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Cervical and Cervicothoracic Osteotomies: Introduction Concepts, Planning, and Performance

  • Heiko Koller
Chapter

Abstract

This chapter introduces the concepts of assessment of cervical deformity as well as planning of cervical deformity (CD) surgery. It highlights the unique characteristics of preoperative analysis indicated in CD surgery to prevent complications. Advances in surgical instrumentation of the cervical spine and anesthesia have facilitated even lengthy surgeries with reproducible results for frail patients in experienced hands. Combined approaches can be necessary to achieve resolution of CD, maintenance of alignment, and fusion on the long-term run. Neuromonitoring is decisive during surgery, as is preoperative medical assessment of the individual patient.

References

  1. 1.
    Kim K-T, Lee S-H, Suk K-S, Lee J-H, Jeon B-O. Outcome of pedicle subtraction osteotomies for fixed sagittal imbalance of multiple etiologies. Spine. 2012;37:1667–75.CrossRefGoogle Scholar
  2. 2.
    Park Y-S, Kim H-S, Baek S-W, Oh J-H. Preoperative computer-based simulations for the correction of kyphotic deformities in ankylosing spondylitis patients. Spine J. 2014;14:2420–4.CrossRefGoogle Scholar
  3. 3.
    Park Y-S, Kim H-S, Baek S-W. Spinal osteotomy in ankylosing spondylitis: radiologic, clinical and psychological results. Spine J. 2014;14:2014.Google Scholar
  4. 4.
    Tabaraee E, Theologis AA, Funao H, Smith JS, Bruch S, Tay B, Kebaish K, Deviren V, Ames C. Three-column osteotomies of the lower cervical and upper thoracic spine: comparison of early outcomes, radiographic parameters, and peri-operative complications in 48 patients. Eur Spine J. 2015;24(Suppl 1):S23–30.PubMedGoogle Scholar
  5. 5.
    Qian B-P, Mao S-H, Jiang J, Wang B, Qiu Y. Mechanism, predisposing factors and prognosis of intra-operative vertebral subluxation during pedicle subtraction osteotomy in surgical correction of thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine. 2017;42:E983.CrossRefGoogle Scholar
  6. 6.
    Zhang X, Zhang Z, Wang J, Lu M, Hu W, Wang Y, Wang Y. Vertebral column decancellation. Bone Joint J. 2016;98-B:672–8.CrossRefGoogle Scholar
  7. 7.
    Hua W-B, Zhang Y-K, Liu X-Z, Yang S-H, Wu X-H, Wang J, Yang C. Analysis of sagittal parameters in patients undergoing one- or two-level closing wedge osteotomy for correcting thoracolumbar kyphosis secondary to ankylosing spondylitis. Spine. 2017;42:E848.CrossRefGoogle Scholar
  8. 8.
    Koller H. Osteotomies in ankylosing spondylitis: where, how many, and how much? Eur Spine J. 2018;27:70.CrossRefGoogle Scholar
  9. 9.
    Lee J-S, Youn MS, Shin JK, Goh TS, Kang SS. Relationship between cervical sagittal alignment and quality of life in ankylosing spondylitis. Eur Spine J. 2014;24:1199–203.CrossRefGoogle Scholar
  10. 10.
    Núñez-Pereira S, Hitzl W, Bullmann V, Meier O, Koller H. Sagittal balance of the cervical spine: an analysis of occipitocervical and spinopelvic interdependence, with C-7 slope as a marker of cervical and spinopelvic alignment. J Neurosurg Spine. 2015;23:16–23.CrossRefGoogle Scholar
  11. 11.
    Lee S-H, Son E-S, Seo E-M, Suk K-S, Kim K-T, et al. Factors determining cervical spine sagittal balance in asymptomatic adults: correlation with spinopelvic balance and thoracic inlet alignment. Spine J. 2015;15:705–12.CrossRefGoogle Scholar
  12. 12.
    Lee D-H, Ha J-K, Chung J-H, Hwang CJ, Lee CS, Cho JH. A retrospective study to reveal the effect of surgical correction of cervical kyphosis on thoraco-lumbo-pelvic sagittal alignment. Eur Spine J. 2016;25:2286–93.CrossRefGoogle Scholar
  13. 13.
    Mizutani J, Abumi K, Endo K, Ishii K, Yagi M, Ames C. Cervical reconstruction surgery achieves spinal balance globally. Annual meeting of CSRS-Asian Pacific, Kobe/Japan. 2017.Google Scholar
  14. 14.
    Mizutina J, Strom RG, Abumi K, Endo K, Ishii K, Yagi M, Verma K, Tay B, Deviren V, Ames CP. Thoracolumbar reciprocal changes after cervical reconstructive surgery. Annual meeting of SRS, Praha/Tschech Republic. 2016.Google Scholar
  15. 15.
    Ames C, Smith JS, Eastlack R, Blaskiewicz JD, Shaffrey CI, et al. Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. 2015;23:673–83.CrossRefGoogle Scholar
  16. 16.
    Arun R, Dabke HV, Mehdian H. Comparison of three types of lumbar osteotomy for ankylosing spondylitis: a case series and evolution of a safe technique. Eur Spine J. 2011;20:2252–60.CrossRefGoogle Scholar
  17. 17.
    Koller H, Meier O, Zenner J, Mayer M, Hitzl W. Non-instrumented correction of cervicothoracic kyphosis in ankylosing spondylitis: a critical analysis on the results of open-wedge osteotomy C7-T1 with gradual Halo-Thoracic-Cast based correction. Eur Spine J. 2013;22:747–58.CrossRefGoogle Scholar
  18. 18.
    McMaster MJ. Osteotomy of the cervical spine in ankylosing spondylitis. J Bone Joint Surg Br. 1997;79:197–203.CrossRefGoogle Scholar
  19. 19.
    Xie J, Wang Y, Zhang Y, Zhao Z. Posterior vertebral column resecton for severe rigid spinal deformity. 45th annual meeting of SRS, Kyoto/Japan. 2010.Google Scholar
  20. 20.
    Chin KR, Ahn J. Controlled cervical extension osteotomy for ankylosing spondylitis utilizing the Jackson operating table - technical note. Spine. 2007;32:1926–9.CrossRefGoogle Scholar
  21. 21.
    Mehdian SMH, Ranganathan A. A safe controlled instrumented reduction technique for cervical osteotomy in ankylosing spondylitis. Spine. 2011;36:715–20.CrossRefGoogle Scholar
  22. 22.
    Patwardhan AG, Havey RM, Khayatzadeh S, Muriuki MG, Voronov LI, Carandang G, et al. Postural consequences of cervical sagittal imbalance - a novel laboratory model. Spine. 2015;40:783–92.CrossRefGoogle Scholar
  23. 23.
    Iyer S, Lenke LG, Nemani VM, Fu M, Shifflett GD, Albert TJ, Sides BA, Metz LN, Cunningham ME, Kim HJ. Variations in occipitocervical and cervicothoracic alignment parameters based on age: a prospective study of asymptomatic volunteers using full-body radiographs. Spine. 2016;41:1837–44.CrossRefGoogle Scholar
  24. 24.
    Protopsaltis TS. T1 slope minus cervical lordosis (TS-CL), the cervical answer to PI-LL, defines cervical sagittal deformity in patients undergoing thoracolumbar osteotomy. Cervical Spine Research Society (CSRS) annual meeting; 5–7 Dec 2013. Los Angeles/USA. 2013.Google Scholar
  25. 25.
    Hyun SJ, Kim K-J, Jahng TA, Kim H-J. Relationship between T1 slope and cervical alignment following multilevel posterior cervical fusion surgery impact of T1 slope minus cervical lordosis. Spine. 2016;41:E396–402.CrossRefGoogle Scholar
  26. 26.
    Tang JA, Scheer JK, Smith JS, Deviren V, Bess S, Hart RA, Lafage V, Shaffrey CI, Schwab F, Ames CP, ISSG. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery. 2015;71:662–9.CrossRefGoogle Scholar
  27. 27.
    Xiaojing S, Song K, Zhang X, Liu C, Tang X. Optimal chin-brow vertical angle for sagittal visual fields in ankylosing spondylitis kyphosis. Eur Spine J. 2016;25:2596–604.CrossRefGoogle Scholar
  28. 28.
    Bao H, Varghese J, Lafage R, Liabaud B, Diebo B, Ramchandran S, et al. Principal radiographic characteristics for cervical spinal deformity: a health-related quality of life analysis. Spine. 2017;42:1375.CrossRefGoogle Scholar
  29. 29.
    Smith JS, Ramchandran S, Lafage V, Shaffrey CI, Ailon T, et al. Prospective multicenter assessment of early complication rates associated with adult cervical deformity surgery in 78 patients. Neurosurgery. 2016;79:378–88.CrossRefGoogle Scholar
  30. 30.
    Koller J, Koller H, Mayer M, Hitzel W, Hempfing A. Preoperative patient characteristics and pedicle screw placement accuracy impact complication rates with fusion surgery at the cervicothoracic junction. Annual meeting of CSRS-Asian Pacific, Kobe/Japan. 2017.Google Scholar
  31. 31.
    Koller H, Smith J, Mehdian H, Ames C, Bartels R, Schroeder J, Ferch G, Toyone T, Deriven V, Shaffrey C, Robinson Y. Outcomes and complications of surgery in patients with severe and rigid cervical kyphosis – results of the CSRS-E multicenter study. CSRS-E annual meeting, Salzburg/Austria. 2017.Google Scholar

Copyright information

© Springer Nature Switzerland AG 2019

Authors and Affiliations

  • Heiko Koller
    • 1
  1. 1.Department of Neurosurgery, Klinikum rechts der IsarTechnische Universität MünchenMunichGermany

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