The Impact of Standing Regional Cervical Sagittal Alignment on Outcomes in Posterior Cervical Fusion Surgery

TLDR

Positive sagittal malalignment of the spine has been linked to pain and disability in thoracolumbar fusion, underscoring the importance of sagittal alignment in spinal surgery. This study aimed to assess how regional cervical sagittal alignment affects postoperative outcomes in patients undergoing multilevel posterior cervical fusion. The authors measured five cervical radiographic parameters and health‑related quality‑of‑life scores in 113 patients and calculated Pearson correlations between them. They found that greater C2‑C7 sagittal vertical axis was associated with worse physical function and higher neck disability, with a threshold of ~40 mm beyond which the correlation was strongest, indicating that positive sagittal malalignment increases disability after cervical fusion.

Abstract

Positive spinal regional and global sagittal malalignment has been repeatedly shown to correlate with pain and disability in thoracolumbar fusion.To evaluate the relationship between regional cervical sagittal alignment and postoperative outcomes for patients receiving multilevel cervical posterior fusion.From 2006 to 2010, 113 patients received multilevel posterior cervical fusion for cervical stenosis, myelopathy, and kyphosis. Radiographic measurements made at intermediate follow-up included the following: (1) C1-C2 lordosis, (2) C2-C7 lordosis, (3) C2-C7 sagittal vertical axis (C2-C7 SVA; distance between C2 plumb line and C7), (4) center of gravity of head SVA (CGH-C7 SVA), and (5) C1-C7 SVA. Health-related quality-of-life measures included neck disability index (NDI), visual analog pain scale, and SF-36 physical component scores. Pearson product-moment correlation coefficients were calculated between pairs of radiographic measures and health-related quality-of-life scores.Both C2-C7 SVA and CGH-C7 SVA negatively correlated with SF-36 physical component scores (r = -0.43, P < .001 and r = -0.36, P = .005, respectively). C2-C7 SVA positively correlated with NDI scores (r = 0.20, P = .036). C2-C7 SVA positively correlated with C1-C2 lordosis (r = 0.33, P = .001). For significant correlations between C2-C7 SVA and NDI scores, regression models predicted a threshold C2-C7 SVA value of approximately 40 mm, beyond which correlations were most significant.Our findings demonstrate that, similar to the thoracolumbar spine, the severity of disability increases with positive sagittal malalignment following surgical reconstruction.