Degenerative Cervical Spondylolisthesis 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.

Significance of Facet Fluid Index in Anterior Cervical Degenerative Spondylolisthesis.

Retrospective cohort study. To correlate cervical facet fluid characteristics to radiographic spondylolisthesis, determine if facet fluid is associated with instability in cervical degenerative spondylolisthesis, and examine whether vertebral levels with certain facet fluid characteristics and spondylolisthesis are more likely to be operated on. The relationship between facet fluid and lumbar spondylolisthesis is well-documented; however, there is a paucity of literature investigating facet fluid in degenerative cervical spondylolisthesis. Patients diagnosed with cervical degenerative spondylolisthesis were identified from a hospital's medical records. Demographic and surgical characteristics were collected through a structured query language search and manual chart review. Radiographic measurements were made on preoperative MRIs for all vertebral levels diagnosed with spondylolisthesis and adjacent undiagnosed levels between C3 and C6. The facet fluid index was calculated by dividing the facet fluid measurement by the width of the facet. Bivariate analysis was conducted to compare facet characteristics based on radiographic spondylolisthesis and spondylolisthesis stability. We included 154 patients, for whom 149 levels were classified as having spondylolisthesis and 206 levels did not. The average facet fluid index was significantly higher in patients with spondylolisthesis (0.26±0.07 vs. 0.23±0.08, p <0.001). In addition, both fluid width and facet width were significantly larger in patients with spondylolisthesis (p <0.001 each). Cervical levels in the fusion construct demonstrated a greater facet fluid index and were more likely to have unstable spondylolisthesis than stable spondylolisthesis (p <0.001 each). Facet fluid index is associated with cervical spondylolisthesis and an increased facet size and fluid width are associated with unstable spondylolisthesis. While cervical spondylolisthesis continues to be an inconclusive finding, vertebral levels with spondylolisthesis, especially the unstable ones, were more likely to be included in the fusion procedure than those without spondylolisthesis.

Laminoplasty is relevant for degenerative cervical spondylolisthesis when there is little risk of postoperative excessive kyphosis during neck flexion

BackgroundElderly patients with degenerative cervical myelopathy frequently have severe symptoms due to spondylolisthesis. The effectiveness of laminoplasty for degenerative cervical spondylolisthesis (DCS) is an important question. ObjectiveThe aim of this study is to elucidate factors associated with the outcome of laminoplasty for DCS. MethodEighty-nine patients with cervical spondylotic myelopathy (CSM) who underwent laminoplasty without instrumented posterior fusion were enrolled. Positive spondylolisthesis was defined as more than 2 mm during neck flexion or extension, from this, 46 DCS cases and 43 non-DCS cases were classified.Radiological parameters, including cervical alignment, balance, range of motion, and slippage along with the Japanese Orthopedic Association (JOA) score, were obtained before and 1 year after surgery. Factors associated with good surgical outcomes for DCS were analyzed using multivariate logistic analysis. ResultsThere were no significant differences in background and preoperative JOA score, but the DCS group recovery rate was significantly less (42% vs 53%). Multivariate logistic analysis revealed only the postoperative C2-7 angle during neck flexion was associated with a favorable outcome for DCS (P = 0.0039, Odds ratio: 1.49, 95% CI: 1.14–1.94). Multivariate regression analysis positively correlated the preoperative C2-7 angle in neutral and during flexion with the postoperative C2-7 angle during flexion. ConclusionThe major factor related to poor outcome was the magnitude of postoperative kyphotic C2-7 angle during neck flexion. Slippage was not directly related to outcome and postoperative cervical alignment. Caution is recommended for surgeons performing laminoplasty on patients with risk factors for postoperative excessive kyphotic C2-7 angle during flexion.

The Utility of Flexion-Extension Radiographs in Degenerative Cervical Spondylolisthesis.

Study Design:Retrospective radiologic analysis.Objective:The aim was to investigate if lateral flexion-extension radiographs identify additional cases of degenerative cervical spondylolisthesis (DCS) that would be missed by obtaining solely neutral upright radiographs, and determine the reliability of magnetic resonance imaging (MRI) in diagnosis.Summary of Background Data:DCS and instability can be a cause of neck pain, radiculopathy, and even myelopathy. Standard anteroposterior and lateral radiographs and MRI of the cervical spine will identify most cervical spine pathology, but spondylolisthesis and instability are dynamic issues. Standard imaging may also miss DCS in some cases.Methods:We compared the number of patients who demonstrated cervical spondylolisthesis on lateral neutral and flexion-extension radiographs in addition to MRI. We used established criteria to define instability as ≥2 mm of listhesis on neutral imaging, and ≥1 mm of motion between flexion-extension radiographs.Results:A total of 111 patients (555 cervical levels) were analyzed. In all, 41 patients (36.9%) demonstrated cervical spondylolisthesis on neutral and/or flexion-extension radiographs. Of the 77 levels of spondylolisthesis, 17 (22.1%) were missed on neutral radiographs (P,0.05). Twenty levels (26.0%) were missed when flexion-extension radiographs were used alone (P=0.02). Twenty-nine levels (37.7%) of DCS identified on radiograph were missed by MRI (P=0.004).Conclusions:Lateral flexion-extension views can be useful in the diagnosis of DCS. These views provide value by identifying a significant cohort of patients that would be undiagnosed based on neutral radiographs alone. Moreover, MRI missed 38% of DCS cases identified by radiographs. Therefore, lateral radiographs can be a useful adjunct to neutral radiographs and MRI when instability is suspected or if these imaging modalities are unable to identify the source of a patient’s neck or arm pain.

The Posterolaterally Oriented and Laterally Downward Sloping Facet Joint Is a Risk Factor for Degenerative Cervical Spondylolisthesis and Myelopathy.

Introduction Facet joints are anatomical structures that are known to be crucial for determining spinal biomechanical motion; however, the potential relationship between facet orientation and the development of cervical spondylolisthesis remains unclear. Thus, in this study, we aimed to explore the relationship between facet orientation and cervical spondylolisthesis as well as myelopathy. Methods Facet orientation in the cervical spine was investigated using computed tomography in 103 patients with cervical myelopathy, and facet inclination was measured on axial, coronal, and sagittal reconstructed images. Patients were divided into anterolisthesis, retrolisthesis, and no spondylolisthesis groups at each intervertebral level (C2/3-C6/7 levels). Results Facet joints in the anterolisthesis and retrolisthesis groups tended to slope posterolaterally and downward laterally compared with those in the no spondylolisthesis group at C3/4, C4/5, and C5/6 levels (P<0.001). Conclusions The posterolaterally oriented and laterally downward sloping facet at C3/4 and C4/5 levels may be a risk factor for the development of cervical spondylolisthesis as well as symptomatic myelopathy.

No Difference in Neck Pain or Health-Related Quality Measures Between Patients With or Without Degenerative Cervical Spondylolisthesis.

This study is a retrospective case control. This study aims to determine whether cervical degenerative spondylolisthesis (DS) is associated with increased baseline neck/arm pain and inferior health quality states compared to a similar population without DS. Patient demographics, pre-operative radiographs, and baseline PROMs were reviewed for 315 patients undergoing anterior cervical decompression and fusion (ACDF) with at least 1 year of follow-up. Patients were categorized based on the presence (S) or absence of a spondylolisthesis (NS). Statistically significant variables were further explored using multiple linear regression analysis. 49/242 (20%) patients were diagnosed with DS, most commonly at the C4-5 level (27/49). The S group was significantly older than the NS group (58.0 ± 10.7 vs 51.9 ± 9.81, P = .001), but otherwise, no demographic differences were identified. Although a higher degree of C2 slope was found among the S cohort (22.5 ± 8.63 vs 19.8 ± 7.78, P = .044), no differences were identified in terms of preoperative visual analogue scale (VAS) neck pain or NDI. In the univariate analysis, the NS group had significantly increased VAS arm pain relative to the S group (4.93 ± 3.16 vs 3.86 ± 3.30, P = .045), which was no longer significant in the multivariate analysis. Although previous reports have suggested an association between cervical DS and neck pain, we could not associate the presence of DS with increased baseline neck or arm pain. Instead, DS appears to be a relatively frequent (20% in this series) age-related condition reflecting radiographic, rather than necessarily clinical, disease.

Spino Cranial Angle and Degenerative Cervical Spondylolisthesis

The purpose of our study was to analyze and compare the spino cranial angle (SCA) in patients with degenerative cervical spondylolisthesis (DCS) and asymptomatic controls and to determine whether SCA could help diagnose DCS. We enrolled 50 patients diagnosed with DCS (4.3%) from among 1168 patients and the same number of asymptomatic participants as the control group by using cervical radiographs. Both groups underwent cervical radiographs and computed tomography at the same time. Various sagittal parameters were measured on computed tomography in a standardized supine position and compared with the asymptomatic control group. The Spearman correlation coefficient was applied to test the correlation among the sagittal parameters in the DCS group. Multivariate logistic regression analysis and receiver operating characteristic curve analysis were performed to determine whether SCA could help predict DCS. Fifty patients were enrolled in the DCS group, and 50 asymptomatic participants were included in the control group. The SCA was significantly lower for the DCS group than for the control group (76.84 ± 7.48 degrees vs. 82.47 ± 8.06 degrees, P < 0.001), and the T1 slope (T1s) was significantly greater for the DCS group than for the control group (27.29 ± 7.84 degrees vs. 22.28 ± 6.43 degrees, P= 0.001). Except for SCA and T1s, no other parameters showed significant differences. The SCA on the computed tomography scan was significantly correlated with the values of the T1s (r=-0.890, P < 0.001), cervical lordosis (r=-0.437, P= 0.002), C2-C7 sagittal vertical axis (r=0.397, P= 0.004), and thoracic inlet angle (r=-0.565, P < 0.001). Multivariate logistic regression analysis and receiver operating characteristic curve analysis showed that both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of <79.1 degrees demonstrated significant diagnostic value for the detection of DCS. Patients in the DCS group had a lower SCA and a higher T1s. Both a lower SCA and a higher T1s could be risk factors for DCS, and an SCA of <79.1 degrees demonstrated significant diagnostic value for the detection of DCS.

Does Spondylolisthesis Affect Severity and Outcome of Degenerative Cervical Myelopathy? A Systematic Review and Meta-analysis.

Study Design:This was a systematic review and meta-analysis.Objectives:Degenerative cervical myelopathy (DCM) with spondylolisthesis remains not well defined, poorly studied, and underreported and plays a minor role in the therapeutic decision-making. Spondylolisthesis, however, is not uncommon and may result in dynamic injury to the spinal cord. We aim to describe the impact of spondylolisthesis in DCM severity and postoperative outcomes.Methods:Two independent reviewers conducted a Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA 2015)-based review between 1970 and May 2020 for articles reporting outcome of DCM in patients with degenerative cervical spondylolisthesis. Patient clinical and radiological data was recorded at baseline and during postoperative follow-up (FU). A meta-analysis comparing surgical outcome between DCM patients with and without spondylolisthesis assessed by the regular/modified Japanese Orthopaedic Association Assessment Scale (mJOA) recovery ratio was completed.Results:A total of 3 studies were included (1 ambispective and 2 retrospective cohorts); 607 patients with DCM were identified, 102 (16.8%) of whom also had spondylolisthesis. DCM patients with spondylolisthesis were significantly older (P < .05), presented with worse baseline mJOA and Nurick grades (P < .05 in 2 studies), and were more commonly operated via posterior approaches (P < .05). All groups experienced a (m)JOA and/or Neck Disability Index score improvement during FU. In the pooled meta-analysis, spondylolisthesis patients showed a significantly lower functional recovery ratio at 2 years compared with other DCM patients (P = .05).Conclusions:Spondylolisthesis is frequent in older DCM patients and may be a predictor of a more advanced degeneration and subsequent worse baseline conditions and postoperative outcome.

Prevalence of cervical anterior and posterior spondylolisthesis and its association with degenerative cervical myelopathy in a general population

The purpose of this study was to examine the prevalence of cervical spondylolisthesis according to age and vertebral level and its association with degenerative cervical myelopathy (DCM). This study included 959 participants (319 men and 640 women; mean age, 66.4 years) in the Wakayama Spine Study from 2008 to 2010. The outcome measures were cervical spinal canal (CSC) diameter at C5 level on plain radiographs, the degree of cervical spondylosis using the Kellgren-Lawrence (KL) grade, cervical cord compression on sagittal T2-weighted magnetic resonance imaging, and physical signs related to DCM. The prevalence of cervical anterior and posterior spondylolisthesis was investigated in men and women by age. In addition, logistic regression analysis determined the association between CSC diameter, posterior spondylolisthesis, and clinical DCM after overall adjustment for age, sex, and body mass index. The prevalence of anterior spondylolisthesis was 6.0% in men and 6.3% in women, and that of posterior spondylolisthesis was 13.2% and 8.9%, respectively. In addition, posterior spondylolisthesis prevalence increased with age in both sexes. Logistic regression analysis revealed that developmental canal stenosis (≤13 mm) and cervical posterior spondylolisthesis are independent significant predictive factors for DCM. The prevalence of degenerative cervical posterior spondylolisthesis was increasing with age and more frequent in men than in women. Narrow canal and degenerative cervical posterior spondylolisthesis on X-ray may be useful in predicting or diagnosing DCM.

176. Degenerative cervical spondylolisthesis: does adjacent level surgical stabilization result in progressive listhesis?

BACKGROUND CONTEXT Patients with CSM often present with multilevel disease and may experience spondylolisthesis within or adjacent to the levels of clinical pathology. The progression of an unfused DCS segment remains unclear when it is not included within the surgical construct. PURPOSE We sought to evaluate if unfused DCS segments, adjacent to the fusion, develop worsening instability that requires surgery. STUDY DESIGN/SETTING Retrospective case series. PATIENT SAMPLE Twenty-three consecutive patients who presented with cervical spondylotic myelopathy (CSM), had radiographs revealing degenerative cervical spondylolisthesis (DCS) at one or more levels, and underwent surgical intervention, were reviewed. All patients showed no evidence of clinical symptoms present at the DCS level and had surgery performed at adjacent levels. OUTCOME MEASURES Radiographic measurements were obtained on preoperative and final follow-up radiographs to assess the amount of listhesis, cervical lordosis, sagittal vertebral axis, and T1 slope at the pathologic level. METHODS Multivariate analysis was used to find independent risk factors for progression of disease. RESULTS DCS was present at C2-3 in three cases (13%), C3-4 nine cases (39.5%), C4-5 seven cases (30.4%), C5-6 two cases (8.7%), C6-7 no cases (0%), C7-T1 two cases (8.7%). The average preoperative slip was 2.7 mm±0.5 mm. At final follow-up, five (21.7%) demonstrated progression (>0.5 mm) of their slip, 18 (78%) remained stable (within 0.5 mm) or improved. Older age and male sex were associated with progression, but did not increase the risk of reoperation. Two patients (8.7%) with DCS underwent revision surgery, one for symptomatic pseudoarthrosis, and one for myeloradiculopathy due to progression of the adjacent DCS. CONCLUSIONS Despite the presence of altered stress at the DCS level with the adjacent surgical intervention, the majority of patients did not experience DCS progression at final follow-up nor require further surgical intervention. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Spinal sagittal alignment and trapezoidal deformity in patients with degenerative cervical spondylolisthesis

Degenerative cervical spondylolisthesis (DCS) is a cervical deformity arising from regressive changes where trapezoidal deformity characterized by hypertrophic osteophytes of spinal elements is often observed. There is a paucity of literature about the spinal contour of DCS and trapezoidal vertebrae. We conducted this research to clarify the relationship between spinal sagittal alignment and trapezoidal deformity in DCS. Total seventy-nine patients with cervical spondylosis were enrolled. Twenty-four patients who exhibited cervical spondylolisthesis were classified into DCS group. Other patients were classified into a control group. Measurements of radiographic parameters and trapezoidal deformity were made. DCS was found mostly in C3-C4 and C4-C5 (16 and 10 cases, respectively). T1S and T1-T4 TK was larger in the DCS group than in the control (T1S: 29.9 ± 2.3° vs. 23.7 ± 1.5°, T1-T4 TK: 14.9 ± 2.1° vs. 9.0 ± 1.4°). C2-C7A was smaller in DCS (3.5 ± 3.6° vs. 11.9 ± 2.3°). Trapezoidal deformity was apparent in the vertebra below the slipped segment. Among sagittal parameters, T1S and T1-T4 TK were positively correlated with DCS (r = 0.523 and r = 0.438, respectively). For these correlations with DCS, both logistic and linear regression models predicted threshold values of approximately 30° for T1S and 15° for T1-T4 TK responsible for DCS. DCS was mostly found in the middle cervical region. Among sagittal parameters, enlarged T1S and T1-T4 TK, which were strongly correlated with amount of slippage, was considered affected to DCS. Cervical kyphosis and trapezoidal deformity also exhibited strong correlations with DCS, and were considered responsible for clinical instability.

Thoracic Inlet Parameters for Degenerative Cervical Spondylolisthesis Imaging Measurement.

BackgroundThe aim of this study was to explore the diagnostic value of sagittal measurement of thoracic inlet parameters for degenerative cervical spondylolisthesis (DCS).Material/MethodsWe initially included 65 patients with DCS and the same number of health people as the control group by using cervical radiograph evaluations. We analyzed the x-ray and computer tomographic (CT) data in prone and standing position at the same time. Measurement of cervical sagittal parameters was carried out in a standardized supine position. Multivariate logistic regression analysis was performed to evaluate these parameters as a diagnostic index for DCS.ResultsThere were 60 cases enrolled in the DCS group, and 62 cases included in the control group. The T1 slope and thoracic inlet angle (TIA) were significantly greater for the DCS group compared to the control group (24.33±2.85º versus 19.59±2.04º, p=0.00; 76.11±9.82º versus 72.86±7.31º, p=0.03, respectively). We observed no significant difference for the results of the neck tilt (NT), C2–C7 angle in the control and the DSC group (p>0.05). Logistic regression analysis and receiver operating characteristic (ROC) curve revealed that preoperative T1 slope of more than 22.0º showed significantly diagnostic value for the DCS group (p<0.05).ConclusionsPatients with preoperative sagittal imbalance of thoracic inlet have a statistically significant increased risk of DCS. T1 slope of more than 22.0º showed significantly diagnostic value for the incidence of DCS.

Concurrent Degenerative Cervical and Lumbar Spondylolisthesis

Concurrent Degenerative Cervical and Lumbar Spondylolisthesis

Space Available for Cord, Motion, and disc degeneration at the adjacent segments level of degenerative cervical spondylolisthesis using kinematic MRI

The objective was to evaluate motion, disc degeneration and Space Available for Cord (SAC) at the adjacent segments of degenerative cervical spondylolisthesis (DCS) using kinematic Magnetic Resonance Imaging (kMRI). The cervical spine kMRI of sixty-one DCS spinal levels (38 anterolisthesis and 23 retrolisthesis) were analyzed at the listhesis level and its adjacent segments in three position using kMRI. MRAnalyzer3 was used to analyze translation, angular motion and SAC. The caudad level had significantly less translation motion than the listhesis level in overall DCS or grade 2 anterolisthesis group (P<0.05). The cephalad level had significant more translational motion than the caudad level in overall DCS or grade 1 retrolisthesis group (P<0.05). For disc degeneration, the cephalad level had the least disc degeneration and showed significant difference with the listhesis level in overall DCS or overall anterolisthesis or overall retrolisthesis or grade 2 anterolisthesis or grade 1 or 2 retrolisthesis (P<0.05). For SAC, the listhesis level had the narrowest space in overall DCS groups. In neutral position, grade 1 anterolisthesis had significantly larger SAC at the listhesis and the cephalad level than grade 1 retrolisthesis (P<0.05). In conclusion, DCS affected cervical spine motion and kinematics. Grade 1 retrolisthesis showed tendency of narrower SAC at the cephalad level more than the same grade anterolisthesis. The likelihood of the adjacent segment disease and spinal cord compression are higher in both grade 2 anterolisthesis and retrolisthesis.

Kinematic evaluation of cervical sagittal balance and thoracic inlet alignment in degenerative cervical spondylolisthesis using kinematic magnetic resonance imaging

Background ContextT1 slope is a novel thoracic parameter used to assess cervical spine sagittal balance. Thoracic index (TI) parameters including T1 slope and cervical sagittal alignment parameters may play an important role in degenerative cervical spondylolisthesis (DCS). Current literature regarding the relationship between TI and cervical sagittal alignment parameters in patients with DCS is limited. Purpose(1) To evaluate the T1 slope, cervical sagittal alignment, and thoracic inlet parameter in patients with DCS using kinematic magnetic resonance imaging (kMRI), and (2) to find a correlation between the T1 slope, TI, and other cervical sagittal parameters in patients with DCS. Design/SettingRetrospective kMRI study, Level III. Patient SampleFifty-two patients with DCS from 1,128 patients from a cervical kMRI database. Outcome MeasuresT1 slope, C2–C7 angle, sagittal vertical axis C2–C7 (SVA C2–C7), cranial tilt, cervical tilt, neck tilt, and thoracic inlet angle (TIA). MethodsCervical spine kMRIs of 52 patients with DCS (mean age 51.7±standard deviation) were analyzed in neutral, flexion, and extension positions. Patients with DCS were divided into two groups: anterolisthesis (N=33) and retrolisthesis (N=19). Each listhesis group was subclassified into grade 1 (slip 2–3 mm) and grade 2 (slip>3 mm). ResultsGrade 2 retrolisthesis had the largest T1 slope followed by grade 1 retrolisthesis, grade 2 anterolisthesis, and grade 1 anterolisthesis. Significant differences were found between the anterolisthesis and the retrolisthesis groups in the neutral position (p=.025). The flexion position had the largest T1 slope and showed a significant difference with anterolisthesis in the neutral position (p=.041). Sagittal vertical axis C2–C7 showed strong correlation with cranial tilt in all DCS groups and all positions. ConclusionsIn our study, T1 slope was larger in grade 2 DCS, and the retrolisthesis group had larger T1 slope than the anterolisthesis group. Presence of larger T1 slope was significantly correlated with larger cervical lordosis curvature. Furthermore, cranial tilt was strongly correlated with SVA C2–C7.

Clinical Outcome of Cervical Laminoplasty and Postoperative Radiological Change for Cervical Myelopathy With Degenerative Spondylolisthesis.

A retrospective cohort study with prospectively collected data. The aim of this study was to investigate the clinical and radiological outcome of cervical laminoplasty for cervical myelopathy with degenerative spondylolisthesis. The presence of spondylolisthesis is thought to represent segmental instability in spine. Cervical laminoplasty is a common decompression surgery for cervical myelopathy, but its clinical result for cervical spondylolisthesis has not been well studied. One hundred seventeen patients who underwent cervical laminoplasty for degenerative cervical myelopathy were included. Japanese Orthopaedic Association score (JOA score) and visual analog scale of neck pain, upper arm pain and numbness were evaluated before surgery, and at scheduled time points after surgery. Spondylolisthesis was defined as more than 2 mm slip on plain radiograph, and the clinical results were compared between the patients with spondylolisthesis (group S) and without spondylolisthesis (group C). In the patients with spondylolisthesis, the slip distance and translational motion between flexion and extension was examined on plain lateral radiograph before surgery and 2 years after surgery. Degenerative cervical spondylolisthesis was found in 49 levels of 33 patients (28.2%), and the average age of group S was significantly higher than group C. JOA score and each VAS score was significantly improved after surgery in both groups. Average JOA score of group S was significantly lower than group C at every time points, but the recovery rate was similar between the two groups. In the level of spondylolisthesis, average slip distance did not changed, but average translational motion was significantly decreased in 2years after surgery. Cervical spondylolisthesis was common in elderly patients. The clinical outcome in group S was comparable with group C, and the level with spondylolisthesis has been stabilized after surgery. Thus, laminoplasty can be a treatment option even for cervical myelopathy with degenerative spondylolisthesis. 3.

Posterior Correction Surgery of Progressive Degenerative Cervical Spondylolisthesis - A Case Report

Degenerative spondylolisthesis of the cervical spine is relative rare. We present a relative rare case of severe degenerative cervical spondylolisthesis with posterior corrective fusion. A 70-year-old female complained of neck pain and gait disturbance with cervical spondylotic myelopathy. Plain radiographs showed 8.3 mm anterolisthesis of C3/ C4, which gradually progressed during four years. The slip was not reduced by flexion and extension position. After releasing C3/C4 facet joint and yellow ligament, posterior reduction with instrumentation were performed and resulted in successful cervical correction and fusion.

T1 Slope and Degenerative Cervical Spondylolisthesis

T1 Slope and Degenerative Cervical Spondylolisthesis

T1 slope and degenerative cervical spondylolisthesis.

Retrospective analysis. The main objectives of this study were to analyze and compare cervical sagittal parameters, including the T1 slope, in a population of 45 patients with degenerative cervical spondylolisthesis (DCS) and to compare these patients with a control group of asymptomatic population. Sagittal balance in the cervical spine is as important as the pelvic incidence and is related to the concept of T1 slope. Compared with degenerative lumbar spondylolisthesis, there are few studies evaluating DCS, and characteristic changes of the cervical sagittal parameters (including T1 slope) in patients with DCS are not well studied. We identified 45 patients with DCS (5.8%) from a database of 767 patients, using cervical radiograph in a standing position. All had radiograph and computed tomographic scan at the same time. Cervical sagittal parameters were analyzed on computed tomographic scan in a standardized supine position. The following cervical sagittal parameters were measured: T1 slope, neck tilt, thoracic inlet angle, and cervical lordosis (C2-C7 angle). The DCS group was compared with a control group of 45 asymptomatic age- and sex-matched adults to the DCS group, who were studied in a recently published study. Of our initial group of 767 patients, 45 with anterolisthesis (5.8%) were included for this study. The T1 slope was significantly greater for DCS (26.06° ± 7.3°) compared with the control group (22.32° ± 7.0°). No significant difference of the neck tilt, thoracic inlet angle, and C2-C7 angle was seen between the DSC group and the control group. Therefore, the T1 slope of the DSC group was significantly greater than that of the control group (P < 0.005). The DCS group was characterized by a greater T1 slope than the control group; therefore, we suggest that a high T1 slope may be a predisposing factor in developing DCS. 3.

The Effect of the Pedicle-Facet Angle on Degenerative Cervical Spondylolisthesis.

ObjectiveTo measure the orientation of the facet joints of cervical spine (C-spine) segments in the sagittal plane, known as the pedicle-facet (P-F) angle, and to use these measurements to evaluate the relationship between the P-F angle and the amount of vertebral anterolisthesis in patients with degenerative cervical spondylolisthesis (DCS).MethodsA retrospective case-control study was performed including 30 age- and sex-matched patients with DCS and 30 control participants. Anterior-posterior and lateral view radiographs of the C-spine were obtained in a standing position. The P-F angle at all cervical levels and the amount of anterolisthesis at C4-5 were measured from lateral view plain radiographs.ResultsThe P-F angles at C4-5 were 141.14±7.14° for the DCS group and 130.53±13.50° (p=0.012) for the control group, and at C5-6 were 137.46±8.53° for the DCS group and 128.53±16.01° for the control group (p=0.001). The mean P-F angle at C4-5 did not correlate with the amount of anterolisthesis (p=0.483). The amount of anterior slippage did correlate with age (p<0.001).ConclusionThe P-F angle was intrinsically higher at C4-5, compared to C5-6, in both the DCS and control groups, which might explain the increased likelihood for anterolisthesis of C4. Higher P-F angles in the DCS group may be a predisposing factor to slippage. The P-F angle may interact with age to increase incidence of anterolisthesis with increasing age.