What is a Right Distal Fusion Level for Prevention of Sagittal Imbalance in Multilevel Posterior Cervical Spine Surgery: C7 or T1?

Seung Jin Choi, Kyung Soo Suk, Jae Ho Yang, Hak Sun Kim, Hwan Mo Lee, Seong Hwan Moon, Byung Ho Lee, Sang Jun Park

Research output: Contribution to journalArticle

Abstract

Study Design: This was a retrospective cohort study. Objective: To evaluate the sagittal alignment and T1 slope after multilevel posterior cervical fusion surgery depending on the distal fusion level; C7 or T1, and find out the appropriate distal fusion level. Summary of Background Data: The sagittal balance of the cervical spine is known to be affected by cervical lordosis and T1 slope. However, T1 slope is not a constant parameter that can be frequently changed after the surgery. Furthermore, useful studies to help guide surgeons in decision-making as to the most appropriate distal level of fusion for cervical sagittal balance are very limited. Materials and Methods: From 2014 to 2015, 50 patients who underwent multilevel posterior cervical fusion surgery were evaluated and followed up for >2 years. Group 1 was composed of 29 patients whose distal fusion level was C7. Group 2 was composed of 21 patients whose distal fusion level was T1. C1-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1 slope were measured on preoperative and the last follow-up. Results: In group 1, C2-C7 SVA (23.1?30.4 mm, P= 0.043) was worsened, and T1 slope (22.3?32.9 degrees, P= 0.001) was increased after the surgery. In group 2, no significant change occurred in C2-C7 SVA after the surgery (25.3 ?23.6 mm, P=0.648). The last follow-up T1 slope was similar with preoperative T1 slope (22.7?21.8 degrees, P=0.04) in group 2. Conclusions: This study showed that sagittal alignment became worse after the multilevel posterior cervical surgery when distal fusion level was stopped at C7, which was associated with increase of T1 slope. However, when we extended the distal fusion level to T1, T1 slope was not changed after the surgery. Therefore, sagittal alignment was maintained after the surgery. On the basis of the results of this study, we recommend distal fusion extends to T1. Level of Evidence: Level III.

Original languageEnglish
Pages (from-to)441-445
Number of pages5
JournalClinical Spine Surgery
Volume31
Issue number10
DOIs
Publication statusPublished - 2018 Dec 1

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Spine
Lordosis
Decision Making
Cohort Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Choi, Seung Jin ; Suk, Kyung Soo ; Yang, Jae Ho ; Kim, Hak Sun ; Lee, Hwan Mo ; Moon, Seong Hwan ; Lee, Byung Ho ; Park, Sang Jun. / What is a Right Distal Fusion Level for Prevention of Sagittal Imbalance in Multilevel Posterior Cervical Spine Surgery : C7 or T1?. In: Clinical Spine Surgery. 2018 ; Vol. 31, No. 10. pp. 441-445.
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title = "What is a Right Distal Fusion Level for Prevention of Sagittal Imbalance in Multilevel Posterior Cervical Spine Surgery: C7 or T1?",
abstract = "Study Design: This was a retrospective cohort study. Objective: To evaluate the sagittal alignment and T1 slope after multilevel posterior cervical fusion surgery depending on the distal fusion level; C7 or T1, and find out the appropriate distal fusion level. Summary of Background Data: The sagittal balance of the cervical spine is known to be affected by cervical lordosis and T1 slope. However, T1 slope is not a constant parameter that can be frequently changed after the surgery. Furthermore, useful studies to help guide surgeons in decision-making as to the most appropriate distal level of fusion for cervical sagittal balance are very limited. Materials and Methods: From 2014 to 2015, 50 patients who underwent multilevel posterior cervical fusion surgery were evaluated and followed up for >2 years. Group 1 was composed of 29 patients whose distal fusion level was C7. Group 2 was composed of 21 patients whose distal fusion level was T1. C1-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1 slope were measured on preoperative and the last follow-up. Results: In group 1, C2-C7 SVA (23.1?30.4 mm, P= 0.043) was worsened, and T1 slope (22.3?32.9 degrees, P= 0.001) was increased after the surgery. In group 2, no significant change occurred in C2-C7 SVA after the surgery (25.3 ?23.6 mm, P=0.648). The last follow-up T1 slope was similar with preoperative T1 slope (22.7?21.8 degrees, P=0.04) in group 2. Conclusions: This study showed that sagittal alignment became worse after the multilevel posterior cervical surgery when distal fusion level was stopped at C7, which was associated with increase of T1 slope. However, when we extended the distal fusion level to T1, T1 slope was not changed after the surgery. Therefore, sagittal alignment was maintained after the surgery. On the basis of the results of this study, we recommend distal fusion extends to T1. Level of Evidence: Level III.",
author = "Choi, {Seung Jin} and Suk, {Kyung Soo} and Yang, {Jae Ho} and Kim, {Hak Sun} and Lee, {Hwan Mo} and Moon, {Seong Hwan} and Lee, {Byung Ho} and Park, {Sang Jun}",
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What is a Right Distal Fusion Level for Prevention of Sagittal Imbalance in Multilevel Posterior Cervical Spine Surgery : C7 or T1? / Choi, Seung Jin; Suk, Kyung Soo; Yang, Jae Ho; Kim, Hak Sun; Lee, Hwan Mo; Moon, Seong Hwan; Lee, Byung Ho; Park, Sang Jun.

In: Clinical Spine Surgery, Vol. 31, No. 10, 01.12.2018, p. 441-445.

Research output: Contribution to journalArticle

TY - JOUR

T1 - What is a Right Distal Fusion Level for Prevention of Sagittal Imbalance in Multilevel Posterior Cervical Spine Surgery

T2 - C7 or T1?

AU - Choi, Seung Jin

AU - Suk, Kyung Soo

AU - Yang, Jae Ho

AU - Kim, Hak Sun

AU - Lee, Hwan Mo

AU - Moon, Seong Hwan

AU - Lee, Byung Ho

AU - Park, Sang Jun

PY - 2018/12/1

Y1 - 2018/12/1

N2 - Study Design: This was a retrospective cohort study. Objective: To evaluate the sagittal alignment and T1 slope after multilevel posterior cervical fusion surgery depending on the distal fusion level; C7 or T1, and find out the appropriate distal fusion level. Summary of Background Data: The sagittal balance of the cervical spine is known to be affected by cervical lordosis and T1 slope. However, T1 slope is not a constant parameter that can be frequently changed after the surgery. Furthermore, useful studies to help guide surgeons in decision-making as to the most appropriate distal level of fusion for cervical sagittal balance are very limited. Materials and Methods: From 2014 to 2015, 50 patients who underwent multilevel posterior cervical fusion surgery were evaluated and followed up for >2 years. Group 1 was composed of 29 patients whose distal fusion level was C7. Group 2 was composed of 21 patients whose distal fusion level was T1. C1-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1 slope were measured on preoperative and the last follow-up. Results: In group 1, C2-C7 SVA (23.1?30.4 mm, P= 0.043) was worsened, and T1 slope (22.3?32.9 degrees, P= 0.001) was increased after the surgery. In group 2, no significant change occurred in C2-C7 SVA after the surgery (25.3 ?23.6 mm, P=0.648). The last follow-up T1 slope was similar with preoperative T1 slope (22.7?21.8 degrees, P=0.04) in group 2. Conclusions: This study showed that sagittal alignment became worse after the multilevel posterior cervical surgery when distal fusion level was stopped at C7, which was associated with increase of T1 slope. However, when we extended the distal fusion level to T1, T1 slope was not changed after the surgery. Therefore, sagittal alignment was maintained after the surgery. On the basis of the results of this study, we recommend distal fusion extends to T1. Level of Evidence: Level III.

AB - Study Design: This was a retrospective cohort study. Objective: To evaluate the sagittal alignment and T1 slope after multilevel posterior cervical fusion surgery depending on the distal fusion level; C7 or T1, and find out the appropriate distal fusion level. Summary of Background Data: The sagittal balance of the cervical spine is known to be affected by cervical lordosis and T1 slope. However, T1 slope is not a constant parameter that can be frequently changed after the surgery. Furthermore, useful studies to help guide surgeons in decision-making as to the most appropriate distal level of fusion for cervical sagittal balance are very limited. Materials and Methods: From 2014 to 2015, 50 patients who underwent multilevel posterior cervical fusion surgery were evaluated and followed up for >2 years. Group 1 was composed of 29 patients whose distal fusion level was C7. Group 2 was composed of 21 patients whose distal fusion level was T1. C1-C2 lordosis, C2-C7 lordosis, C2-C7 sagittal vertical axis (SVA), and T1 slope were measured on preoperative and the last follow-up. Results: In group 1, C2-C7 SVA (23.1?30.4 mm, P= 0.043) was worsened, and T1 slope (22.3?32.9 degrees, P= 0.001) was increased after the surgery. In group 2, no significant change occurred in C2-C7 SVA after the surgery (25.3 ?23.6 mm, P=0.648). The last follow-up T1 slope was similar with preoperative T1 slope (22.7?21.8 degrees, P=0.04) in group 2. Conclusions: This study showed that sagittal alignment became worse after the multilevel posterior cervical surgery when distal fusion level was stopped at C7, which was associated with increase of T1 slope. However, when we extended the distal fusion level to T1, T1 slope was not changed after the surgery. Therefore, sagittal alignment was maintained after the surgery. On the basis of the results of this study, we recommend distal fusion extends to T1. Level of Evidence: Level III.

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