Skip to main content
SpringerLink
Log in

Comparison Between Sagittal Balance Outcomes After Corpectomy, Laminectomy, and Fusion for Cervical Spondylotic Myelopathy: A Matched Cohort Study

  • Chapter
  • First Online:
The Funnel: From the Skull Base to the Sacrum

Part of the book series: Acta Neurochirurgica Supplement ((NEUROCHIRURGICA,volume 135))

  • 274 Accesses

Abstract

Cervical spondylotic myelopathy (CSM) can be successfully decompressed via either anterior cervical corpectomy and fusion (ACCF) or posterior laminectomy with fusion (LMF). However, few studies have compared the isolated effect of both techniques on cervical sagittal balance, a surrogate end point for clinical outcomes.

We aimed to compare the sagittal balance radiological outcomes of ACCF against LMF. A case-matched controlled study of radiological cervical alignment parameters (C0-2, C2-3, index angles, T1 slope, and sagittal vertical axis (SVA)) in two groups of patients was performed by using pre- and postoperative neutral cervical X-rays.

In total, 34 patients were enrolled (ACCF n = 17; LMF n = 17). The mean preoperative C2-7 angle was similar (11.58 ± 16.00° for ACCF; 13.36 ± 12.21° for LMF) in both cohorts. Both led to a loss of lordosis (−2.68 ± 13.8°, p = 0.43; −2.94 ± 11.5°, p = 0.31, respectively). At the C0-2, the two operations induced opposite variations (−0.9 ± 8.0°, p = 0.709 for ACCF; 3.5 ± 15.4°, p = 0.357 for LMF). ACCF led to a significant increase in SVA (7.1 ± 11.9 mm, p = 0.002). The C2-3 disk angle more pronouncedly increased with LMF.

Both techniques show an equivalent kyphotic effect, with a greater disadvantage for ACCF. The negative impact on SVA changes is greater with ACCF. Both affect the C0-2 unit, with a tendency for kyphosis with ACCF and one for lordosis with LMF. When choosing the appropriate decompression and fusion technique, preoperative sagittal balance parameters should be included in the decision-making process.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

Log in via an institution
Chapter
USD 29.95
Price excludes VAT (USA)
  • Available as PDF
  • Read on any device
  • Instant download
  • Own it forever
eBook
USD 169.00
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Hardcover Book
USD 219.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

References

  1. Kalsi-Ryan S, Karadimas SK, Fehlings MG. Cervical spondylotic myelopathy: the clinical phenomenon and the current pathobiology of an increasingly prevalent and devastating disorder. Neuroscientist. 2013;19:409–21.

    Article  PubMed  Google Scholar 

  2. Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Wang JC. A clinical practice guideline for the management of degenerative cervical myelopathy: introduction, rationale, and scope. Global Spine J. 2017;7(3):21–7.

    Article  Google Scholar 

  3. Fehlings MG, Tetreault LA, Riew KD, Middleton JW, Aarabi B, Arnold PM, Brodke DS, Burns AS, Carette S, Chen R, Chiba K, Dettori JR. A clinical practice guideline for the management of patients with degenerative cervical myelopathy: recommendations for patients with mild, moderate, and severe disease and nonmyelopathic patients with evidence of cord compression. Global Spine J. 2017;7(3 Suppl):70S–83S.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Lawrence BD, Jacobs WB, Norvell DC, Hermsmeyer JT, Chapman JR, Brodke DS. Anterior versus posterior approach for treatment of cervical spondylotic myelopathy: a systematic review. Spine. 2013;38(22 Suppl 1):173–82.

    Article  Google Scholar 

  5. Jain V, Madan A, Thakur M, Thakur A. Functional outcomes of subaxial spine injuries managed with 2-level anterior cervical corpectomy and fusion: a prospective study. Neurospine. 2018;15(4):368.

    Article  PubMed  PubMed Central  Google Scholar 

  6. Oni P, Schultheiß R, Scheufler KM, Roberg J, Harati A. Radiological and clinical outcome after multilevel anterior cervical discectomy and/or corpectomy and fixation. J Clin Med. 2018;7(12):E469.

    Article  Google Scholar 

  7. Bajamal AH, Kim SH, et al. Posterior surgical techniques for cervical spondylotic myelopathy: WFNS Spine Committee Recommendations. Neurospine. 2019;16(3):421–34.

    Article  PubMed  PubMed Central  Google Scholar 

  8. Deora H, Kim SH, Behari S, Behari S, Rudrappa S, Rajshekhar V, Zileli M, Parthiban JKBC. Anterior surgical techniques for cervical spondylotic myelopathy: WFNS Spine Committee Recommendations. Neurospine. 2019;16(3):408–20.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Ikeda N, Odate S, Shikata J. Compensatory mechanisms for kyphotic change in the cervical spine according to alignment analysis of the cases after anterior cervical corpectomy and fusion. World Neurosurg. 2020;133:e233–40.

    Article  PubMed  Google Scholar 

  10. Hitchon PW, Woodroffe RW, Noeller JA, Helland L, Hramakova N, Nourski KV. Anterior and posterior approaches for cervical myelopathy: clinical and radiographic outcomes. Spine. 2019;44(9):615–23.

    Article  PubMed  Google Scholar 

  11. Liu Y, Hou Y, Yang L, Chen H, Wang X, Wu X, Gao R, Wang C, Yuan W. Comparison of 3 reconstructive techniques in the surgical management of multilevel cervical spondylotic myelopathy. Spine. 2012;37:E1450–8.

    Article  PubMed  Google Scholar 

  12. Aghayev K, Doulgeris JJ, Gonzalez-Blohm SA, Eleraky M, Lee WE, Vrionis FD. Biomechanical comparison of a two-level anterior discectomy and a one-level corpectomy, combined with fusion and anterior plate reconstruction in the cervical spine. Clin Biomech. 2014;29:21–5.

    Article  Google Scholar 

  13. Lee S, Cho DC, Roh SW, Jeon SR, Moon EJ, Lee JJ, Park JH. Cervical alignment following posterior cervical fusion surgery: cervical pedicle screw versus lateral mass screw fixation. Spine. 2018;46(10):E576–83.

    Article  Google Scholar 

  14. Miyazaki M, Ishihara T, Notani N, Kanezaki S, Tsumura H. Relationship of T1 slope with loss of lordosis and surgical outcomes after laminoplasty for cervical ossification of the posterior longitudinal ligament. Clin Neurol Neurosurg. 2018;164:19–24.

    Article  PubMed  Google Scholar 

  15. Yang BS, Lee SK, Song KS, Yoon SP, Jang G, Lee CC, Moon SH, Lee HM, Lee SH. The Use of T1 sagittal angle in predicting cervical disc degeneration. Asian Spine J. 2018;9(5):757–61.

    Article  Google Scholar 

  16. Ames CP, Blondel B, Scheer JK, Schwab FJ, Huec JL, Massicotte EM, Patel AA, Traynelis VC, Kim HJ, Shaffrey CI, Smith JS, Lafage V. Cervical radiographical alignment: comprehensive assessment techniques and potential importance in cervical myelopathy. Spine. 2013;38(22 Suppl 1):149–60.

    Article  Google Scholar 

  17. Abumi K, Shono Y, Taneichi T, Ito M, Kaneda K. Correction of cervical kyphosis using pedicle screw fixation systems. Spine. 1999;24(22):2389–96.

    Article  CAS  PubMed  Google Scholar 

  18. Lee BS, Walsh KM, Lubelski D, Knusel KD, Steinmetz MP, Mroz TE, Schlenk RP, Kalfas IH, Benzel EC. The effect of C2-3 disc angle on postoperative adverse events in cervical spondylotic myelopathy. J Neurosurg Spine. 2018;30(1):38–45.

    Article  PubMed  Google Scholar 

Download references

Contributions

RR performed the data collection and analysis and wrote the chapter. DK and LP contributed to the data collection and statistical work. OLA elaborated on the intellectual concept of the article, designed the study, and wrote the chapter. All authors have reviewed the manuscript.

Ethics Statement

The authors are accountable for all aspects of the work, including ensuring that questions related to the accuracy or integrity of any part of the work have been appropriately investigated and resolved.

Author information

Authors and Affiliations

  1. Department of Neurosurgery, Hospital Center of Vila Nova de Gaia/Espinho, Vila Nova de Gaia, Portugal

    R. Reinas, D. Kitumba, L. Pereira, V. Pinto & O. L. Alves

  2. Department of Neurosurgery, Hospital Américo Boavida, Angola, Portugal

    D. Kitumba

  3. Department of Neurosurgery, Hospital Lusíadas Porto, Porto, Portugal

    O. L. Alves

Authors
  1. R. Reinas
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. D. Kitumba
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. L. Pereira
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. V. Pinto
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. O. L. Alves
    View author publications

    You can also search for this author in PubMed Google Scholar

Editor information

Editors and Affiliations

  1. Institute of Neurosurgery, Catholic University of Rome, Rome, Italy

    Massimiliano Visocchi

Rights and permissions

Reprints and permissions

Copyright information

© 2023 The Author(s), under exclusive license to Springer Nature Switzerland AG

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Reinas, R., Kitumba, D., Pereira, L., Pinto, V., Alves, O.L. (2023). Comparison Between Sagittal Balance Outcomes After Corpectomy, Laminectomy, and Fusion for Cervical Spondylotic Myelopathy: A Matched Cohort Study. In: Visocchi, M. (eds) The Funnel: From the Skull Base to the Sacrum. Acta Neurochirurgica Supplement, vol 135. Springer, Cham. https://doi.org/10.1007/978-3-031-36084-8_52

Download citation

  • DOI: https://doi.org/10.1007/978-3-031-36084-8_52

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-031-36083-1

  • Online ISBN: 978-3-031-36084-8

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics

Search

Navigation