The association of cervical sagittal alignment with adjacent segment degeneration
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ORIGINAL ARTICLE
The association of cervical sagittal alignment with adjacent segment degeneration Xiaoyu Yang1 · Ronald H. M. A. Bartels2 · Roland Donk3 · Mark P. Arts4 · Caroline M. W. Goedmakers1 · Carmen L. A. Vleggeert‑Lankamp1 Received: 7 February 2019 / Revised: 5 September 2019 / Accepted: 16 September 2019 © The Author(s) 2019
Abstract Purpose Cervical spine surgery may affect sagittal alignment parameters and induce accelerated degeneration of the cervical spine. Cervical sagittal alignment parameters of surgical patients will be correlated with radiological adjacent segment degeneration (ASD) and with clinical outcome parameters. Methods Patients were analysed from two randomized, double-blinded trials comparing anterior cervical discectomy with arthroplasty (ACDA), with intervertebral cage (ACDF) and without intervertebral cage (ACD). C2–C7 lordosis, T1 slope, C2–C7 sagittal vertical axis (SVA) and the occipito-cervical angle (OCI) were determined as cervical sagittal alignment parameters. Radiological ASD was scored by the combination of decrease in disc height and anterior osteophyte formation. Neck disability index (NDI), SF-36 PCS and MCS were evaluated as clinical outcomes. Results The cervical sagittal alignment parameters were comparable between the three treatment groups, both at baseline and at 2-year follow-up. Irrespective of surgical method, C2–C7 lordosis was found to increase from 11° to 13°, but the other parameters remained stable during follow-up. Only the OCI was demonstrated to be associated with the presence and positive progression of radiological ASD, both at baseline and at 2-year follow-up. NDI, SF-36 PCS and MCS were demonstrated not to be correlated with cervical sagittal alignment. Likewise, a correlation with the value or change of the OCI was absent. Conclusion OCI, an important factor to maintain horizontal gaze, was demonstrated to be associated with radiological ASD, suggesting that the occipito-cervical angle influences accelerated cervical degeneration. Since OCI did not change after surgery, degeneration of the cervical spine may be predicted by the value of OCI. NECK trial Dutch Trial Register Number NTR1289. PROCON trial Trial Register Number ISRCTN41681847. Graphic abstract These slides can be retrieved under Electronic Supplementary Material.
Key points
Table 4: Cervical sagittal alignment parameters with the presence and progression of ASD ASD
1. The choice of the intervertebral device in anterior cervical discectomy surgery does not influence cervical sagittal alignment. 2. OCI was demonstrated to be a factor associated with radiological ASD.
Yang X, Bartels RHMA, Donk R, Arts MP, Goedmakers CMW, Vleggeert-Lankamp CLA (2019) The Association of Cervical Sagittal Alignment with Adjacent Segment Degeneration. Eur Spine J;
P value
ASD
Mild-ASD
P value
ASD posi ve
ASD nega ve
progression
progression
Lordosis
10.8±9.4
11.6±9.0
0.568
12.7±9.5
11.1±9.1
0.412
-
-
-
SVA
22.7±12.4
22.5±11.3
0.884
25.8±11.3
22.1±11.6
0.122
-
-
-
T1
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