• Eur Spine J · Nov 2020

    Randomized Controlled Trial

    The association of cervical sagittal alignment with adjacent segment degeneration.

    • Xiaoyu Yang, Bartels Ronald H M A RHMA Department of Neurosurgery, Radboud University Medical Centre, Nijmegen, The Netherlands., Roland Donk, Mark P Arts, Caroline M W Goedmakers, and Vleggeert-Lankamp Carmen L A CLA J11-R-83: Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands..
    • J11-R-83: Department of Neurosurgery, Leiden University Medical Centre, Albinusdreef 2, 2300 RC, Leiden, The Netherlands. X.Yang@lumc.nl.
    • Eur Spine J. 2020 Nov 1; 29 (11): 2655-2664.

    PurposeCervical spine surgery may affect sagittal alignment parameters and induce accelerated degeneration of the cervical spine. Cervical sagittal alignment parameters of surgical patients will be correlated with radiological adjacent segment degeneration (ASD) and with clinical outcome parameters.MethodsPatients were analysed from two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF) and without intervertebral cage (ACD). C2-C7 lordosis, T1 slope, C2-C7 sagittal vertical axis (SVA) and the occipito-cervical angle (OCI) were determined as cervical sagittal alignment parameters. Radiological ASD was scored by the combination of decrease in disc height and anterior osteophyte formation. Neck disability index (NDI), SF-36 PCS and MCS were evaluated as clinical outcomes.ResultsThe cervical sagittal alignment parameters were comparable between the three treatment groups, both at baseline and at 2-year follow-up. Irrespective of surgical method, C2-C7 lordosis was found to increase from 11° to 13°, but the other parameters remained stable during follow-up. Only the OCI was demonstrated to be associated with the presence and positive progression of radiological ASD, both at baseline and at 2-year follow-up. NDI, SF-36 PCS and MCS were demonstrated not to be correlated with cervical sagittal alignment. Likewise, a correlation with the value or change of the OCI was absent.ConclusionOCI, an important factor to maintain horizontal gaze, was demonstrated to be associated with radiological ASD, suggesting that the occipito-cervical angle influences accelerated cervical degeneration. Since OCI did not change after surgery, degeneration of the cervical spine may be predicted by the value of OCI.Neck TrialDutch Trial Register Number NTR1289.Procon TrialTrial Register Number ISRCTN41681847. These slides can be retrieved under Electronic Supplementary Material.

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