Compensatory Mechanisms for Kyphotic Change in the Cervical Spine According to Alignment Analysis of the Cases after Anterior Cervical Corpectomy and Fusion

• Published in: World neurosurgery Vol. 133; pp. e233 - e240
• Main Authors: Ikeda, Norimasa, Odate, Seiichi, Shikata, Jitsuhiko
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2020
• Subjects: Adaptation, Physiological - physiology; Aged; Alignment analysis; Anterior cervical corpectomy and fusion; Anthropometry; Cervical spine; Cervical Vertebrae - diagnostic imaging; Cervical Vertebrae - surgery; Compensatory mechanisms; Female; Humans; Kyphosis; Kyphosis - diagnostic imaging; Kyphosis - etiology; Kyphotic change; Male; Middle Aged; Postoperative Complications - diagnostic imaging; Postoperative Complications - etiology; Posture - physiology; Spinal Fusion; Anterior cervical corpectomy and fusion; O-C7a; Kyphosis; Kyphotic change; cSVA; Compensatory mechanisms; CL; O-C2a; ACCF; Cervical spine; Alignment analysis
• ISSN: 1878-8750; 1878-8769
• DOI: 10.1016/j.wneu.2019.08.241

Compensatory mechanisms for cervical kyphosis are unclear. Few alignment analyses have targeted ongoing cervical kyphosis and detailed the effects of compensatory alignment changes. We analyzed the radiographic alignment parameters of 31 patients (21 men and 10 women) with postoperative kyphotic changes after anterior cervical corpectomy and fusion (ACCF) between 2006 and 2015. This analysis included lordotic angle of the fusion area, fusion area length, cervical lordosis angle (CL), O-C7 angle (O-C7a), and cervical sagittal vertical axis (cSVA) as basic parameters and occipito-C2 angle (O-C2a), adjacent cranial angle, adjacent caudal angle, and T1 slope as compensatory parameters at 2 time points after surgery. Alignment analysis revealed that CL was significantly decreased by 5.0 ± 7.7° (P < 0.01) and O-C7a was changed by only −0.2 ± 6.8° (P = 0.75). An inverse correlation was found between ΔCL and ΔO-C2a (ρ = −0.40), with a nearly 1:1 relationship in the scatter diagram. ΔT1 slope had no direct compensatory correlation with ΔCL (P = 0.28) but was strongly correlated with ΔcSVA (ρ = 0.78). The scatter diagram of ΔcSVA and ΔT1 slope showed compensatory relevance and a shifted point to its collapse as the T1 slope lost control of cSVA; thereafter, both parameters incessantly increased, and ΔT1 and ΔcSVA became positive. When CL decreased after ACCF, ΔO-C2 immediately compensated for the CL loss that could lead to failure to obtain horizontal gaze. If cSVA increased, Δcaudal adjacent angle and ΔT1 slope (extension below the kyphosis) compensated for the horizontal offset translation. The noncompensatory status (ΔcSVA and ΔT1 positive) may necessitate further correction surgery in which the caudal fused level is beyond T1.