+ Site Statistics
+ Search Articles
+ PDF Full Text Service
How our service works
Request PDF Full Text
+ Follow Us
Follow on Facebook
Follow on Twitter
Follow on LinkedIn
+ Subscribe to Site Feeds
Most Shared
PDF Full Text
+ Translate
+ Recently Requested

Long-term follow-up of cervical radiographic sagittal spinal alignment after 1- and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy: a retrospective study



Long-term follow-up of cervical radiographic sagittal spinal alignment after 1- and 2-level cervical corpectomy for the treatment of spondylosis of the subaxial cervical spine causing radiculomyelopathy or myelopathy: a retrospective study



Journal of Neurosurgery. Spine 16(1): 2-7



Few data exist regarding long-term outcomes after cervical corpectomy for spondylotic cervical myelopathy and radiculomyelopathy. In this retrospective review, long-term radiographic outcomes are reported for 130 patients after 1- or 2-level cervical corpectomy for spondylotic myelopathy or radiculomyelopathy. Electronic medical records including clinical data and radiographic images during a 15-year period (1993-2008) were reviewed at the Cincinnati Department of Veterans Affairs Medical Center. All patients underwent radiographic follow-up for at least 12 months (range 12-156, mean 45 ± 39.3 months), as well as clinical follow-up performed by neurosurgery staff for a mean of 29.3 ± 39.6 months (range 4-156 months). Clinical parameters at surgery and last examination included the Chiles modified Japanese Orthopaedic Association (mJOA) Myelopathy Scale. Measurements included cervical spine sagittal alignment on lateral radiographs preoperatively and postoperatively, focal Cobb angles at operated levels, and C2-7 regional alignment. Statistical analysis included the Student t-test and chi-square test. Perioperative complications and additional surgery in the cervical spine were recorded. The mJOA scores improved from a mean of 11.91 ± 2.4 preoperatively to 14.9 ± 2.33 postoperatively. The mean sagittal lordosis of the C2-7 spine increased from -16.2° ± 9.2° preoperatively to -18.5° ± 11.9° at last follow-up. Focal Cobb angles averaged a slight kyphotic angulation of 4.1° ± 2.3° at latest radiographic follow-up; of note, 7 patients (5.4%), all who had cylindrical titanium mesh cages (CTMCs), showed severe kyphotic angulation (+8.4° ± 2.4°). Patients with preoperative myelopathy showed clinical improvement at follow-up. The fusion rate was 96.2%; 3 of the 5 patients with radiographic evidence of nonfusion were smokers. Patients with postoperative kyphosis had significantly more chronic neck pain (visual analog scale score >4 lasting more than 6 months) and visits related to pain (p <0.01). Those with CTMCs had higher rates of postoperative kyphosis, chronic neck pain, and visits related to pain, irrespective of the number of levels fused (p <001). At latest follow-up, although a kyphotic increase occurred in the focal cervical sagittal Cobb angles, lordosis increased in C2-7 sagittal Gore angles. Two patients (1.5%) underwent revision of the implanted graft and/or hardware, and 5 patients (3.8%) had another procedure for adjacent-level pathologies 1-9 years later (mean 4.4 ± 2.7 years). Long-term follow-up data in our veteran population support cervical corpectomy as an effective, long-lasting treatment for spondylotic myelopathy of the cervical spine. Use of CTMCs without end caps was associated with statistically significant increased postoperative kyphotic angulation and chronic pain. Despite an increase in focal kyphosis over time, regional cervical sagittal lordotic alignment had increased at the latest follow-up. Further investigation will include the association of chronic neck pain and postoperative kyphosis, and high fusion rates among a veteran population of heavy smokers.

Please choose payment method:






(PDF emailed within 0-6 h: $19.90)

Accession: 054165486

Download citation: RISBibTeXText

PMID: 22035103

DOI: 10.3171/2011.9.spine10430


Related references

Radiographic analysis of the correlation between ossification of the nuchal ligament and sagittal alignment and segmental stability of the cervical spine in patients with cervical spondylotic myelopathy. Acta Radiologica 60(2): 196-203, 2019

Relationships between sagittal alignment of the cervical spine and morphology of the spinal cord and clinical outcomes in patients with cervical spondylotic myelopathy treated with expansive laminoplasty. Journal of Spinal Disorders and Techniques 15(5): 391-397, 2002

Reduction in range of cervical motion on serial long-term follow-up in patients undergoing oblique corpectomy for cervical spondylotic myelopathy. European Spine Journal 22(7): 1509-1516, 2013

Preoperative cervical sagittal alignment parameters and their impacts on myelopathy in patients with cervical spondylotic myelopathy: a retrospective study. Peerj 5: E4027, 2017

The mid-term effects of Bryan cervical disc prosthesis on sagittal alignment of overall cervical spine and the functional spinal unit. Zhonghua Wai Ke Za Zhi 50(3): 243-246, 2012

Importance of Sagittal Alignment of the Cervical Spine in the Management of Degenerative Cervical Myelopathy. Neurosurgery Clinics of North America 29(1): 69-82, 2018

Comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy: sagittal alignment, cervical lordosis, graft collapse, and adjacent-level ossification. Spine Journal 10(3): 193-199, 2010

Anterior cervical corpectomy and fusion versus discectomy and fusion for the treatment of two-level cervical spondylotic myelopathy: analysis of sagittal balance and axial symptoms. International Orthopaedics 42(8): 1877-1882, 2018

Assessment of T1 Slope Minus Cervical Lordosis and C2-7 Sagittal Vertical Axis Criteria of a Cervical Spine Deformity Classification System Using Long-Term Follow-up Data After Multilevel Posterior Cervical Fusion Surgery. Operative Neurosurgery 16(1): 20-26, 2019

Studies on pathogenesis of cervical spondylotic myelopathy: sagittal diameter of the spinal canal and cerebrospinal fluid characteristics in cervical spondylosis. Folia Psychiatrica et Neurologica Japonica 28(1): 35-44, 1974

Radiographic comparison of anterior cervical fusion after two-level discectomy or single-level corpectomy for two-level cervical spondylotic myelopathy. Zhonghua Yi Xue Za Zhi 92(37): 2636-2640, 2012

Effects of a cervical disc prosthesis on maintaining sagittal alignment of the functional spinal unit and overall sagittal balance of the cervical spine. European Spine Journal 17(1): 20-29, 2008

Cervical myelopathy after low grade distortion of the cervical spine. Possible association with pre-existing spondylosis of the cervical spine. Der Unfallchirurg 118(4): 372-375, 2015

Longitudinal prospective long-term radiographic follow-up after treatment of single-level cervical disk disease with the Bryan Cervical Disc. Neurosurgery 67(3): 679-87; Discussion 687, 2010

Anterior corpectomy combined with cervical spine locking plate for treatment of multilevel cervical spondylotic myelopathy. Zhonghua Wai Ke Za Zhi 38(3): 182-4 11, 2000