Role Of Spinopelvic Parameters In Postoperative Axial Symptoms Of Cervical Spondylotic Myelopathy And Improvement In Quality Of Life Of Degenerative Scoliosis

BackgroundIn recent years, more and more attention has been paid to the role of spinopelvic imaging parameters in the diagnosis and treatment of spinal diseases; the spinopelvic imaging parameters are important not only in the diagnosis and treatment of spinal deformity, but also gradually recognized that it is of great significance in the diagnosis and treatment of cervical spondylosis, lumbar disc herniation,spondylolisthesis, thoracolumbar compression fractures and other diseases. The spinopelvic parameters can be divided into the global and local parameters. The results showed that there was no significant correlation between the clinical symptoms, quality of life and the global coronal plane imbalance, and was closely related to the global sagittal balance. Studies have shown that global sagittal balance is the most important factor in improving the clinical outcome of adult spinal deformities. As the global spinal parameters, local spinal parameters are also important factors affecting the surgical complications and quality of life. Lumbar lordosis(LL) is the most important local parameter of postoperative pain and quality of life in patients with adult spinal deformity. Abnormalities of the spinopelvic parameters can cause spinal deformity, pain, dysfunction and surgical complications,what seriously affect the quality of life of patients; then restoration of the spinopelvic parameters is closely related to the treatment outcome. The ability of the spine surgeon to relate the spinopelvic parameters to the patient's symptoms, surgical complications and quality of life may be beneficial in the surgical decision-making and planning of spinal disease.Now, there is a partial understanding of the role of the spinopelvic parameters in spinal disease, but the role of the spinopelvic parameters in spinal disease is still at an initial stage of development, and there are still many blind areas in theory, such as which parameters involved in the surgical complications, changes of whichparameters significant effecting on improvement of quality of life with the most predictive significance.These questions require further research. Therefore, the present paper was designed to investigate the effects of local and global spinopelvic parameters on surgical complication and improvement in quality of life in patients with spinal diseases.Cervical spondylotic myelopathy (CSM) is one of the most frequently encountered disorders of the neurological system in the elderly population.Conventional single-door cervical laminoplasty (CL), designed by Hirabayashi in 1977, has been widely used for treating CSM. CL is simple and results in favorable outcomes. However, it has been modified because of complications such as postoperative axial symptoms (post-AS), laminar reclosure, reduced range .of neck motion and C5 palsy. Titanium miniplate fixation is a modified laminoplasty (ML).However, post-AS after ML is still a common and severe complication. The overall incidence of post-AS after the single-door cervical laminoplasty ranges from 29% to 73.3%. Although post-AS are not fatal, they are often severe enough to disturb normal daily activity and to become the chief postoperative complaint. The etiology of post-AS remains unclear. It is important to know which preoperative factors are the most predictive of the incidence of post-AS. A few researchers have attempted to characterize the relationship between post-AS and risk factors. However, these studies were only indirect and retrospective, or used univariate analysis. A retrospective report including only the ML group showed that some factors, such as cervical range of motion and facet joints destroyed, might be associated with post-AS.The major study limitation of this retrospective report was the lack of a control group,so it could not determine which surgical procedure was superior in reducing the incidence of post-AS. A prospective,comparative,multivariate analysis is needed to determine the most predictive preoperative factors for post-AS, mainly including preoperative cervical parameters?The main symptoms of adult degenerative scoliosis (ADS) include low back pain, leg pain and deformity, and the deformity associated with sagittal and coronal imbalance. ADS as a special type of adult scoliosis is one of the most challenging spinal deformity. Operative intervention for ADS is technically challenging and may be associated with greater risks of complications and inferior clinical outcomes, such as more body pain, severer to disturb normal daily living, and progressive junctional kyphosis. These complications disrupt the normal daily life of patients, seriously affecting the quality of life of patients. Now, It is recognized that the evaluation of the operative outcomes of adult spinal deformity not only includes the evaluation of imaging parameters, but also the evaluation of the quality of life of patients. A few studies have showed the relationship between some spinopelvic parameters and clinical symptoms in adult scoliosis, but these studies have only focused on relationship between preoperative spinopelvic parameters and preoperative symptoms,or relationship between postoperative spinopelvic parameters and postoperative symptoms. In addition, ADS needs to be distinguished from other types of adult scoliosis, because ADS is a spinal deformity caused by progressive degeneration of the structural elements of the spine,while adult scoliosis is a collective noun,including all types of spinal deformities after skeletal maturation. As far as we know,there is currently a lack of literature on the immediate changes in the spinopelvic parameters and the improvement of quality of life in adult degenerative scoliosis.And in the face of such patients, this correlation is useful for planning and predicting prognosis for spine surgeons.Therefore, the purpose of this study was to investigate the role of the spinopelvic parameters in postoperative axial symptoms of cervical spondylotic myelopathy and improvement in quality of life of degenerative scoliosis. This study is divided into two parts, part one was to study the role of preoperative cervical parameters in postoperative axial symptoms of cervical spondylotic myelopathy; part two was to study the correlation between the immediate changes of the spinopelvic parameters and the improvement of the quality of life of adult degenerative scoliosis.Part One Role Of Preoperative Radiographic Parameters In Affecting Postoperative Axial Symptoms After Single-Door Cervical Laminoplasty For Cervical Spondylotic MyelopathyObjectiveThe purpose of the present study was to elucidate the preoperative factors that influence pre-AS of CSM alone using multivariate analysis; to elucidate the preoperative factors (risk or protective) that influence post-AS after single-door cervical laminoplasty for CSM alone, by prospectively comparing the surgical procedures of CL and ML and using multivariate analysis.Material and MethodsA total of 102 patients with CSM who underwent single-door cervical laminoplasty between 2009 and 2015 were studied. According to operation date,patients were prospectively assigned to treatment with conventional laminoplasty(CL) or modified laminoplasty (ML). Preoperative clinical and radiological parameters were recorded. The incidence of post-AS with 2 procedures was compared prospectively. Multivariate analysis was used to determine the preoperative radiographic and clinical factors affecting pre-AS and post-AS. A11 of the data was analyzed by software SPSS 20.0, using multivariate analysis to determine the preoperative factors affecting pre-AS and post-AS.ResultsPreoperative cervical C2-7 Cobb angle (CCA) was significant radiographic factor against pre-AS (P=0.011, odds ratio=0.930). Patients with pre-AS had a lower preoperative CCA than patients without pre-AS (P=0.004). The other preoperative radiographic and clinical factors were not significantly associated with pre-AS. The incidence of post-AS after ML was significantly lower than after CL (P=0.010). ML and preoperative cervical C2-7 Cobb angle (CCA) were significant protective factors against post-AS (ML: P=0.011,odds ratio=0.302; CCA: P=0.042, odds ratio=0.947).Patients with post-AS had a lower preoperative CCA than patients without post-AS(P=0.043). The other preoperative radiographic and clinical factors were not significantly associated with post-AS.ConclusionThe results of this part suggest that preoperative CCA is a risk factor for pre-AS;choosing ML procedure or selecting patients with high preoperative CCA can reduce the incidence of post-AS after single-door cervical laminoplasty for CSM, and that the other preoperative radiographic and clinical parameters are less critical.Part Two Correlation Analysis Between Immediate Changes In spinopelvic Parameters And Improvement In Quality Of Life In Adult Degenerative Scoliosis undergoing Corrective SurgeryObjectiveIn adult degenerative scoliosis (ADS), to compare the differences of the spinopelvic parameters and quality of life before and after operation; Univariate and multivariate linear regression analysis were used to assess the relationship between immediate changes in the spinopelvic parameters and improvement in quality of life after corrective surgery.Material and MethodsWe conducted a retrospective review of a single-center database of collecting patients with ADS undergoing corrective surgery. Spinopelvic parameters were coronal spinal parameters, sagittal spinal parameters and pelvic parameters including Cobb angle, coronal vertical axis (CVA), sagittal vertical axis (SVA), lumbar lordosis(LL), thoracic kyphosis (TK), pelvic tilt (PT) and sacral slope (SS). Quality of life scores were evaluated using two self-reported questionnaires on Oswestry Disability Index (ODI) and visual analogue scale (VAS). The immediate changes in spinopelvic parameters and improvement in quality of life were defined, respectively. Paired t-tests and linear regressions were performed to analyze.ResultsFifty-two patients were finally included for analysis. Significant differences were seen between preoperative and postoperative parameters,but not for CVA. Only ASVA and ALL were independent predictors of improvement in quality of life.Univariate analysis showed a significant correlation between ATK and improvement in quality of life, but multivariate analysis did not get a significant result. The changes in the other parameters were not significantly associated with improvement in quality of life.ConclusionsTo improve quality of life of ADS, reduction of SVA and increase of LL are the critical goals for corrective surgery. Immediate change in TK is a confounding factor for predicting improvement in quality of life, while the changes in coronal spinal and pelvic parameters are less critical predictors.