Analysis of imaging characteristics and effectiveness of cervical spondylotic myelopathy with cervical kyphosis_Chinese Journal of Reparative and Reconstructive Surgery

Authors：

LU Haitao ,  YU Haiyang , ZHANG Wei , CHAI Zihao , GE Xiubo , ZHAO Rui , ZHANG Haoran , HU Xiaoming

Department of Orthopedics, Fuyang Hospital of Bengbu Medical University (Fuyang People’s Hospital), Spinal Deformity Clinical Medical Research Center of Anhui, Fuyang Anhui, 236000, P. R. China;

Corresponding author：

YU Haiyang, Email: fy.yhy@163.com

Keywords：

Cervical spondylotic myelopathy; cervical kyphosis; imaging characteristic; sagittal parameter

DOI：

10.7507/1002-1892.202402018

Video：

Export PDF Favorites Scan Get Citation

Abstract Full text Figures/Tables Video References Cited by

Objective To investigate the imaging characteristics of cervical kyphosis and spinal cord compression in cervical spondylotic myelopathy (CSM) with cervical kyphosis and the influence on effectiveness. Methods The clinical data of 36 patients with single-segment CSM with cervical kyphosis who were admitted between January 2020 and December 2022 and met the selection criteria were retrospectively analyzed. The patients were divided into 3 groups according to the positional relationship between the kyphosis focal on cervical spine X-ray film and the spinal cord compression point on MRI: the same group (group A, 20 cases, both points were in the same position), the adjacent group (group B, 10 cases, both points were located adjacent to each other), and the separated group (group C, 6 cases, both points were located >1 vertebra away from each other). There was no significant difference between groups (P>0.05) in baseline data such as gender, age, body mass index, lesion segment, disease duration, and preoperative C_2-7 angle, C_2-7 sagittal vertical axis (C_2-7 SVA), C₇ slope (C₇S), kyphotic Cobb angle, fusion segment height, and Japanese Orthopedic Association (JOA) score. The patients underwent single-segment anterior cervical discectomy with fusion (ACDF). The occurrence of postoperative complications was recorded; preoperatively and at last follow-up, the patients’ neurological function was evaluated using the JOA score, and the sagittal parameters (C_2-7 angle, C_2-7 SVA, C₇S, kyphotic Cobb angle, and height of the fused segments) were measured on cervical spine X-ray films and MRI and the correction rate of the cervical kyphosis was calculated; the correlation between changes in cervical sagittal parameters before and after operation and the JOA score improvement rate was analyzed using Pearson correlation analysis. Results In 36 patients, only 1 case of dysphagia occurred in group A, and the dysphagia symptoms disappeared at 3 days after operation, and the remaining patients had no surgery-related complications during the hospitalization. All patients were followed up 12-42 months, with a mean of 20.1 months; the difference in follow-up time between the groups was not significant (P>0.05). At last follow-up, all the imaging indicators and JOA scores of patients in the 3 groups were significantly improved when compared with preoperative ones (P<0.05). The correction rate of cervical kyphosis in group A was significantly better than that in group C, and the improvement rate of JOA score was significantly better than that in groups B and C, all showing significant differences (P<0.05), and there was no significant difference between the other groups (P>0.05). The correlation analysis showed that the improvement rate of JOA score was negatively correlated with C_2-7 angle and kyphotic Cobb angle at last follow-up (r=−0.424, P=0.010; r=−0.573, P<0.001), and positively correlated with the C₇S and correction rate of cervical kyphosis at last follow-up (r=0.336, P=0.045; r=0.587, P<0.001), and no correlation with the remaining indicators (P>0.05). Conclusion There are three main positional relationships between the cervical kyphosis focal and the spinal cord compression point on imaging, and they have different impacts on the effectiveness and sagittal parameters after ACDF, and those with the same position cervical kyphosis focal and spinal cord compression point have the best improvement in effectiveness and sagittal parameters.

Citation： LU Haitao, YU Haiyang, ZHANG Wei, CHAI Zihao, GE Xiubo, ZHAO Rui, ZHANG Haoran, HU Xiaoming. Analysis of imaging characteristics and effectiveness of cervical spondylotic myelopathy with cervical kyphosis. Chinese Journal of Reparative and Reconstructive Surgery, 2024, 38(5): 542-549. doi: 10.7507/1002-1892.202402018 Copy

1.	Ogura Y, Dimar JR, Djurasovic M, et al. Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg, 2021, 7(3): 422-433.
2.	Li XY, Wang Y, Zhu WG, et al. Cervical sagittal alignment changes following anterior cervical discectomy and fusion, laminectomy with fusion, and laminoplasty for multisegmental cervical spondylotic myelopathy. J Orthop Surg Res, 2023, 18(1): 190. doi: 10.1186/s13018-023-03640-9.
3.	Du W, Wang HX, Lv J, et al. Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy. Heliyon, 2023, 9(8): e19106. doi: 10.1016/j.heliyon.2023.e19106.
4.	Wang LF, Dong Z, Miao DC, et al. Risk factor analysis of axial symptoms after single-segment anterior cervical discectomy and fusion: A retrospective study of 113 patients. J Int Med Res, 2019, 47(12): 6100-6108.
5.	Wang XZ, Liu H, Li JQ, et al. Comparison of anterior cervical discectomy and fusion with cervical laminectomy and fusion in the treatment of 4-level cervical spondylotic myelopathy. Orthop Surg, 2022, 14(2): 229-237.
6.	Du W, Wang HX, Zhang JT, et al. Cervical alignment and clinical outcome of anterior decompression with fusion vs posterior decompression with fixation in kyphotic cervical spondylotic myelopathy. Front Neurosci, 2022, 16: 1029327. doi: 10.3389/fnins.2022.1029327.
7.	McCormick JR, Sama AJ, Schiller NC, et al. Cervical spondylotic myelopathy: A guide to diagnosis and management. J Am Board Fam Med, 2020, 33(2): 303-313.
8.	Zhong W, Wang L, Huang T, et al. Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy. J Orthop Surg Res, 2021, 16(1): 75. doi: 10.1186/s13018-021-02227-6.
9.	Wu B, Liu B, Sang D, et al. The association between cervical focal kyphosis and myelopathy severity in patients with cervical spondylotic myelopathy before surgery. Eur Spine J, 2021, 30(6): 1501-1508.
10.	Lim J, Lee D, Kim S, et al. Analysis of abnormal muscle activities in patients with loss of cervical lordosis: a cross-sectional study. BMC Musculoskelet Disord, 2023, 24(1): 666. doi: 10.1186/s12891-023-06782-3.
11.	Funaba M, Imajo Y, Suzuki H, et al. The deterioration of cervical kyphosis during neck flexion after laminoplasty affects the surgical outcome of cervical spondylotic myelopathy. Global Spine J, 2023, 13(8): 2497-2507.
12.	Abdelmalek G, Coban D, Patel N, et al. Are patients with segmental cervical kyphosis appropriate candidates for cervical disc arthroplasty (CDA)? A clinical and radiographic analysis compared to anterior cervical discectomy and fusion (ACDF). Global Spine J, 2024, 15: 21925682241232616. doi: 10.1177/21925682241232616.
13.	Kumarasamy S, Sawarkar DP, Singh PK, et al. Correction of pediatric cervical kyphosis: our experience and systematic-literature review. Spine Deform, 2024. doi: 10.1007/s43390-023-00809-4.
14.	Zhang KR, Yang Y, Liu H, et al. Is there any correlation between the recovery rate of JOA and the increasing of cervical spinal cord area after single-door cervical laminoplasty? Clin Neurol Neurosurg, 2022, 213: 107103. doi: 10.1016/j.clineuro.2021.107103.
15.	韩渤, 陈宇翔, 海涌, 等. 颈椎矢状位参数及其在常见脊柱疾病中应用的研究进展. 中华医学杂志, 2021, 101(41): 3438-3442.
16.	关晓明, 马迅, 冯皓宇, 等. 多节段脊髓型颈椎病伴后凸畸形不同入路方式的选择及疗效. 中国脊柱脊髓杂志, 2016, 26(6): 481-487.
17.	于留钱, 刘杰, 李坚, 等. 不同入路方式在多节段脊髓型颈椎病伴后凸畸形手术中的应用效果比较. 中国医刊, 2020, 55(2): 181-184.
18.	Rodrigues-Pinto R, Montenegro TS, Davies BM, et al. Optimizing the application of surgery for degenerative cervical myelopathy [AO spine RECODE-DCM research priority number 10]. Global Spine J, 2022, 12(1_suppl): 147S-158S.
19.	Waddell WH, Vaughan WE, Abtahi AM. Radiographic parameters in cervical myelopathy: Review of current literature. Clin Spine Surg, 2022, 35(10): 389-395.
20.	Waly FJ, Abduljabbar FH, Fortin M, et al. Preoperative computed tomography myelography parameters as predictors of outcome in patients with degenerative cervical myelopathy: Results of a systematic review. Global Spine J, 2017, 7(6): 521-528.
21.	Chavanne A, Pettigrew DB, Holtz JR, et al. Spinal cord intramedullary pressure in cervical kyphotic deformity: a cadaveric study. Spine (Phila Pa 1976), 2011, 36(20): 1619-1626.
22.	柴子豪, 杨晓露, 张伟, 等. 退变性颈椎后凸畸形的影像学特征及颈椎矢状位参数间的关系. 中国修复重建外科杂志, 2022, 36(11): 1413-1419.
23.	Acharya S, Khanna V, Chahal RS, et al. Clinicoradiological risk factors associated with inability to achieve minimum clinically important difference in operated cases of cervical spondylotic myelopathy. Asian Spine J, 2023, 17(5): 904-915.
24.	Xu C, Wang R, Li J, et al. Intervertebral-spreader-assisted anterior cervical discectomy and fusion prevents postoperative axial pain by alleviating facet joint pressure. J Orthop Surg Res, 2022, 17(1): 91. doi: 10.1186/s13018-022-02983-z.
25.	Koeppen D, Piepenbrock C, Kroppenstedt S, et al. The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis. PLoS One, 2017, 12(4): e0174527. doi: 10.1371/journal.pone.0174527.
26.	Chai Z, Yang X, Lu H, et al. Relationship between C₂ slope with sagittal parameters and clinical function of degenerative cervical kyphosis. J Orthop Surg Res, 2023, 18(1): 514. doi: 10.1186/s13018-023-04011-0.
27.	Virk S, Passias P, Lafage R, et al. Intraoperative alignment goals for distinctive sagittal morphotypes of severe cervical deformity to achieve optimal improvements in health-related quality of life measures. Spine J, 2020, 20(8): 1267-1275.
28.	Koeppen D, Stelling H, Goll M, et al. Comparison of sagittal vertical axis and decompression on the clinical outcome of cervical spondylotic myelopathy. Clin Neurol Neurosurg, 2022, 213: 107125. doi: 10.1016/j.clineuro.2022.107125.
29.	房昕, 吴恺, 刘品端, 等. C₇倾斜角与ACDF术后矢状位参数的关系研究. 颈腰痛杂志, 2021, 42(1): 126-128.
30.	苏启航, 陈涛, 张岩, 等. 单节段颈前路椎间盘切除植骨融合术后颈椎椎间高度和整体曲率的影像学变化. 同济大学学报 (医学版), 2020, 41(1): 100-106.
31.	Hou SB, Sun XZ, Liu FY, et al. Relationship of change in cervical curvature after laminectomy with lateral mass screw fixation to spinal cord shift and clinical efficacy. J Neurol Surg A Cent Eur Neurosurg, 2022, 83(2): 129-134.
32.	赵子豪, 段显亮, 李凡, 等. 颈椎前路大角度 (12°) 3D打印融合器在治疗颈椎退变性后凸畸形中的应用. 北华大学学报 (自然科学版), 2023, 24(6): 795-799.

1. Ogura Y, Dimar JR, Djurasovic M, et al. Etiology and treatment of cervical kyphosis: state of the art review-a narrative review. J Spine Surg, 2021, 7(3): 422-433.
2. Li XY, Wang Y, Zhu WG, et al. Cervical sagittal alignment changes following anterior cervical discectomy and fusion, laminectomy with fusion, and laminoplasty for multisegmental cervical spondylotic myelopathy. J Orthop Surg Res, 2023, 18(1): 190. doi: 10.1186/s13018-023-03640-9.
3. Du W, Wang HX, Lv J, et al. Cervical alignment and clinical outcome of anterior cervical discectomy and fusion vs anterior cervical corpectomy and fusion in local kyphotic cervical spondylotic myelopathy. Heliyon, 2023, 9(8): e19106. doi: 10.1016/j.heliyon.2023.e19106.
4. Wang LF, Dong Z, Miao DC, et al. Risk factor analysis of axial symptoms after single-segment anterior cervical discectomy and fusion: A retrospective study of 113 patients. J Int Med Res, 2019, 47(12): 6100-6108.
5. Wang XZ, Liu H, Li JQ, et al. Comparison of anterior cervical discectomy and fusion with cervical laminectomy and fusion in the treatment of 4-level cervical spondylotic myelopathy. Orthop Surg, 2022, 14(2): 229-237.
6. Du W, Wang HX, Zhang JT, et al. Cervical alignment and clinical outcome of anterior decompression with fusion vs posterior decompression with fixation in kyphotic cervical spondylotic myelopathy. Front Neurosci, 2022, 16: 1029327. doi: 10.3389/fnins.2022.1029327.
7. McCormick JR, Sama AJ, Schiller NC, et al. Cervical spondylotic myelopathy: A guide to diagnosis and management. J Am Board Fam Med, 2020, 33(2): 303-313.
8. Zhong W, Wang L, Huang T, et al. Risk factors for rapid progressive neurological deterioration in patients with cervical spondylotic myelopathy. J Orthop Surg Res, 2021, 16(1): 75. doi: 10.1186/s13018-021-02227-6.
9. Wu B, Liu B, Sang D, et al. The association between cervical focal kyphosis and myelopathy severity in patients with cervical spondylotic myelopathy before surgery. Eur Spine J, 2021, 30(6): 1501-1508.
10. Lim J, Lee D, Kim S, et al. Analysis of abnormal muscle activities in patients with loss of cervical lordosis: a cross-sectional study. BMC Musculoskelet Disord, 2023, 24(1): 666. doi: 10.1186/s12891-023-06782-3.
11. Funaba M, Imajo Y, Suzuki H, et al. The deterioration of cervical kyphosis during neck flexion after laminoplasty affects the surgical outcome of cervical spondylotic myelopathy. Global Spine J, 2023, 13(8): 2497-2507.
12. Abdelmalek G, Coban D, Patel N, et al. Are patients with segmental cervical kyphosis appropriate candidates for cervical disc arthroplasty (CDA)? A clinical and radiographic analysis compared to anterior cervical discectomy and fusion (ACDF). Global Spine J, 2024, 15: 21925682241232616. doi: 10.1177/21925682241232616.
13. Kumarasamy S, Sawarkar DP, Singh PK, et al. Correction of pediatric cervical kyphosis: our experience and systematic-literature review. Spine Deform, 2024. doi: 10.1007/s43390-023-00809-4.
14. Zhang KR, Yang Y, Liu H, et al. Is there any correlation between the recovery rate of JOA and the increasing of cervical spinal cord area after single-door cervical laminoplasty? Clin Neurol Neurosurg, 2022, 213: 107103. doi: 10.1016/j.clineuro.2021.107103.
15. 韩渤, 陈宇翔, 海涌, 等. 颈椎矢状位参数及其在常见脊柱疾病中应用的研究进展. 中华医学杂志, 2021, 101(41): 3438-3442.
16. 关晓明, 马迅, 冯皓宇, 等. 多节段脊髓型颈椎病伴后凸畸形不同入路方式的选择及疗效. 中国脊柱脊髓杂志, 2016, 26(6): 481-487.
17. 于留钱, 刘杰, 李坚, 等. 不同入路方式在多节段脊髓型颈椎病伴后凸畸形手术中的应用效果比较. 中国医刊, 2020, 55(2): 181-184.
18. Rodrigues-Pinto R, Montenegro TS, Davies BM, et al. Optimizing the application of surgery for degenerative cervical myelopathy [AO spine RECODE-DCM research priority number 10]. Global Spine J, 2022, 12(1_suppl): 147S-158S.
19. Waddell WH, Vaughan WE, Abtahi AM. Radiographic parameters in cervical myelopathy: Review of current literature. Clin Spine Surg, 2022, 35(10): 389-395.
20. Waly FJ, Abduljabbar FH, Fortin M, et al. Preoperative computed tomography myelography parameters as predictors of outcome in patients with degenerative cervical myelopathy: Results of a systematic review. Global Spine J, 2017, 7(6): 521-528.
21. Chavanne A, Pettigrew DB, Holtz JR, et al. Spinal cord intramedullary pressure in cervical kyphotic deformity: a cadaveric study. Spine (Phila Pa 1976), 2011, 36(20): 1619-1626.
22. 柴子豪, 杨晓露, 张伟, 等. 退变性颈椎后凸畸形的影像学特征及颈椎矢状位参数间的关系. 中国修复重建外科杂志, 2022, 36(11): 1413-1419.
23. Acharya S, Khanna V, Chahal RS, et al. Clinicoradiological risk factors associated with inability to achieve minimum clinically important difference in operated cases of cervical spondylotic myelopathy. Asian Spine J, 2023, 17(5): 904-915.
24. Xu C, Wang R, Li J, et al. Intervertebral-spreader-assisted anterior cervical discectomy and fusion prevents postoperative axial pain by alleviating facet joint pressure. J Orthop Surg Res, 2022, 17(1): 91. doi: 10.1186/s13018-022-02983-z.
25. Koeppen D, Piepenbrock C, Kroppenstedt S, et al. The influence of sagittal profile alteration and final lordosis on the clinical outcome of cervical spondylotic myelopathy. A Delta-Omega-analysis. PLoS One, 2017, 12(4): e0174527. doi: 10.1371/journal.pone.0174527.
26. Chai Z, Yang X, Lu H, et al. Relationship between C₂ slope with sagittal parameters and clinical function of degenerative cervical kyphosis. J Orthop Surg Res, 2023, 18(1): 514. doi: 10.1186/s13018-023-04011-0.
27. Virk S, Passias P, Lafage R, et al. Intraoperative alignment goals for distinctive sagittal morphotypes of severe cervical deformity to achieve optimal improvements in health-related quality of life measures. Spine J, 2020, 20(8): 1267-1275.
28. Koeppen D, Stelling H, Goll M, et al. Comparison of sagittal vertical axis and decompression on the clinical outcome of cervical spondylotic myelopathy. Clin Neurol Neurosurg, 2022, 213: 107125. doi: 10.1016/j.clineuro.2022.107125.
29. 房昕, 吴恺, 刘品端, 等. C₇倾斜角与ACDF术后矢状位参数的关系研究. 颈腰痛杂志, 2021, 42(1): 126-128.
30. 苏启航, 陈涛, 张岩, 等. 单节段颈前路椎间盘切除植骨融合术后颈椎椎间高度和整体曲率的影像学变化. 同济大学学报 (医学版), 2020, 41(1): 100-106.
31. Hou SB, Sun XZ, Liu FY, et al. Relationship of change in cervical curvature after laminectomy with lateral mass screw fixation to spinal cord shift and clinical efficacy. J Neurol Surg A Cent Eur Neurosurg, 2022, 83(2): 129-134.
32. 赵子豪, 段显亮, 李凡, 等. 颈椎前路大角度 (12°) 3D打印融合器在治疗颈椎退变性后凸畸形中的应用. 北华大学学报 (自然科学版), 2023, 24(6): 795-799.

Chinese Journal of Reparative and Reconstructive Surgery

Analysis of imaging characteristics and effectiveness of cervical spondylotic myelopathy with cervical kyphosis

Abstract Full text Figures/Tables Video References Cited by

Previous Article

Next Article

Format

Content