THE EFFECT OF PREOPERATIVE CERVICAL SAGITTAL ALIGNMENT ON POSTOPERATIVE SURGICAL RESULTS IN PATIENTS TREATED BY ANTERIOR CERVICAL DISCECTOMY AND FUSION

Objective: Cervical degenerative disc diseases arise in some degenerative settings. These degenerative cervical changes may be a consequence of cervical sagittal malalignment. The aim of this study is to assess preoperative profile and postoperative changes in cervical sagittal profiles; and correlation between these changes and surgical outcomes in patients undergoing anterior cervical discectomy and fusion. Materials and Methods: Eighty consecutive men and women who underwent anterior cervical discectomy and fusion (ACDF) were enrolled in the study. Cervical alignment was classified into 4 types-lordotic, flat, sigmoid, and kyphotic. Lordosis angle was measured by the Cobb method. Segmental angle at the level of discectomy was measured. Preoperative, early postoperative, and the 1st and 3rd month visual analog scale results were recorded. Improvement of cervical sagittal alignment and visual analogue scale (VAS) changes were compared statistically. Results: The median preoperative VAS score was 7. This score decreased to 1 as a median immediately after operation. This change was statistically significant. Sagittal alignment changes in early postoperative period were not statistically significant despite the observation of improvement in some patients. However, after 1st and 3rd months, results showed significant improvements. Conclusion: ACDF is an effective treatment of cervical degenerative disc diseases (CDDD). Decompression is still the main issue of the degenerative cervical diseases. Sagittal alignment may be restored by using lordotic cages. Patients with F sagittal shape may tend to develop CDDD more than N sagittal profile. There is a correlation between clinical improvement and radiologic improvement.

Kaynakça

1. Aronson N, Bagan M, Filtzer DL. Results of using the Smith-Robinson approach for herniated and extruded cervical discs. Technical note. J Neurosurg 1970;32:721-2.

2. Bertalanffy H, Eggert HR. Complications of anterior cervical discectomy without fusion in 450 consecutive patients. Acta Neurochir (Wien) 1989;99:41-50.

3. Breig A. Adverse mechanical tension in the central nervous system: An analysis of cause and effect: Relief by functional neurosurgery: J Wiley 1978.

4. Cobb J. Outline for the study of scoliosis. Instr Course Lect 1948;5:261-75.

5. Erdin Ç, Er U, Tuncer C. Altering of cervical sagittal parameters after 1 or 2 levels of anterior cervical discectomy and fusion with lordotic cages. Short term results. JTSS 2018;28:169-74.

6. Gay RE. The curve of the cervical spine: variations and significanceManipulative Physiol Ther 1993:591-4.

7. Gore DR, Sepic SB, Gardner GM. Roentgenographic findings of the cervical spine in asymptomatic people. Spine 1986;11:521-4.

8. Guo GM, Li J, Diao QX, Zhu TH, Song ZX, Guo YY, et al. Cervical lordosis in asymptomatic individuals: a meta-analysis. J Orthop Surg Res. 2018;13:147-54.

9. Harrison DD, Janik TJ, Troyanovich SJ, Holland B. Comparisons of lordotic cervical spine curvatures to a theoretical ideal model of the static sagittal cervical spine. Spine 1996;21:667-75.

10. Lennon J, Shealy N, Cady RK, Matta W, Cox R, Simpson WF. Postural and respiratory modulation of autonomic function, pain, and health. Am J Pain Manag 1994;4:36-9.

11. Okada E, Matsumoto M, Ichihara D, Chiba C, Toyama Y, Fujiwara H, et al. Does the sagittal alignment of the cervical spine have an impact on disk degeneration? Minimum 10-year follow-up of asymptomatic volunteers. Eur Spine J 2009;18:1644–51.

12. Panjabi MM, Oda T, Crisco JJ, Dvorak J, Grob D. Posture affects motion coupling patterns of the upper cervical spine. J Orthop Res 1993;11:525-36.

13. Şimşek S, Er U, Yiğitkanlı K. Relation between cervical sagittal alignment and surgical outcome for laminectomy and posterior fusion operations. JTSS 2017;28:15-20.

14. Toyama Y, Hirabayashi H, Kamata M. Long-term clinical result of anterior interbody fusion for cervical spondylotic myelopathy [in Japanese]. East Jpn J Orthop Traumatol 1997:487-92.

15. Walmsley RP, Kimber P, Culham E. The effect of initial head position on active cervical axial rotation range of motion in two age populations. Spine 1996;21:2435-42.

16. Xu-hui Z, Jia-hu F, Lian-shun J, Zhi-yong C, Yong Z, Xiong-sheng C, et al. Clinical significance of cervical vertebral flexion and extension spatial alignment changes. Spine 2009;34:E21-E6.

Kaynak Göster