Degenerative Cervical Kyphosis Research Articles

Cervical sagittal parameters in degenerative cervical spondylolisthesis versus degenerative cervical kyphosis with myeloradiculopathy treated by anterior cervical discectomy and fusion.

Adult spinal deformity, especially sagittal imbalance, is affecting health-related quality-of-life (HRQOL) scores. There is a lack of emphasis in the comparison of cervical sagittal parameters in patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis. The aim of study is to determine the preoperative and postoperative cervical sagittal parameters in myeloradiculopathic patients with degenerative cervical spondylolisthesis and degenerative cervical kyphosis treated by anterior cervical discectomy and fusion (ACDF). A retrospective medical records and radiographic study of 30 adult patients were reviewed. Fifteen patients with degenerative cervical spondylolisthesis and 15 patients with degenerative cervical kyphosis have been performed ACDF from 2010-2020. We measured the preoperative and postoperative cervical sagittal parameters: C0-C2 angle, C1-C2 angle, C2-C7 angle, C2-C7 sagittal vertical axis (SVA), T1 slope, neck tilt angle and thoracic inlet angle. Minimum follow-up period was at least 2 years. Patients in degenerative cervical kyphosis group have C2-C7 angle less than degenerative cervical spondylolisthesis group (-14.88±7.32 vs. 9.60±13.60), leading to increase the mismatch between T1 slope and C2-C7 angle in kyphotic group and hyperlordosis of C0-C2 angle and C1-C2 angle (31.13±7.68, 37.88±5.08) compare with spondylolisthesis group (13±10.20, 24.60±10.70). Whereas patients with degenerative cervical spondylolisthesis have C2-C7 SVA (33.22±13.92) more than kyphosis group (13.70±13.60). After surgery, there is significant increase of the C2-C7 angle in the kyphosis group compare before and after surgery (-14.88±7.32 vs. 4.10±11.80). While the spondylolisthesis group has no significantly different parameters compare to before surgery. However, the postoperative cervical sagittal parameters of all patients are within the normal thresholds (T1-Slope minus C2-C7 lordosis <15° and C2-C7 SVA <40 mm). The study demonstrates the difference of sagittal parameters between degenerative cervical spondylolisthesis and kyphosis before and after surgery. ACDF not only provides neural decompressive procedure, but also corrects the regional cervical sagittal parameters.

Relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis

PurposeTo explore the relationship between C2 slope with sagittal parameters and clinical function of degenerative cervical kyphosis (DCK).MethodsA retrospective analysis of 127 patients with degenerative cervical spondylosis treated in our spinal deformity center from January 2019 to June 2022. Patients were categorized into two groups and compared based on C2-7 angle (C2-7 ≥ 5° as kyphosis group, C2-7 < 5° as lordosis group). Pearson correlation or Spearman correlation was used to analyze the relationship between C2S and conventional radiological parameters and health -related quality-of-life (HRQOL) outcomes as measured by the EuroQol 5 dimension questionnaire (EQ5D), NRS, and the neck disability index (NDI). The cutoff value of C2S was determined by a receiver operating characteristic (ROC) curve.ResultsThere were 127 patients who met inclusion criteria (79 men and 48 women). Average 56.00 ± 10.27 years old (range 31–81 years old). C2S of kyphosis group is higher than non-kyphosis group. Aggravating cervical kyphosis increases cSVA positively. For all patients, C2S demonstrated a significant correlation with the O-C2 angle, C2-7 angle, cSVA, and TS-CL (p < 0.05). NRS, NDI and EQ5D-VAS scores revealed a significant correlation with C2S and cSVA (p < 0.01). For the subgroup of patients presenting with DCK, ROC curves demonstrated the cutoff values of C2S as 26.3°, and 30.5°, according to a cSVA of 40 mm, and severe disability expressed by NDI, respectively.ConclusionOn the basis of retaining the consistency of cranio-cervical and cervico-thoracic structure, C2S can better analyze the sagittal alignment of DCK patients than TS-CL and has good practicability in clinical application and HRQOL evaluation.

The correlation between degenerative cervical kyphosis and the cranio-cervical curve and ossification of ligaments-an unrecognized ossified ligament

The correlation between degenerative cervical kyphosis and the cranio-cervical curve and ossification of ligaments-an unrecognized ossified ligament

The Radiological Characteristics of Degenerative Cervical Kyphosis with Cervical Spondylotic Myelopathy

The Radiological Characteristics of Degenerative Cervical Kyphosis with Cervical Spondylotic Myelopathy

Radiological features of degenerative cervical kyphosis and relationship between sagittal parameters

To investigate the radiological features of degenerative cervical kyphosis (DCK) and the relationship between cervical sagittal parameters. The quality of life scores and imaging data of 89 patients with DCK treated between February 2019 and February 2022 were retrospectively analysed. There were 47 males and 42 females, with an average age of 48.4 years (range, 25-81 years). Quality of life scores included visual analogue scale (VAS) score and neck disability index (NDI). The imaging data included C 0-C 2 angle, C 2-C 7 angle, C 3-C 7 inclination of zygapophyseal joints, C 7 slope (C 7S), cervical sagittal vertical axis (cSVA), kyphosis range, and kyphosis focal. The patients were grouped by gender, and the differences of the above parameters between the two groups were compared. Pearson correlation was used to analyze the relationship between age, quality of life scores, and cervical sagittal parameters, and the relationship between cervical sagittal parameters. The preoperative VAS score was 0-9 (mean, 4.3); NDI was 16%-44% (mean, 30.0%). There was no significant difference in VAS score and NDI between male and female groups ( P>0.05). The kyphosis range of cervical spines was C 3-5 in 3 cases, C 3-6 in 41 cases, C 3-7 in 30 cases, C 4-6 in 4 cases, C 4-7 in 10 cases, C 5-7 in 1 case, and the kyphosis focal was mostly located between C 4-C 5 (78/89, 87.64%). The C 3-C 7 inclination of zygapophyseal joints were (60.25±5.56)°, (55.42±5.77)°, (53.03±6.33)°, (58.39±7.27)°, and (64.70±6.40)°, respectively. The C 0-C 2 angle, C 2-C 7 angle, C 7S, and cSVA were (-23.81±6.74)°, (10.15±2.94)°, (15.31±4.59)°, and (2.37±1.19) mm, respectively. The C 7S and cSVA of males were significantly larger than females ( P<0.05), with no significant difference in other parameters between male and female groups ( P>0.05). VAS score and NDI were negatively correlated with C 0-C 2 angle ( P<0.05), and positively correlated with C 2-C 7 angle and cSVA ( P<0.05); VAS score was negatively correlated with C 7S ( P<0.05). Except VAS, NDI and all cervical sagittal parameters were affected by age. Age was positively correlated with NDI, C 7S, and cSVA ( P<0.05), and negatively correlated with C 0-C 2 angle and C 2-C 7 angle ( P<0.05). The correlation analysis of cervical sagittal parameters showed that C 0-C 2 angle was negatively correlated with C 2-C 7 angle and cSVA ( P<0.05); C 7S was negatively correlated with C 2-C 7 angle ( P<0.05) and positively correlated with cSVA ( P<0.05). There was no correlation among other parameters ( P>0.05). The inclination of zygapophyseal joints of cervical spines of DCK patients is U-shaped in the kyphosis range, and the inclination at the kyphosis focal is the smallest. When cervical degenerative kyphosis occurs, in addition to the interaction of sagittal parameters, age, gender, neck pain, and dysfunction will also affect the cervical sagittal balance. Furthermore, cervical curvature and morphological changes are not purely local problems.

Anterior Canal Reconstruction and Fusion for Myelopathy Caused by Degenerative Cervical Kyphosis and Stenosis With or Without Ossification of the Posterior Longitudinal Ligament.

This was a retrospective study. To introduce an anterior surgical technique for myelopathy caused by degenerative cervical kyphosis and stenosis (DCKS) with or without ossification of the posterior longitudinal ligament (OPLL). The optimal approach in the treatment of DCKS remains a controversy because each anterior or posterior route surgery has advantages and disadvantages. In the period from June 2017 through June 2019, a consecutive cohort of adults diagnosed with DCKS underwent anterior canal reconstruction and fusion (ACRF). All patients underwent x-ray, computed tomography, and magnetic resonance imaging of the cervical spine. Radiologic assessment included kyphosis, canal area, canal reconstruction, OPLL, and spinal cord curvature and morphology. The Japanese Orthopaedic Association (JOA) scoring system was used to evaluate the neurological status. Surgery-related and implant-related complications were all recorded. Follow-up was carried out at 3, 6, 12, 24, and 36 months postoperation. Fourty-one patients were included in the study, of which 19 presented with OPLL. Postoperatively, the canal area were significantly greater at last follow-up compared with preoperation (208.4 vs. 123.2 mm2; P=0.001). There was significant kyphosis correction (-17.6 vs. 8.5 degrees, P=0.001) at last follow-up. Ninety-six segmental canal reconstruction were performed, 89 (92.7%) reached bone fusion at both grooves with a mean time of 7.9 months. On sagittal magnetic resonance imaging, 33 (80.5%) patients presented with lordosis in the spinal cord curvature, 8 (19.5%) with straight. The mean JOA score at last follow-up was significantly better than preoperation (15.0 vs. 9.3 points; P<0.01). One patient presented with cerebrospinal fluid leakage, 1 with screw displacement and 2 with dysphagia. ACRF, receiving good correction of kyphosis, amplified canal area, solid instrumented fusion and circumferential decompression, is an effective and safe surgical technique for cervical myelopathy caused by DCKS with or without OPLL. Level III-a retrospective analysis.

Anterior Cervical Discectomy With Fusion and Plating for Correction of Degenerative Cervical Kyphosis: 2-Dimensional Operative Video.

This surgical video demonstrates the technique for correcting degenerative cervical kyphosis using an anterior cervical discectomy and fusion (ACDF). Degenerative cervical kyphosis can cause radiculopathy, myelopathy, and difficulty holding up one's head. The goal of surgical intervention is to alleviate pain, improve the ability for upright gaze, and decompress the spinal cord or nerve roots. Posterior-only approaches and anterior corpectomies are alternative treatments to address cervical kyphosis. However, an ACDF allows for sequential induction of lordosis via distraction over multiple segments and for further lordosis induction by sequential screw tightening, pulling the spine towards a lordotic cervical plate.1 This video shows 2 cases demonstrating a technique of correcting severe cervical degenerative kyphosis. The video illustrates our initial kyphotic Caspar pin placement coupled with sequential anterior distraction to correct kyphosis. The technique is most useful in patients who have good bone density, nonankylosed facets, and degenerative cervical kyphosis. We have received informed consent of this patient to submit this video.

Degenerative Adult Cervical Kyphosis With Secondary Diagnosis Codes Are Associated With Higher Cost and Complications After Spinal Fusion: A Medicare Database Study

Adult cervical deformity (ACD) is a potentially debilitating condition resulting from kyphosis, scoliosis, or both, of the cervical spine. Conditions such as ankylosing spondylitis, rheumatoid arthritis, Parkinson's disease, and neuromuscular diseases are particularly known to cause severe deformities. We describe the 90-day cost and complications associated with spinal fusion for ACD using International Classification of Diseases (ICD) coding terminology and study if secondary diagnoses associated with potential for severe deformity affect the cost and complication profile of ACD surgery. Medicare data were used to study hospital costs and complications within 90 days after primary cervical fusion for ACD in 2 cohorts matched by demographics and comorbidity burden: (1) patients with diagnoses of secondary pathology (SP) known to cause severe deformity and (2) without SP. Univariate and multiple-variable analyses to study incidence of complications, readmission, and costs within 90 days were done. A total of 2900 patients in matched cohorts of 1450 each were included. The mean index hospital payment ($26 545 ± $25 968 versus $22 991 ± $21 599) and length of stay (4.8 ± 5.6 versus 3.9 ± 4.5 days) was significantly (P < .01) higher in ACD patients with SP. On adjusted analysis, the risk of procedure-related complications was higher (odds ratio [OR] = 1.47, 95% confidence interval [CI], 1.18-1.83) in patients with SP than those without SP, but not readmission (OR = 1.04, 95% CI, 0.82-1.32) or refusion (OR = 0.95, 95% CI, 0.45-2.0) within 90 days. The cost profile of complications, readmission, and refusion has been given. ACD patients with secondary diagnosis codes such as inflammatory arthropathy or neuromuscular pathology incur higher 90-day costs due to the inherent requirement of bigger fusions and higher risk of peri-operative complications, but with similar risk of readmission and refusion as those without SP. 3. With evolving health care reforms and payment models, knowledge of conditions associated with higher expenditure after elective spine surgical procedures will be beneficial to providers and payors for appropriate risk stratification.

Risk Factor Analysis of Facet Fusion Following Cervical Lateral Mass Screw Fixation with a Minimum 1-Year Follow-up: Assessment of Maximal Insertional Screw Torque and Incidence of Loosening.

Posterior stabilization is a common surgical procedure, which aims for rigid stabilization by facet fusion. Facet non-union has a potential risk of the screw loosening and malalignment. Although some authors have reported the influencing factors about screw loosening in the lumbar spine, there are few reports about the risk factor contributing to the facet non-union in the cervical spine. In all, 22 patients (78 facets and 122 screws) with degenerative cervical kyphosis or spondylolisthesis who underwent decompression and lateral mass screw (LMS) fixation were analyzed. Age, gender, smoking, bone mineral density (BMD), the degree of facet decortication with bone packing, and screw loosening were investigated as risk factors contributing to the facet non-union at each segmental fused level. Facet fusion rate was 85.9% (67/78 facets) and the incidence of loosening was 4.9% (6/122 screws, 4 patients). Insufficient facet decortication with bone packing is a significant risk factor of facet non-union (p <0.05, odds ratio: 26.5). All six loosened screws were associated with bony non-union of the facet and were located in the uppermost or lowermost vertebrae. Comparing loosened screws and stable screws, the average maximal insertional screw torque (MIT) was 9.8 cNm and 39.5 cNm, respectively (p <0.05). Additionally, the length of the stable screws was significantly longer versus the loosened screws (p <0.05). Lower MIT and shorter screw length located near the ends of the lateral mass may predict loosening, which can lead to facet non-union. Sufficient facet decortication with bone packing is one of the important factors contributing to the facet fusion.

Anterior Controllable Antedisplacement Fusion as a Choice for Degenerative Cervical Kyphosis with Stenosis: Preliminary Clinical and Radiologic Results

The optimal surgical procedure for degenerative cervical kyphosis with stenosis (DCKS) remains controversial. The purpose of this study is to describe the preliminary clinical and radiologic results of anterior controllable antedisplacement fusion (ACAF) as a surgical technique for DCKS. In the period from 2016 through 2017, a consecutive cohort of adults with degenerative cervical kyphosis (30° ≥ Cobb angles ≥5°) and stenosis (anteroposterior diameter of the spinal canal <12 mm) underwent ACAF, a technique making the vertebrae move forward in a hoisting manner. We retrospectively reviewed these patients, and primary outcomes of interest included operation duration, blood loss, hospital stay, kyphosis correction, decompression width, anteroposterior diameter of the spinal canal, morphology of the spinal cord, Japanese Orthopaedic Association (JOA) scores, and complications. Thirty patients were included in the study. All patients were followed for a mean of 12 months. Mean operation duration and estimated blood loss were 104.8 minutes and 221.6 mL, respectively, and the mean length of hospital stay was 5.6 days. The decompression width reached 17.7 mm. The postoperative anteroposterior diameter of the spinal canal was 14.8 mm, with a significant improvement compared with preoperation (P < 0.01). There was also significant kyphosis correction after operation (20.4° vs. 4.8°, P < 0.01). The mean JOA score was significantly better than preoperation (15.0 vs. 9.3 points; P < 0.01). There were no surgery-related complications. ACAF, correcting cervical kyphosis and simultaneously enlarging the volume of the spinal canal, is a good choice for DCKS.

Pedicle Reduction Osteotomy in the Upper Cervical Spine: Technique, Case Report and Review of the Literature.

To present a case report of the correction of a degenerative cervical 45-degree kyphosis centered at C4 with a single stage PSO. Correction of a fixed cervical kyphosis is a surgical challenge that is frequently managed with a combination of anterior and posterior surgical procedures. An alternative the three stage operation is a single stage pedicle subtraction osteotomy (PSO). A PSO releases the posterior, middle and anterior columns of the spine by resecting the facet joints, pedicles, and a portion of the vertebral body at the apex of a kyphosis through a posterior approach. This was a case report of a patient who had degenerative cervical 45 degree kyphosis and was corrected with a single stage pedicle subtraction osteotomy. We did a literature review to provide information on current techniques to treat these patients. With careful resection of the lateral mass and decompression of the vertebral artery by removal of the posterior margin of the foramen transversarium the upper cervical pedicles can be accessed and a PSO can be performed. The vertebral arteries were not obstructed or kinked with posterior reduction of the PSO in this case. A closing wedge PSO is a useful tool for correcting fixed kyphotic deformities in the upper cervical spine. Further studies are necessary to evaluate the long-term outcomes in these patients.

Degenerative Cervical Kyphosis: Treatment, Complications, and Outcomes

Degenerative disease in the cervical spine is a common source of axial neck pain and neurologic disturbances. In addition to pain, upper extremity radiculopathy and myelopathy, advanced cervical degenerative disease can result in altered biomechanics, most commonly manifested as a kyphotic deformity. As the disk spaces narrow, the weight-bearing axis of the spine is translated anteriorly, placing the posterior structures under an abnormal tensile load. This in turn leads to attenuation of the posterior ligamentous structures, allowing further progression of the deformity. Treatment of cervical kyphotic deformities is generally multimodal, often beginning with conservative measures. In cases in which conservative measures have failed or in cases of incapacitating pain or progressive neurologic decline, operative measures might be indicated.

Degenerative Cervical Kyphosis: Anatomy, Biomechanics, and Etiology

Alignment plays a critical role in cervical spine function. In the thoracic and lumbar spines, degenerative disease often manifests as complex deformities involving coronal and sagittal plane decompensation, but in the cervical spine, degenerative disease often presents with isolated sagittal plane deformity. Multiple etiologies of cervical kyphosis have been described including traumatic, iatrogenic, inflammatory, and neoplastic processes; all share a common pathway of anterior column shortening, failure of the posterior tension band, or, most commonly, both. The focus of this article will be on the degenerative etiology of cervical kyphosis.

Anterior fusion alone compared with combined anterior and posterior fusion for the treatment of degenerative cervical kyphosis

We evaluated the efficacy of anterior fusion alone compared with combined anterior and posterior fusion for the treatment of degenerative cervical kyphosis. Anterior fusion alone was undertaken in 15 patients (group A) and combined anterior and posterior fusion was carried out in a further 15 (group B). The degree and maintenance of the angle of correction, the incidence of graft subsidence, degeneration at adjacent levels and the rate of fusion were assessed radiologically and clinically and the rate of complications recorded. The mean angle of correction in group B was significantly higher than in group A (p = 0.0009). The mean visual analogue scale and the neck disability index in group B was better than in group A (p = 0.043, 0.0006). The mean operation time and the blood loss in B were greater than in group A (p < 0.0001, 0.037). Pseudarthrosis, subsidence of the cage, and problems related to the hardware were more prevalent in group A than in group B (p = 0.034, 0.025, 0.013). Although the combined procedure resulted in a longer operating time and greater blood loss than with anterior fusion alone, our results suggest that for the treatment of degenerative cervical kyphosis the combined approach leads to better maintenance of sagittal alignment, a higher rate of fusion, a lower incidence of complications and a better clinical outcome.