A Comparison of Three Different Positioning Techniques on Surgical Corrections and Postoperative Alignment in Cervical Spinal Deformity (CD) Surgery.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
01 May 2021
01 May 2021
Historique:
pubmed:
9
12
2020
medline:
9
6
2021
entrez:
8
12
2020
Statut:
ppublish
Résumé
Retrospective review of a prospective multicenter cervical deformity database. To examine the differences in sagittal alignment correction between three positioning methods in cervical spinal deformity surgery (CD). Surgical correction for CD is technically demanding and various techniques are utilized to achieve sagittal alignment objectives. The effect of different patient positioning techniques on sagittal alignment correction following CD remains unknown. Patients with sagittal deformity who underwent a posterior approach (with and without anterior approach) with an upper instrumented vertebra of C6 or above. Patients with Grade 5, 6, or 7 osteotomies were excluded. Positioning groups were Mayfield skull clamp, bivector traction, and halo ring. Preoperative lower surgical sagittal curve (C2-C7), C2-C7 sagittal vertical axis (cSVA), cervical scoliosis, T1 slope minus cervical lordosis (TS-CL), T1 slope (T1S), chin-brow vertebral angle (CBVA), C2-T3 curve, and C2-T3 SVA was assessed and compared with postoperative radiographs. Segmental changes were analyzed using the Fergusson method. Eighty patients (58% female) with a mean age of 60.6 ± 10.5 years (range, 31-83) were included. The mean postoperative C2-C7 lordosis was 7.8° ± 14 and C2-C7 SVA was 34.1 mm ± 15. There were overall significant changes in cervical alignment across the entire cohort, with improvements in T1 slope (P < 0.001), C2-C7 (P < 0.001), TS-CL (P < 0.001), and cSVA (P = 0.006). There were no differences postoperatively of any radiographic parameter between positioning groups (P > 0.05). The majority of segmental lordotic correction was achieved at C4-5-6 (mean 6.9° ± 11). Additionally, patients who had bivector traction applied had had significantly more segmental correction at C7-T1-T2 compared with Mayfield and halo traction (4.2° vs. 0.3° vs. -1.7° respectively, P < 0.027). Postoperative cervical sagittal correction or alignment was not affected by patient position. The majority of segmental correction occurred at C4-5-6 across all positioning methods, while bivector traction had the largest corrective ability at the cervicothoracic junction.Level of Evidence: 4.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective review of a prospective multicenter cervical deformity database.
OBJECTIVE
OBJECTIVE
To examine the differences in sagittal alignment correction between three positioning methods in cervical spinal deformity surgery (CD).
SUMMARY OF BACKGROUND DATA
BACKGROUND
Surgical correction for CD is technically demanding and various techniques are utilized to achieve sagittal alignment objectives. The effect of different patient positioning techniques on sagittal alignment correction following CD remains unknown.
METHODS
METHODS
Patients with sagittal deformity who underwent a posterior approach (with and without anterior approach) with an upper instrumented vertebra of C6 or above. Patients with Grade 5, 6, or 7 osteotomies were excluded. Positioning groups were Mayfield skull clamp, bivector traction, and halo ring. Preoperative lower surgical sagittal curve (C2-C7), C2-C7 sagittal vertical axis (cSVA), cervical scoliosis, T1 slope minus cervical lordosis (TS-CL), T1 slope (T1S), chin-brow vertebral angle (CBVA), C2-T3 curve, and C2-T3 SVA was assessed and compared with postoperative radiographs. Segmental changes were analyzed using the Fergusson method.
RESULTS
RESULTS
Eighty patients (58% female) with a mean age of 60.6 ± 10.5 years (range, 31-83) were included. The mean postoperative C2-C7 lordosis was 7.8° ± 14 and C2-C7 SVA was 34.1 mm ± 15. There were overall significant changes in cervical alignment across the entire cohort, with improvements in T1 slope (P < 0.001), C2-C7 (P < 0.001), TS-CL (P < 0.001), and cSVA (P = 0.006). There were no differences postoperatively of any radiographic parameter between positioning groups (P > 0.05). The majority of segmental lordotic correction was achieved at C4-5-6 (mean 6.9° ± 11). Additionally, patients who had bivector traction applied had had significantly more segmental correction at C7-T1-T2 compared with Mayfield and halo traction (4.2° vs. 0.3° vs. -1.7° respectively, P < 0.027).
CONCLUSION
CONCLUSIONS
Postoperative cervical sagittal correction or alignment was not affected by patient position. The majority of segmental correction occurred at C4-5-6 across all positioning methods, while bivector traction had the largest corrective ability at the cervicothoracic junction.Level of Evidence: 4.
Identifiants
pubmed: 33290369
pii: 00007632-202105010-00004
doi: 10.1097/BRS.0000000000003851
doi:
Types de publication
Comparative Study
Journal Article
Multicenter Study
Langues
eng
Sous-ensembles de citation
IM
Pagination
567-570Informations de copyright
Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.
Références
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Stokes IA, Aronson DD, Ronchetti PJ, et al. Reexamination of the Cobb and Ferguson angles: bigger is not always better. J Spinal Disord 1993; 6:333–338.
Callahan RA, Brown MD. Positioning techniques in spinal surgery. Clin Orthop Relat Res 1981; 22–26.
Cho SK, Safir S, Lombardi JM, et al. Cervical spine deformity: indications, considerations, and surgical outcomes. J Am Acad Orthop Surg 2019; 27:e555–e567.
Karikari IO, Bumpass DB, Gum J, et al. Use of bivector traction for stabilization of the head and maintenance of optimal cervical alignment in posterior cervical fusions. Glob Spine J 2017; 7:227–229.
Manabe N, Shimizu T, Tanouchi T, et al. A novel skull clamp positioning system and technique for posterior cervical surgery: clinical impact on cervical sagittal alignment. Medicine (Baltimore) 2015; 94:e695.