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Xu S, Ma F, Tang C, Liao Y, Tang Q, Chen S, Wang Q, Zhong D. Comparison of three methods for measuring C0-1 angles and C0-2 angles. BMC Musculoskelet Disord 2023; 24:301. [PMID: 37069521 PMCID: PMC10111783 DOI: 10.1186/s12891-023-06402-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Accepted: 04/06/2023] [Indexed: 04/19/2023] Open
Abstract
BACKGROUND The mutual compensatory relationship between the upper cervical sagittal alignment and the lower cervical sagittal alignment has been repeatedly reported. However, the evaluation of the upper cervical sagittal parameters are varied in previous studies. This retrospective study was performed to compare three methods for measuring the upper cervical sagittal parameters. METHODS A total of 263 individuals with standing neutral lateral cervical radiographs were included in this study. The Frankfort horizontal line (FHL), foramen magnum line (FML), and McGregor line (ML) were separately used as the reference lines for measuring the C0-1 angle and C0-2 angle. Intraclass correlation (ICC) values were used to compare the consistency and repeatability of the three methods. Pearson's correlation analysis was used to analyze the correlation between the sagittal parameters of the upper and lower cervical spine. RESULTS The interobserver and intraobserver ICC values obtained from using the ML to measure the C0-1 angle and C0-2 angle were both higher than those obtained from using the FML or FHL. The C0-1 angle and C0-2 angle measured by the three methods were negatively correlated with the C2-7 angle. The upper sagittal parameters measured by the FHL were the most correlated with the C2-7 angle. The correlation between the C0-1 angle measured by the three methods and the C0-2 angle measured with the FHL or ML and the C2-7 angle increased with aging. CONCLUSION Use of the ML to measure the C0-1 angle and C0-2 angle has higher reliability. Use of the FHL to measure the sagittal alignment of the upper cervical spine is more suitable for evaluating the compensation mechanism between the upper and the lower cervical spine.
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Affiliation(s)
- Shicai Xu
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Fei Ma
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Chao Tang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Yehui Liao
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Qiang Tang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Shiyu Chen
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Qing Wang
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China
| | - Dejun Zhong
- Department of Orthopaedics, The Affiliated Hospital of Southwest Medical University, No.25 Taipingjie, Lu Zhou, Sichuan, 646000, PR China.
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Fang Q, Chen J, Jiang A, Chen Y, Meng Q. Correlation between C0–C2 height, occipital-C2 angle and clivus-axial angle: CT-based anatomical study. JOURNAL OF RADIATION RESEARCH AND APPLIED SCIENCES 2023. [DOI: 10.1016/j.jrras.2022.100488] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Charles YP, Prost S, Pesenti S, Ilharreborde B, Bauduin E, Laouissat F, Riouallon G, Wolff S, Challier V, Obeid I, Boissière L, Ferrero E, Solla F, Le Huec JC, Bourret S, Faddoul J, Abi Lahoud GN, Fière V, Vande Kerckhove M, Campana M, Lebhar J, Giorgi H, Faure A, Sauleau EA, Blondel B. Variation of cervical sagittal alignment parameters according to gender, pelvic incidence and age. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2022; 31:1228-1240. [PMID: 34989876 DOI: 10.1007/s00586-021-07102-w] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/30/2021] [Revised: 12/03/2021] [Accepted: 12/20/2021] [Indexed: 11/26/2022]
Abstract
PURPOSE The aim was to describe radiographic cervical sagittal alignment variations according to age, gender and pelvic incidence (PI) and to investigate relationships with thoracic alignment. METHODS A total of 2599 individuals (5-93 years) without spinal deformity were studied. Cranial cervical parameters were: McGregor slope, occipita-C2 angle, McGregor-C2 lordosis and C1-C2 lordosis. Caudal cervical parameters were: C2-C7, cranial arch and caudal arch lordosis and C7- and T1-slope. A Bayesian inference compared parameter distributions. Correlations with spinopelvic and global alignment parameters were investigated. RESULTS Among cranial cervical parameters, variations of McGregor slope were non-significant. McGregor-C2 lordosis and C1-C2 lordosis were smaller in males and increased significantly during growth, whereas the occipito-C2 angle decreased (Pr > 0.95). The occipito-C2 angle was larger and McGregor-C2 lordosis was smaller in low PI (Pr > 0.95). Among caudal cervical parameters, C2-C7 lordosis and C7- and T1-slope were larger in males and increased after 50 years (Pr > 0.95). Lordosis changes were non-significant in the cranial arch, whereas values increased in the caudal arch after 35 years (Pr > 0.95). Caudal parameter differences were non-significant between PI groups. Strong correlations existed between C2-C7, caudal arch lordosis, C7-slope, T1-slope and thoracic kyphosis. The sagittal vertical axis C2 correlated with caudal arch lordosis and T1-slope (ρ > 0.5; Pr > 0.95). CONCLUSION Cervical alignment parameters vary according to age, gender and PI. In the cranial cervical spine, changes occur mainly during growth. In the caudal cervical spine, lordosis increases in the caudal arch, which is related to thoracic kyphosis increase with age. The caudal cervical arch acts as a compensatory segment by progressive extension, allowing horizontal gaze.
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Affiliation(s)
- Yann Philippe Charles
- Service de Chirurgie du Rachis, Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, 1 Avenue Molière, 67200, Strasbourg, France.
| | - Solène Prost
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Sébastien Pesenti
- Service d'Orthopédie Pédiatrique, CHU Timone, Aix-Marseille Université, Marseille, France
| | - Brice Ilharreborde
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Eloïse Bauduin
- Service de Chirurgie Orthopédique et Traumatologie, Hôpital Maison Blanche, CHU de Reims, Reims, France
| | | | - Guillaume Riouallon
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | - Stéphane Wolff
- Service de Chirurgie Orthopédique et Traumatolgique, Groupe Hospitalier Paris Saint Joseph, Paris, France
| | | | | | | | - Emmanuelle Ferrero
- Service de Chirurgie Orthopédique de la Colonne Vertébrale, AP-HP, Hôpital Européen Georges-Pompidou, Université de Paris, Paris, France
| | - Federico Solla
- Service d'Orthopédie Pédiatrique, Fondation Lenval, Nice, France
| | | | - Stéphane Bourret
- Polyclinique Bordeaux Nord Aquitaine, Université de Bordeaux, Bordeaux, France
| | - Joe Faddoul
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Georges Naïm Abi Lahoud
- Institut de la Colonne Vertébrale et des Neurosciences, Centre Médico-Chirurgical Bizet, Paris, France
| | - Vincent Fière
- Centre Orthopédique Santy, Unité du Rachis, Lyon, France
| | | | - Matthieu Campana
- Service de Chirurgie Orthopédique Pédiatrique, AP-HP, CHU Robert Debré, Université de Paris, Paris, France
| | - Jonathan Lebhar
- Institut Locomoteur de L'Ouest Rachis, Centre Hospitalier Privé Saint-Grégoire, Saint-Grégoire, France
| | | | | | - Erik André Sauleau
- Pôle Santé Publique, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
| | - Benjamin Blondel
- Unité de Chirurgie Rachidienne, CHU Timone, Aix-Marseille Université, Marseille, France
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Zhu C, Wang LN, Chen TY, Mao LL, Yang X, Feng GJ, Liu LM, Song YM. Sequential sagittal alignment changes in the cervical spine after occipitocervical fusion. World J Clin Cases 2022; 10:1172-1181. [PMID: 35211550 PMCID: PMC8855180 DOI: 10.12998/wjcc.v10.i4.1172] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/06/2021] [Revised: 11/13/2021] [Accepted: 12/31/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND There are few studies regarding sequential changes in the sagittal alignment of the upper and lower cervical regions of the spine after occipitocervical fusion (OCF). In addition, no comparisons of cervical sagittal alignment (CSA) between patients with craniocervical junction disorders (CJDs) and normal populations have been reported.
AIM To compare the CSA of patients with CJDs with that of normal controls and investigate the sequential changes in the CSA of the upper and lower cervical spine after OCF.
METHODS Eighty-four patients who underwent OCF (OCF group) and 42 asymptomatic volunteers (control group) were included. Radiographic parameters, including the occipital to C2 angle (O-C2a), occipital and external acoustic meatus to axis angle (O-EAa), C2–7 angle (C2-7a), and pharyngeal inlet angle (PIA), were measured and compared pre- and postoperatively. The correlations among the parameters were analyzed using Pearson’s correlation test.
RESULTS The O-C2a and PIA of the OCF group were smaller than those of the control group, while their O-EAa and C2-7a values were larger than those of the normal controls. There were no significant differences in O-C2a, C2-7a, or PIA in the OCF group at baseline, 1 mo, or the final follow-up after surgery. The Pearson’s correlation results showed that there were significant correlations between the O-C2a and C2Ta, C2-7a, C2-7 sagittal vertical axis (SVA), and PIA at 1 mo after OCF surgery and between O-C2a and O-EAa, C2Ta, C2-7a, C2-7 SVA, and PIA at the final follow-up.
CONCLUSION Patients with CJDs have a more kyphotic upper CSA and a more lordotic lower CSA than normal controls. The effectiveness of OCF surgery in restoring CSA may be limited by the realignment of the craniocervical junction being neglected. The reduction in O-C2a after OCF surgery may increase C2-7a and decrease PIA.
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Affiliation(s)
- Ce Zhu
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Lin-Nan Wang
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Tai-Yong Chen
- Department of Orthopedics Surgery, The Second Affiliated Hospital of Zunyi Medical University, Zunyi 563000, Guizhou Province, China
| | - Li-Li Mao
- Department of Ultrasound, Hospital of Traditional Chinese Medicine Affiliated to Southwest Medical University, Luzhou 646000, Sichuan Province, China
| | - Xi Yang
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Gan-Jun Feng
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Li-Min Liu
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
| | - Yue-Ming Song
- Department of Orthopedics Surgery and Orthopedics Research Institute, West China Hospital of Sichuan University, Chengdu 610041, Sichuan Province, China
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Chen T, Yang X, Xiu P, Song Y. [Relationship between O-EA angle and lower cervical curvature in patients with anterior atlantoaxial dislocation before and after occipitocervical fusion]. ZHONGGUO XIU FU CHONG JIAN WAI KE ZA ZHI = ZHONGGUO XIUFU CHONGJIAN WAIKE ZAZHI = CHINESE JOURNAL OF REPARATIVE AND RECONSTRUCTIVE SURGERY 2021; 35:453-457. [PMID: 33855829 DOI: 10.7507/1002-1892.202011057] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Objective To investigate the relationship between O-EA angle and lower cervical curvature in patients with anterior atlantoaxial dislocation undergoing occipitocervical fusion, and to analyze the effect of O-EA angle on lower cervical curvature. Methods The clinical data of 61 patients with anterior atlantoaxial dislocation undergoing occipitocervical fusion who were admitted between April 2010 and July 2018 and met the selection criteria were retrospectively analyzed. There were 32 males and 29 females, with an age of 14-76 years (mean, 50.7 years). The fixed segment included 19 cases of C 0-C 2, 27 cases of C 0-C 3, 14 cases of C 0-C 4, and 1 case of C 0-C 5. The O-EA angle, C 2-7 Cobb angle, and T 1 tilt angle were measured before operation and at last follow-up. According to the O-EA angle measured at last follow-up, the patients were divided into <95° group (group A), 95°-105° group (group B), and >105° group (group C), and compared the differences of gender, age, fixed segment (short segment was at C 3 and above, long segment was beyond C 3), and C 2-7 Cobb angle. Correlation analysis between the O-EA angle and C 2-7 Cobb angle before operation and at last follow-up, as well as the changes of O-EA angle and C 2-7 Cobb angle between before operation and at last follow-up were analyzed. Results All 61 patients were followed up 12-24 months, with an average of 22.4 months. There was no significant difference in O-EA angle, C 2-7 Cobb angle, and T 1 tilt angle before operation and at last follow-up ( P>0.05). According to the last follow-up O-EA angle grouping, there were 14 cases in group A, 29 cases in group B, and 18 cases in group C. There was no significant difference in age, gender composition, and fixed segment composition among the three groups ( P>0.05); the differences in C 2-7 Cobb angles among the three groups were significant ( P<0.05), groups A, B, and C showed a gradually increasing trend. The O-EA angle was positively correlated with C 2-7 Cobb angle before operation and at last follow-up ( r=0.572, P=0.000; r=0.618, P=0.000); O-EA angle change at last follow-up was also positively correlated with C 2-7 Cobb change ( r=0.446, P=0.000). Conclusion The O-EA angle of patients with anterior atlantoaxial dislocation is positively correlated with C 2-7 Cobb angle. Too large O-EA angle should be avoided during occipitocervical fixation, otherwise it may accelerate the degeneration of the lower cervical spine.
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Affiliation(s)
- Taiyong Chen
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China.,Department of Orthopedics, the Second Affiliated Hospital of Zunyi Medical University, Zunyi Guizhou, 563006, P.R.China
| | - Xi Yang
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Peng Xiu
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
| | - Yueming Song
- Department of Orthopedics, West China Hospital, Sichuan University, Chengdu Sichuan, 610041, P.R.China
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Iqbal M, George KJ. Considerations in revising occipitocervical fixation for dysphagia. Surg Neurol Int 2021; 12:135. [PMID: 33880240 PMCID: PMC8053454 DOI: 10.25259/sni_43_2021] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Accepted: 03/18/2021] [Indexed: 11/05/2022] Open
Abstract
Background: Dysphagia after occipitocervical fixation (OCF) is a complex phenomenon and revision surgery in this context involves difficult decision-making. The pathogenesis is explored and surgical strategies discussed. A surgical strategy that has not been described before in the management of this condition, is discussed with two illustrative cases. Methods: Two cases are presented where dysphagia occurred after OCF for C1/C2 instability. The preoperative imaging was not available to determine whether the optimal craniocervical angle had been achieved. Both had revision surgery with removal of the cranial fixation and fusion to the atlas instead. One of the cases had the revision surgery more than 10 years after the original OCF. Results: The dysphagia recovered after the revision surgery in both cases. The patients gained weight and reported more satisfaction with their posture and head movements compared to before the revision surgery. There was no head ptosis and instead, patients reported better forward gaze and head position. Conclusion: In cases of C1/C2 instability, it is preferable to perform C1/C2 fusion rather than OCF. If performing an OCF, care must be taken to fix the head at the same O-C2 angle as preoperative. When an OCF done for C1 C2 instability ends up causing dysphagia, it is feasible and effective to shorten the rostral construct by removing the cranial fixation and fusing to C1 instead.
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Affiliation(s)
- Mazhar Iqbal
- Department of Neurosurgery, Salford Royal Hospital, Stott Lane, Salford, Manchester, M6 8HD, England, United Kingdom
| | - K Joshi George
- Department of Neurosurgery, Salford Royal Hospital, Stott Lane, Salford, Manchester, M6 8HD, England, United Kingdom
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Is it Suitable to Fix the Occipito-C2 Angle and the Posterior Occipitocervical Angle in a Normal Range During Occipitocervical Fusion? Clin Spine Surg 2020; 33:E342-E351. [PMID: 32205521 DOI: 10.1097/bsd.0000000000000981] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
STUDY DESIGN This is a retrospective study. OBJECTIVES The objective of this study was (1) to measure the occipito-C2 angle (OC2A) and the posterior occipitocervical angle (POCA) in a normal population, and (2) to observe the effects of OC2A and POCA selection on postoperative clinical efficacy and lower cervical curvature after occipitocervical fusion (OCF) in patients with basilar invagination (BI) and atlantoaxial fracture and dislocation (AAFD). SUMMARY OF BACKGROUND DATA OC2A has received special attention with respect to the clinical efficacy during OCF. However, none of studies have focused on the relationship between OC2A and POCA and have assessed their impact on clinical outcomes in patients with different occipiocervical diseases. MATERIALS AND METHODS One hundred fifty healthy subjects without any cervical disease (healthy group) were randomly selected based on sex and age. Three spine surgeons measured the OC2A and POCA in the healthy group and averaged the values. Forty-two patients with BI (BI group) and 32 patients with AAFD (AAFD group) who underwent OCF between January 2012 and January 2017 were reviewed. OC2A, POCA, and cervical spinal angle (CSA) were measured preoperatively, postoperatively immediately after surgery and ambulation, and at the final follow-up visit. The preoperative and final follow-up visual analog scale (VAS), Japanese Orthopaedic Association score (JOA), neck disability index (NDI), and the change of CSA from postoperatively immediately after surgery and ambulation to the final follow-up (dCSA) were recorded. RESULTS The values of OC2A and POCA were 14.5±3.7 and 108.2±8.1 degrees in the healthy group, respectively, and the respective 95% confidence intervals were 7.2-21.8 and 92.3-124.0 degrees as the normal range. There was a negative correlation between OC2A and POCA (r=-0.386, P<0.001). The preoperative value of OC2A (5.6±4.3 degrees) in BI group was smaller than that in the healthy group (P<0.05); however, the preoperative value of POCA (123.0±10.4 degrees) in the BI group was larger than that in the healthy group (P<0.05). There was no significantly different of OC2A and POCA between the healthy group and the AAFD group before the operation (P>0.05). The preoperative value of CSA (25.7±9.5 degrees) in the BI group was larger than that in the AAFD group (16.5±5.1 degrees) (P<0.05). In the BI group, 26 patients had ideal OC2A and POCA (both within 95% confidence interval of the healthy group) postoperatively immediately after surgery and ambulation as a subgroup of the ideal angle group. In the remaining patients with BI (nonideal angle group), VAS, JOA, and NDI at the final follow-up were significantly better than those in the ideal angle group (P<0.05). The ideal angle group showed statistically greater dCSA than the nonideal angle group of the BI group (P<0.05). On the contrary, in the AAFD group, the NDI in the ideal angle group (20 patients) was better than that in the nonideal angle group at the final follow-up, and the ideal angle group had a smaller dCSA compared with the nonideal angle group (P<0.05). CONCLUSIONS The biomechanical balance of occipitocervical region in patients with occipitocervical diseases with different pathogenesis is different. On the basis of the different types of occipitocervical diseases, an appropriate range of OC2A and POCA should be selected by the surgeon during OCF, which can further improve the clinical efficacy and reduce the loss of the lower cervical curvature after surgery.
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Tang C, Yang S, Liao YH, Tang Q, Ma F, Wang Q, Zhong DJ. A novel method for measurement of the occipital-cervical distance via the occiput-C4 distance. BMC Musculoskelet Disord 2020; 21:385. [PMID: 32539760 PMCID: PMC7296656 DOI: 10.1186/s12891-020-03398-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2020] [Accepted: 06/03/2020] [Indexed: 11/25/2022] Open
Abstract
Background The aim of the present study was to describe and measure the occipital-cervical distance by a novel method utilizing the occiput-C4 distance (OC4D) in normal subjects, as a proposed tool to guide restoration of vertical dislocations of the occipitocervical region in patients with basilar invaginations and for performing standardized testing of occipitocervical constructs. Methods We analyzed neutral, flexion, and extension lateral cervical spine radiographs of 150 asymptomatic subjects (73 males and 77 females) that were judged to be normal. The mean age of the included asymptomatic subjects was 48.0 ± 8.4 years old (range 20–69 years old; 48.4 ± 10.2 years old for males and 47.6 ± 6.4 years old for females). The OC4D was defined as the shortest distance from the center of the C4 vertebral body to the McGregor’s line. Occipitocervical distances (OCDs) were measured and analyzed its correlation with OC4Ds. Two spine surgeons each performed three measurements of the OC4D and OCD from each asymptomatic subject, from which our reported average values were derived. The height, weight, and body mass index (BMI) of each subject were recorded and analyzed for their correlations with the OC4D and OCD. Results The OC4Ds from neutral, flexion, and extension lateral cervical spine radiographs were 69.0 ± 6.9, 68.9 ± 6.8, and 68.1 ± 6.9 mm, respectively. There was no significant difference in the OC4D values among neutral, flexion, and extension lateral cervical spine radiographs (P > 0.05). The neutral, flexion, and extension OCDs were 23.0 ± 4.8, 27.6 ± 6.0, and 13.8 ± 4.7 mm, respectively. In particular, the neutral OCD was significantly different from those in flexion and extension lateral cervical spine radiographs (P < 0.001). There was no significant correlation between OC4D and OCD in neutral, flexion, and extension (P > 0.05 for all). There were positive correlations between OC4D and height, as well as OC4D and weight, in neutral, flexion, and extension lateral cervical spine radiographs (P < 0.001 for all). Furthermore, the intra-class correlation coefficients for inter- and intra-observer reliabilities of OC4Ds in neutral, flexion, and extension lateral cervical spine radiographs were significantly higher than those for OCDs (P < 0.001). Conclusions The OC4D represents a novel measurement for estimating the occipital-cervical distance that is not affected by changes in neutral, flexion, and extension positions. Hence, the OC4D may serve as a valuable parameter and intra-operative tool to guide vertical restoration during occipitocervical fusion (OCF) for patients with altered occiput-cervical anatomy.
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Affiliation(s)
- Chao Tang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China
| | - Sheng Yang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China
| | - Ye Hui Liao
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China
| | - Qiang Tang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China
| | - Fei Ma
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China
| | - Qing Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China
| | - De Jun Zhong
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, No. 25 Taiping Street, Luzhou City, 646000, China.
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Tang C, Li GZ, Liao YH, Tang Q, Ma F, Wang Q, Zhong DJ. Importance of the Occipitoaxial Angle and Posterior Occipitocervical Angle in Occipitocervical Fusion. Orthop Surg 2019; 11:1054-1063. [PMID: 31743954 PMCID: PMC6904633 DOI: 10.1111/os.12553] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2019] [Revised: 09/10/2019] [Accepted: 09/17/2019] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To observe the effects of occipitoaxial angle (O-C2 angle, OC2A) and posterior occipitocervical angle (POCA) selection on postoperative clinical efficacy and lower cervical curvature in patients with acute acquired atlantoaxial dislocation after occipitocervical fusion (OCF). METHODS A total of 150 healthy subjects without cervical disease (healthy group) were randomly selected based on gender and age. Three spine surgeons measured the OC2A and POCA of the healthy group and averaged the values. A total of 30 patients with an average age of 51.0 years (range, 18-70 years; 16 male and 14 female) with trauma or rheumatoid arthritis (disease group) who underwent occipitocervical fusion (OCF) for atlantoaxial dislocation between January 2012 and June 2016 were reviewed. OC2A, POCA, and cervical spinal angle (CSA) were measured postoperative/soon after surgery and ambulation, and at the final follow-up visit. The preoperative and final follow-up visual analog scale (VAS), Japanese orthopedics association score (JOA), neck disability index (NDI), and dCSA (change of CSA from postoperative/soon after surgery and ambulation to final follow-up) were recorded. RESULTS The values of OC2A and POCA in 150 healthy subjects were 14.5° ± 3.7° and 108.2° ± 8.1°, respectively, and the 95% confidence interval (CI) were 7.2°-21.8° and 92.3°-124.0°, respectively. There was a negative correlation between OC2A and POCA (r = -0.386, P < 0.001). There were 18 patients (group one) of ideal OC2A and POCA (both within 95% CI of the healthy group) postoperative/soon after surgery and ambulation with a mean follow-up time of 26.3 ± 20.9 months in disease group. The remaining patients (group two) with a mean follow-up time of 31.3 ± 21.3 months. There was no statistically significant difference in the baseline data as well as pre-operative outcomes, including VAS score, JOA score, and NDI between the two groups. Likewise, the post-operative outcomes in final follow-up, including VAS and JOA score, had no distinct difference in the two groups. However, NDI (11.0 ± 2.9) in group two at the final follow-up was significantly higher than that in group one (7.0 ± 2.3) (P < 0.001). And group two showed statistically greater dCSA (5.9 ± 7.5°) than group one (-2.3° ± 6.2°) (P = 0.003). CONCLUSIONS The negative correlation between OC2A and POCA plays an important role in maintaining the biodynamic balance of the occipital-cervical region. OC2A and POCA should be controlled of a normal population in patients with acute acquired atlantoaxial dislocation during OCF, which can further improve the clinical efficacy and prevent loss of lower cervical curvature after surgery.
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Affiliation(s)
- Chao Tang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Guang Zhou Li
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Ye Hui Liao
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qiang Tang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Fei Ma
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - Qing Wang
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
| | - De Jun Zhong
- Department of Spine Surgery, Affiliated Hospital of Southwest Medical University, Luzhou, China
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Compensatory Mechanisms for Kyphotic Change in the Cervical Spine According to Alignment Analysis of the Cases after Anterior Cervical Corpectomy and Fusion. World Neurosurg 2019; 133:e233-e240. [PMID: 31518735 DOI: 10.1016/j.wneu.2019.08.241] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 08/29/2019] [Indexed: 11/23/2022]
Abstract
BACKGROUND Compensatory mechanisms for cervical kyphosis are unclear. Few alignment analyses have targeted ongoing cervical kyphosis and detailed the effects of compensatory alignment changes. METHODS 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. RESULTS 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. CONCLUSIONS 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.
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Tang C, Li GZ, Kang M, Liao YH, Tang Q, Zhong DJ. Revision surgery after rod breakage in a patient with occipitocervical fusion: A case report. Medicine (Baltimore) 2018; 97:e0441. [PMID: 29642217 PMCID: PMC5908617 DOI: 10.1097/md.0000000000010441] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/03/2022] Open
Abstract
RATIONALE Rod breakage after occipitocervical fusion (OCF) has never been described in a patient who has undergone surgery for basilar invagination (BI) and atlantoaxial dislocation (AAD). Here, we present an unusual but significant case of revision surgery to correct this complication. PATIENT CONCERNS A 32-year-old female presented with neck pain, unstable leg motion in walking, and also BI with AAD. Her first surgery was planned to correct these conditions and for fusion at the occipital junction (C3-4) using a screw-rod system. At the 31-month follow-up after her first operation, the patient complained of severe neck pain and limitation of motion, suggesting rod breakage. DIAGNOSES Rod breakage after occipitocervical fusion for BI and AAD. INTERVENTIONS The patient underwent reoperation for replacement of the broken rods, adjustment of the occipitocervical angle, maintenance of the bone graft bed, and fusion. OUTCOMES At follow-up, the hardware was found to be in good condition, with no significant loss of cervical lordosis. At the 37-month follow-up after her second operation, the patient was doing better and continuing to recover. LESSONS We concluded that nonideal choice of occipitocervical angle may play an important role in rod breakage; however, an inadequate bone graft and poor postoperative fusion may also contribute to implant failure.
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Affiliation(s)
| | | | - Min Kang
- Department of Gastroenterology, Affiliated Hospital of Southwest Medical University, China
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12
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Lan S, Xu J, Wu Z, Xia H, Ma X, Zhang K, Ai F, Wang J, Yin Q, Yi H, Duan M. Atlantoaxial Joint Distraction for the Treatment of Basilar Invagination: Clinical Outcomes and Radiographic Evaluation. World Neurosurg 2017; 111:e135-e141. [PMID: 29248777 DOI: 10.1016/j.wneu.2017.12.013] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2017] [Revised: 12/01/2017] [Accepted: 12/04/2017] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To investigate the causes of partial remission in patients with basilar invagination (BI) and irreducible atlantoaxial dislocation (IAAD) treated with transoral atlantoaxial reduction plate (TARP) without odontoidectomy and quantify the distance of odontoid descent. METHODS Between August 2010 and July 2012, 22 consecutive patients with BI with IAAD who underwent TARP surgery were reviewed. The preoperative and postoperative radiographic parameters were evaluated. Follow-up data and the symptom treatment interval (STI), defined as the interval between the onset of symptoms and surgical treatment, were assessed. Neurological function was evaluated as neurologic improvement, defined as ([Postoperative Japanese Orthopedic Association (JOA) score] - [Preoperative JOA score])/(17 - [Preoperative JOA score]). The patients were assigned to group A (<50%) or group B (≥50%) based on their level of neurologic improvement. RESULTS All 22 patients improved clinically to varying degrees. The mean preoperative STI was 105.6 ± 67.6 months for group A and 45.3 ± 46.7 months for group B (P < 0.05). There were no significant between-group differences in follow-up (P > 0.05) or with respect to radiographic parameters (P > 0.05). Persistent brainstem compression was observed in 1 patient, whose symptoms were not adequately relieved after revision surgery (transoral odontoidectomy and posterior decompression and fusion). No fixation failure was observed. CONCLUSIONS Descent of the odontoid process is useful for treating basilar invagination. TARP surgery without odontoidectomy may pull the dens caudally and ventrally to achieve sufficient decompression of the spinal cord. Neurologic improvement may be associated with STI.
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Affiliation(s)
- Sibin Lan
- Southern Medical University, Guangzhou, People's Republic of China; Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China
| | - Junjie Xu
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China.
| | - Zenghui Wu
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Hong Xia
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Xiangyang Ma
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Kai Zhang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Fuzhi Ai
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Jianhua Wang
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Qingshui Yin
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Honglei Yi
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China; Institute of Traumatic Orthopedics of the People's Liberation Army, Guangzhou, People's Republic of China
| | - Mingyang Duan
- Department of Orthopedics, Guangzhou General Hospital of Guangzhou Military Command, Guangzhou, People's Republic of China
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An in vitro evaluation of sagittal alignment in the cervical spine after insertion of supraphysiologic lordotic implants. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 27:433-441. [PMID: 28501956 DOI: 10.1007/s00586-017-5110-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/06/2016] [Revised: 04/13/2017] [Accepted: 04/21/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE Cervical spine malalignment can develop as a consequence of degenerative disc disease or following spinal surgery. When normal sagittal alignment of the spine is disrupted, further degeneration may occur adjacent to the deformity. The purpose of this study was to investigate changes in lordosis and sagittal alignment in the cervical spine after insertion of supraphysiologic lordotic implants. METHODS Eight cadaveric cervical spines (Occiput-T1) were tested. The occiput was free to translate horizontally and vertically but constrained from angular rotation. The T1 vertebra was rigidly fixed with a T1 tilt of 23°. Implants with varying degrees of lordosis were inserted starting with single-level constructs (C5-C6), followed by two (C5-C7), and three-level (C4-C7) constructs. Changes in sagittal alignment, Occ-C2 angle, cervical lordosis (C2-7), and segmental lordosis were measured. RESULTS Increasing cage lordosis led to global increases in cervical lordosis. As implanted segmental lordosis increased, the axial levels compensated by decreasing in lordosis to maintain horizontal gaze. An increase in cage lordosis also corresponded with larger changes in SVA. CONCLUSION Reciprocal compensation was observed in the axial and sub-axial cervical spine, with the Occ-C2 segment undergoing the largest compensation. Adding more implant lordosis led to larger reciprocal changes and changes in SVA. Implants with supraphysiologic lordosis may allow for additional capabilities in correcting cervical sagittal plane deformity, following further clinical evaluation.
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Miyamoto H, Hashimoto K, Ikeda T, Akagi M. Effect of correction surgery for cervical kyphosis on compensatory mechanisms in overall spinopelvic sagittal alignment. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2017; 26:2380-2385. [PMID: 28451859 DOI: 10.1007/s00586-017-5106-7] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Accepted: 04/18/2017] [Indexed: 01/12/2023]
Abstract
PURPOSE Progression of kyphotic deformity at the middle/lower cervical spine can cause difficulty with horizontal gaze, so compensation at other spinopelvic parts may occur. However, the precise mechanism remains unclear. The present study investigated the effect of correction surgery for cervical kyphosis on the compensatory mechanisms in overall spinopelvic sagittal alignment. METHODS Forty-one patients, comprising 23 males and 18 females (mean age 67 years), underwent correction surgery for cervical kyphosis using the posterior screw-rod system. Spinopelvic lateral radiographs in the standing position were taken before and after surgery. C0-1 angle, C1-2 angle, clivo-axial angle (CAA), C2-7 angle, thoracic kyphosis, lumbar lordosis, pelvic incidence, pelvic tilt, and sacral slope were measured. Correlations between C2-7 angle and these parameters before surgery, and correlations between the correction angle of cervical kyphosis and postoperative changes of these parameters were evaluated. RESULTS Negative correlations were found between the C2-7 angle and CAA (R = -0.640, p < 0.01), and C2-7 angle and C0-1 angle (R = -0.762, p < 0.001) before surgery. Negative correlations were found between the correction angle of C2-7 and change of CAA (R = -0.718, p < 0.001), and between the correction angle of C2-7 and change of C0-1 angle (R = -0.672, p < 0.01) after surgery. CONCLUSIONS The present study demonstrated that C0-1 angle and CAA are more important in the compensatory mechanism for kyphotic deformity at the middle/lower cervical spine compared to downward parameters. That is, to maintain horizontal gaze, lordosis increases at the cranio-cervical junction with greater kyphosis at the middle/lower cervical spine. Correction of cervical kyphosis in the middle/lower cervical spine resulted in normalization of the C0-1 angle and CAA because the compensatory mechanism at the cranio-cervical junction for obtaining horizontal gaze was no longer necessary after surgical intervention.
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Affiliation(s)
- Hiroshi Miyamoto
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2, Ohnohigashi, Osaka-Sayama, Osaka, 589-8511, Japan.
| | - Kazuki Hashimoto
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2, Ohnohigashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Terumasa Ikeda
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2, Ohnohigashi, Osaka-Sayama, Osaka, 589-8511, Japan
| | - Masao Akagi
- Department of Orthopaedic Surgery, Kindai University Hospital, 377-2, Ohnohigashi, Osaka-Sayama, Osaka, 589-8511, Japan
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