Purpose To identify factors associated with adjacent-level ossification development (ALOD) after anterior cervical discectomy and fusion (ACDF) and associated clinical outcomes.
Methods We retrospectively reviewed records of 140 adults who underwent primary ACDF for degenerative disc disease. We compared patients with and without ALOD after ACDF. Radiographic measurements and factors associated with ALOD were assessed preoperatively and at minimum 24-month follow-up. Clinical outcomes were incidence of clinical adjacent-segment pathologies (CASP), revision surgery, and patient-reported outcomes.
Results Factors associated with both cranial and caudal ALOD were short plate-to-disc distance (PDD), adjacent-segment kyphosis, hyperlordotic ACDF causing junctional segment kyphosis, and preoperative ossification of the anterior longitudinal ligament (OALL). Mean final adjacent-segment range of motion (ROM) was less in those with cranial ALOD (6.9° ± 2.8°) than in those without cranial ALOD (12° ± 4.2°) (p < 0.01). Mean final adjacent-segment ROM was also less in those with caudal ALOD (5.5° ± 2.4º) than in those without caudal ALOD (8.2º ± 3.7º) (p < 0.01). The incidence of CASP-required surgery was higher in those with caudal ALOD (p = 0.02) but no different in those with cranial ALOD (p = 0.69) compared with those without ALOD.
Conclusion Factors associated with ALOD were a kyphotic segment adjacent to ACDF, hyperlordotic fusion, preoperative OALL, and short PDD. ALOD was associated with less segmental ROM and, for those with caudal but not cranial ALOD, higher incidence of revision surgery for CASP.
Objective Few studies have reported radiographic and clinical outcomes of transverse process hook (TPH) placement at the proximal thoracic upper instrumented vertebra (UIV) in adult spinal deformity (ASD) surgery. This study aims to investigate radiographic and clinical outcomes of TPH placement at the UIV for ASD surgery.
Methods This is a retrospective cohort of 56 patients with ASD (age, 59 ± 13 years; followup, 44 ± 19 months) from Johns Hopkins Hospital, who underwent long posterior spinal fusion to the proximal thoracic spine (T2–5). Visual analogue scale (VAS) for back pain, Oswestry Disability Index (ODI), 36-item Short Form health survey scores, thoracic kyphosis (TK), lumbar lordosis, sacral slope, pelvic tilt, pelvic incidence, proximal junctional kyphosis (PJK) angle, PJK incidence, pattern of PJK, grades of TPH dislodgement, revision surgery, and factors associated with high-grade TPH dislodgement were analyzed.
Results VAS for back pain and ODI values improved significantly from preoperatively to final follow-up. Mean change in PJK angle was 12° (range, 0.5°–43°). Twenty patients (36%) developed PJK, of whom 13 had compression fractures at 1 vertebra distal to the UIV (UIV–1). Final TPH position was stable in 42 patients (75%). In most patients (86%), TPH dislodgement did not progress after 6-month postoperative follow-up. Three patients (5.3%) underwent revision surgery to extend the fusion because of symptomatic PJK. Unstable TPH position was associated only with revision surgery and TK.
Conclusion TPH placement at the proximal thoracic UIV for long fusion showed favorable clinical and radiographic outcomes in terms of the incidence of PJK and mean PJK angle at mean 44-month follow-up. TPHs placed in the proximal thoracic UIV were in stable position in 75% of patients. Compression fracture at UIV–1 was the most common pattern of PJK. PJK angle progression was greater in revision cases and in patients with greater preoperative thoracic kyphosis.
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Methods We introduce a modified posterolateral technique, termed the intertransverse approach, utilizing a steeper access angle less than 25° through the intertransversarii muscle and the intertransverse space with expanding Kambin triangle via lateral facetectomy/foraminoplasty, to reduce dorsal root ganglion/exiting nerve root irritation under direct visualization and lower the incidence of POD. Consecutive patients undergoing endoscopic spine surgery via the intertransverse approach for foraminal and/or extraforaminal disc herniations or bony stenosis were retrospectively reviewed. Clinical outcomes were reviewed with the primary outcome being POD.
Results Twenty-two patients were included in the review. Patients showed significantly improved clinical outcomes (visual analogue scale leg and back pain and Oswestry Disability Index) postoperatively. There was a low rate of dorsal root ganglion (DRG)-related POD (9.1%, 2 of 22) that was minimal and resolved soon.
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Introducing Angle B: A Novel Quantitative Approach for Sagittal Alignment Reduction in Atlanto-Axial Dislocation Surgery Shengyu Cui, Xinyu Wang, Kang Li, Hailong Feng, Zhenlei Liu, Fengzeng Jian, Kai Wang Therapeutics and Clinical Risk Management.2024; Volume 20: 789. CrossRef
Comparison of Open Microscopic and Biportal Endoscopic Approaches in Multi-Level Posterior Cervical Foraminotomy: Radiological and Clinical Outcomes Hyung Rae Lee, Jae Min Park, In-Hee Kim, Jun-Hyun Kim, Jae-Hyuk Yang Journal of Clinical Medicine.2024; 14(1): 164. CrossRef
Magnetic Resonance Imaging Is Inadequate to Assess Cervical Sagittal Alignment Parameters Brian C. Goh, Harry M. Lightsey, Wylie Y. Lopez, Daniel G. Tobert, Harold A. Fogel, Thomas D. Cha, Joseph H. Schwab, Christopher M. Bono, Stuart H. Hershman Clinical Spine Surgery.2023; 36(2): E70. CrossRef
Clinical significance of the C2 slope after multilevel cervical spine fusion Namhoo Kim, Kyung-Soo Suk, Ji-Won Kwon, Joonoh Seo, Hunjin Ju, Byung Ho Lee, Seong-Hwan Moon, Hak-Sun Kim, Hwan-Mo Lee Journal of Neurosurgery: Spine.2023; 38(1): 24. CrossRef
Changes in intervertebral sagittal alignment of the cervical spine from supine to upright Anthony A. Oyekan, Clarissa M. LeVasseur, Jeremy D. Shaw, William F. Donaldson, Joon Y. Lee, William J. Anderst Journal of Orthopaedic Research.2023; 41(7): 1538. CrossRef
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Cervical kinematic change after posterior full-endoscopic cervical foraminotomy for disc herniation or foraminal stenosis Seungyoon Paik, Yunhee Choi, Chun Kee Chung, Young Il Won, Sung Bae Park, Seung Heon Yang, Chang-Hyun Lee, John Min Rhee, Kyoung-Tae Kim, Chi Heon Kim, Thamer Hamdan PLOS ONE.2023; 18(2): e0281926. CrossRef
Cervical sagittal balance after consecutive three-level hybrid surgery versus anterior cervical discectomy and fusion: radiological results from a single-center experience Shihao Chen, Yuxiao Deng, Hao Liu, Tingkui Wu, Kangkang Huang, Junbo He, Beiyu Wang Journal of Orthopaedic Surgery and Research.2023;[Epub] CrossRef
Factors related to T1 slope: spinopelvic balance and thoracic compensation Chengxin Liu, Yongjin Li, Xiangyu Li, Bin Shi, Shibao Lu BMC Surgery.2023;[Epub] CrossRef
Variation of cervical sagittal alignment parameters according to age and pelvic incidence in degenerative spinal deformity patients Vincent Lamas, Renan Chapon, Solène Prost, Benjamin Blondel, Stéphane Fuentes, Erik André Sauleau, Yann Philippe Charles European Spine Journal.2023; 32(10): 3624. CrossRef
Effect of T1 Slope on Disappearance of Cervical Lordosis after Posterior Cervical Double-Door Laminoplasty Based on Medical Informatics Yulin Zhao, Binglei Zhang, Baisheng Yuan Brain Sciences.2023; 13(8): 1189. CrossRef
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A Novel Intraoperative Posture‐Adjustment Apparatus for Correction of Cervical Lordosis in Anterior Cervical Surgery Yifei Deng, Beiyu Wang, Hao Liu, Yang Meng, Xin Rong, Tingkui Wu, Hao Chen, Ying Hong Orthopaedic Surgery.2023; 15(12): 3162. CrossRef
A novel rapid measurement method of cervical sagittal parameters based on the integrated inclinometer of a smartphone: a validity and reliability study Tianji Huang, Chunyang Zhang, Zhenghan Han, Weiyang Zhong, Zenghui Zhao, Yong Zhu, Xiaoji Luo, Jie Zhang Annals of Medicine.2023;[Epub] CrossRef
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What is the most accurate substitute for an invisible T1 slope in cervical radiographs? A comparative study of a novel method with previously reported substitutes Brian J. Park, Colin J. Gold, Royce W. Woodroffe, Satoshi Yamaguchi Journal of Neurosurgery: Spine.2022; 36(5): 815. CrossRef
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Reciprocal Changes in the Whole-Body Following Realignment Surgery in Adult Spinal Deformity Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim Asian Spine Journal.2022; 16(6): 958. CrossRef
Odontoid Incidence: A Novel Cervical Parameter Influencing Cervical Alignment From Top to Bottom Jae-Koo Lee, Seung-Jae Hyun, Ki-Jeong Kim Neurospine.2022; 19(2): 463. CrossRef
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Does the asymmetry and extension function of the preoperative cervical paraspinal extensor predict postoperative cervical sagittal deformity in patients who undergo modified laminoplasty? Sibo Lin, Taotao Lin, Zhengru Wu, Gang Chen, Zhitao Shangguan, Zhenyu Wang, Wenge Liu The Spine Journal.2022; 22(12): 1953. CrossRef
Validity and reliability of a novel iPhone method to rapidly measure cervical sagittal parameters Jie Zhang, Chunyang Zhang, Weiyang Zhong, Zenghui Zhao, Fei Han, Zhenghan Han, Hang Zhang, Tianji Huang, Xiaoji Luo Scientific Reports.2022;[Epub] CrossRef
Changes in T1 slope and cervical sagittal vertical axis correlate to improved neurological function recovery after cervical laminoplasty Dong-Fan Wang, Xiang-Yu Li, Chao Kong, Cheng-Xin Liu, Bin Shi, Shi-Bao Lu Frontiers in Surgery.2022;[Epub] CrossRef
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Sagittal balance of the cervical spine in children older than 4 years: what is the norm? D. A. Glukhov, V. I. Zorin, Ya. A. Maltseva, A. Yu. Mushkin Hirurgiâ pozvonočnika (Spine Surgery).2022; 19(4): 19. CrossRef
Clinical Impact and Correlations of Odontoid Parameters Following Multilevel Posterior Cervical Fusion Surgery Jae-Koo Lee, Seung-Jae Hyun, Seung Heon Yang, Ki-Jeong Kim Neurospine.2022; 19(4): 912. CrossRef
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The state of the sagittal balance of the injured cervical spine depending on the nature of the damage to the subaxial level O.S. Nekhlopochyn, V.V. Verbov TRAUMA.2021; 22(3): 48. CrossRef
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