Anterior approach for complex cervical spondylotic myelopathy.

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Abstract

[Indexed for MEDLINE] 13. Spine (Phila Pa 1976). 2018 Feb 1;43(3):E154-E162. doi: 10.1097/BRS.0000000000002253. Global Spinal Alignment in Patients With Cervical Spondylotic Myelopathy. Yoshida G(1)(2), Alzakri A(1), Pointillart V(1), Boissiere L(1), Obeid I(1), Matsuyama Y(2), Vital JM(1), Gille O(1). Author information: (1)Spine Surgery Unit, Bordeaux University Hospital, Bordeaux, France. (2)Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Japan. STUDY DESIGN: A prospective radiographic analysis of cervical spondylotic myelopathy (CSM). OBJECTIVE: The aim of this study was to clarify the pathophysiology of CSM, and use the characteristic of global spinal alignment for determining the surgical strategy. SUMMARY OF BACKGROUND DATA: Radiographic evaluation of CSM, in general, comprises cervical magnetic resonance imaging (MRI) and regional cervical radiography, which cannot distinguish between cervical hyperlodorsis with spinopelvic compensation and cervical lordorsis with normal global alignment. METHODS: Our inclusion criteria were preoperative whole spine radiography and cervical MRI and health-related quality of life scores. Global spinal alignment was characterized by cervical lordosis (CL), C7 sagittal vertical axis (SVA), T1 slope (T1S), thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), pelvic tilt (PT), sacral slope (SS), and knee flexion angle (KFA). Cervical alignment was characterized by O-C2, C2-4, C5-7, and C2-7 angles; cranial center of gravity (CCG) C7SVA; and C2-7 SVA. Responsible lesion determined using MRI was divided from C2/3 to C7/T1. RESULTS: Eighty-eight surgically treated CSM patients with EOS full spine imaging were prospectively analyzed. There were 72 normal (Type 1; SVA