Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: R. Reinas

Author(s):

R. Reinas(1), D. Kitumba(2,3), Ó. L. Alves(2,4)

(1) Centro Hospitalar Vila Nova de Gaia, Neurosurgery, Vila Nova de Gaia, Portugal
(2) Centro Hospitalar Vila Nova de Gaia, Vila Nova de Gaia, Portugal
(3) Hospital Américo Boavida, Luanda, Angola
(4) Hospital Lusíadas Porto, Porto, Portugal

Abstract

Introduction: Anterior cervical corpectomy and fusion (ACCF) is frequently used for multilevel spinal cord compression causing myelopathy with cervical laminectomy with posterior fusion being a valid alternative. Very but few published studies compare the effect of both techniques on overall cervical sagittal balance.

Objective: To compare radiological outcomes of ACCF against posterior laminectomy and fusion in terms of segmental and global cervical alignments.

Methods: We performed a randomized study of radiological cervical alignment parameters (C0-2, C3-7, index Cobb angles, T1 slope, SVA) of 2 groups of patients matched for their pre-operative C3-7 alignment. Between 2012-2017, patients with multilevel cervical compression were treated with either ACCF or laminectomy and fusion. Pre and post-operative neutral position cervical spine x-rays were used to measure the parameters, using the SECTRA® imaging software. All changes in different parameters are expressed as % of variation. We expressed kyphosis as negative angles and lordosis as positive angles.

Results: Twenty eight patients were studied, equally divided between ACCF and laminectomy and fusion groups. In the ACCF group, there were 5 males and 9 females, with a mean age of 59,7 years, and a mean of 1,57 levels treated per patient (range of 1-3). In the laminectomy and posterior fusion group, the patients were equally divided between male and female, with mean age of 58,9 years and mean of 2,71 levels treated per patient (range of 1-4). Mean pre-operative C3-7 angle was 15,55º (range of -9,4º to 35,9º) in the corpectomy group versus mean of 14,81º (range of -15,1º to 33,5º) in the laminectomy group. Regarding C3-7 sagittal alignment, a mean variation was found to be similar between the two procedures (mean of -29,6% vs -31,1% respectively). At the index level, the mean Cobb angle change was 41,96% vs 32,20%, respectively. As for the C0-2 functional unit, the two operations induced opposite variations (mean -1,95% for corpectomy vs 6,12% for posterior fusion). While there is a reduction in T1 slope, the effect was more marked in laminectomy and fusion (-14,22% for posterior fusion vs -5,95% for ACCF). In terms of SVA, corpectomy led to an increase of 49,2%, whereas posterior fusion only increased by 4,8%.

Conclusions: On global and index sagittal balance, the two techniques are equivalent, although there is a tendency for greater loss of lordosis in ACCF compared to laminectomy and fusion. Equally, the impact on SVA changes is greater with ACCF than with laminectomy and fusion, leading both to an increase in this parameter. None are free of effect on the C0-2 functional unit, with a tendency for kyphosis with ACCF and lordosis with laminectomy and posterior fixation. When choosing the appropriate decompression and fusion technique, pre-operative C0-2 angle and SVA should be strongly taken into account.

Keywords: Sagittal Balance; Cervical Myelopathy; Corpectomy and Fusion; Laminectomy and Fusion