How Cervical Reconstruction Surgery Affects Global Spinal Alignment

Jun Mizutani, Russell Strom, Kuniyoshi Abumi, Kenji Endo, Ken Ishii, Mitsuru Yagi, Bobby Tay, Vedat Deviren, Christopher Ames

Research output: Contribution to journalArticle

Abstract

BACKGROUND: There have been no reports describing how cervical reconstruction surgery affects global spinal alignment (GSA). OBJECTIVE: To elucidate the effects of cervical reconstruction for GSA through a retrospective multicenter study. METHODS: Seventy-eight patients who underwent cervical reconstruction surgery for cervical kyphosis were divided into a Head-balanced group (n = 42) and a Trunk-balanced group (n = 36) according to the values of the C7 plumb line (PL). We also divided the patients into a cervical sagittal balanced group (CSB group, n = 18) and a cervical sagittal imbalanced group (CSI group, n = 60) based on the C2 PL-C7 PL distance. Various sagittal Cobb angles and the sagittal vertical axes were measured before and after surgery. RESULTS: Cervical alignment was improved to achieve occiput-trunk concordance (the distance between the center of gravity [COG] PL, which is considered the virtual gravity line of the entire body, and C7 PL < 30 mm) despite the location of COG PL and C7PL. A subsequent significant change in thoracolumbar alignment was observed in Head-balanced and CSI groups. However, no such significant change was observed in Trunk-balanced and CSB groups. We observed 1 case of transient and 1 case of residual neurological worsening. CONCLUSION: The primary goal of cervical reconstruction surgery is to achieve occiput-trunk concordance. Once it is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize GSA. Cervical reconstruction can restore both cervical deformity and GSA. However, surgeons must consider the risks and benefits in such challenging cases.

Original languageEnglish
Pages (from-to)898-907
Number of pages10
JournalNeurosurgery
Volume84
Issue number4
DOIs
Publication statusPublished - 2019 Apr 1

Fingerprint

Gravitation
Head
Kyphosis
Multicenter Studies
Retrospective Studies

Keywords

  • Cervical kyphotic deformity
  • Cervical spine reconstruction
  • Global spinal alignment
  • Occiput-trunk concordance
  • Sagittal vertical axis
  • Spinal deformity

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Mizutani, J., Strom, R., Abumi, K., Endo, K., Ishii, K., Yagi, M., ... Ames, C. (2019). How Cervical Reconstruction Surgery Affects Global Spinal Alignment. Neurosurgery, 84(4), 898-907. https://doi.org/10.1093/neuros/nyy141

How Cervical Reconstruction Surgery Affects Global Spinal Alignment. / Mizutani, Jun; Strom, Russell; Abumi, Kuniyoshi; Endo, Kenji; Ishii, Ken; Yagi, Mitsuru; Tay, Bobby; Deviren, Vedat; Ames, Christopher.

In: Neurosurgery, Vol. 84, No. 4, 01.04.2019, p. 898-907.

Research output: Contribution to journalArticle

Mizutani, J, Strom, R, Abumi, K, Endo, K, Ishii, K, Yagi, M, Tay, B, Deviren, V & Ames, C 2019, 'How Cervical Reconstruction Surgery Affects Global Spinal Alignment', Neurosurgery, vol. 84, no. 4, pp. 898-907. https://doi.org/10.1093/neuros/nyy141
Mizutani J, Strom R, Abumi K, Endo K, Ishii K, Yagi M et al. How Cervical Reconstruction Surgery Affects Global Spinal Alignment. Neurosurgery. 2019 Apr 1;84(4):898-907. https://doi.org/10.1093/neuros/nyy141
Mizutani, Jun ; Strom, Russell ; Abumi, Kuniyoshi ; Endo, Kenji ; Ishii, Ken ; Yagi, Mitsuru ; Tay, Bobby ; Deviren, Vedat ; Ames, Christopher. / How Cervical Reconstruction Surgery Affects Global Spinal Alignment. In: Neurosurgery. 2019 ; Vol. 84, No. 4. pp. 898-907.
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abstract = "BACKGROUND: There have been no reports describing how cervical reconstruction surgery affects global spinal alignment (GSA). OBJECTIVE: To elucidate the effects of cervical reconstruction for GSA through a retrospective multicenter study. METHODS: Seventy-eight patients who underwent cervical reconstruction surgery for cervical kyphosis were divided into a Head-balanced group (n = 42) and a Trunk-balanced group (n = 36) according to the values of the C7 plumb line (PL). We also divided the patients into a cervical sagittal balanced group (CSB group, n = 18) and a cervical sagittal imbalanced group (CSI group, n = 60) based on the C2 PL-C7 PL distance. Various sagittal Cobb angles and the sagittal vertical axes were measured before and after surgery. RESULTS: Cervical alignment was improved to achieve occiput-trunk concordance (the distance between the center of gravity [COG] PL, which is considered the virtual gravity line of the entire body, and C7 PL < 30 mm) despite the location of COG PL and C7PL. A subsequent significant change in thoracolumbar alignment was observed in Head-balanced and CSI groups. However, no such significant change was observed in Trunk-balanced and CSB groups. We observed 1 case of transient and 1 case of residual neurological worsening. CONCLUSION: The primary goal of cervical reconstruction surgery is to achieve occiput-trunk concordance. Once it is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize GSA. Cervical reconstruction can restore both cervical deformity and GSA. However, surgeons must consider the risks and benefits in such challenging cases.",
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AU - Deviren, Vedat

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N2 - BACKGROUND: There have been no reports describing how cervical reconstruction surgery affects global spinal alignment (GSA). OBJECTIVE: To elucidate the effects of cervical reconstruction for GSA through a retrospective multicenter study. METHODS: Seventy-eight patients who underwent cervical reconstruction surgery for cervical kyphosis were divided into a Head-balanced group (n = 42) and a Trunk-balanced group (n = 36) according to the values of the C7 plumb line (PL). We also divided the patients into a cervical sagittal balanced group (CSB group, n = 18) and a cervical sagittal imbalanced group (CSI group, n = 60) based on the C2 PL-C7 PL distance. Various sagittal Cobb angles and the sagittal vertical axes were measured before and after surgery. RESULTS: Cervical alignment was improved to achieve occiput-trunk concordance (the distance between the center of gravity [COG] PL, which is considered the virtual gravity line of the entire body, and C7 PL < 30 mm) despite the location of COG PL and C7PL. A subsequent significant change in thoracolumbar alignment was observed in Head-balanced and CSI groups. However, no such significant change was observed in Trunk-balanced and CSB groups. We observed 1 case of transient and 1 case of residual neurological worsening. CONCLUSION: The primary goal of cervical reconstruction surgery is to achieve occiput-trunk concordance. Once it is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize GSA. Cervical reconstruction can restore both cervical deformity and GSA. However, surgeons must consider the risks and benefits in such challenging cases.

AB - BACKGROUND: There have been no reports describing how cervical reconstruction surgery affects global spinal alignment (GSA). OBJECTIVE: To elucidate the effects of cervical reconstruction for GSA through a retrospective multicenter study. METHODS: Seventy-eight patients who underwent cervical reconstruction surgery for cervical kyphosis were divided into a Head-balanced group (n = 42) and a Trunk-balanced group (n = 36) according to the values of the C7 plumb line (PL). We also divided the patients into a cervical sagittal balanced group (CSB group, n = 18) and a cervical sagittal imbalanced group (CSI group, n = 60) based on the C2 PL-C7 PL distance. Various sagittal Cobb angles and the sagittal vertical axes were measured before and after surgery. RESULTS: Cervical alignment was improved to achieve occiput-trunk concordance (the distance between the center of gravity [COG] PL, which is considered the virtual gravity line of the entire body, and C7 PL < 30 mm) despite the location of COG PL and C7PL. A subsequent significant change in thoracolumbar alignment was observed in Head-balanced and CSI groups. However, no such significant change was observed in Trunk-balanced and CSB groups. We observed 1 case of transient and 1 case of residual neurological worsening. CONCLUSION: The primary goal of cervical reconstruction surgery is to achieve occiput-trunk concordance. Once it is achieved, subsequent thoracolumbar alignment changes occur as needed to harmonize GSA. Cervical reconstruction can restore both cervical deformity and GSA. However, surgeons must consider the risks and benefits in such challenging cases.

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