects and cervical spondylotic patients, finding that cervical alignment correlated with spino-pelvic curves [7]. Other authors explored the correlation between cervical and thoracic spine alignment in asymptomatic subjects, and compensatory changes of cervical alignment that occurred after surgical correction of thoracic and lumbar deformity [2, 8, 9]. The excellent clinical outcomes and dependable fusion rate of ACDF are well recognized [11, 12]
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