Greater cervicothoracic flexibility may increase complications after cervical fusion
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Key takeaways:
- Cervicothoracic flexibility may be a predictor of ongoing pain after posterior cervical fusion.
- Results showed significant differences in pain and disability for each radiographic measurement technique.
Presented results showed patients undergoing posterior cervical fusion with greater cervicothoracic flexibility between X-ray and MRI/CT measurements had higher complication and revision rates.
“The take-home message is to be aware of two things: one is the increased risk that patients that have a high T1 slope have of having ongoing significant neck pain and failures but then, secondly, also recognizing that there is a significant subset of patients for whom that T1 slope varies quite a bit from when they are laying on their back vs. upright. So, preoperative upright imaging is critical,” Eeric Truumees, MD, professor of orthopedic and neurological surgery at the University of Texas, Dell Medical School, told Healio about results presented at the North American Spine Society Annual Meeting.
Among 227 patients who underwent a three or more levels of posterior cervical fusion, Truumees and colleagues retrospectively collected demographics; smoking status; radiographic measurements of T1 slope, C2-C7 lordosis and C2-C7 sagittal vertical axis from both X-ray films and correlated measures from MRI/CT scans; surgical complications; and patient-reported outcome measures for pain and disability. Researchers categorized patients into three groups for each measurement technique based on distribution of the delta between X-ray and MRI/CT values.
Results showed patients had a median delta T1 slope of 9°, with a delta T1 slope less than 4° in group 1, between 4° or more and less than 15° in group 2 and of 15° or more in group 3. Truumees and colleagues found a median delta value of 4° for delta C2-C7 lordosis and a median delta C2-C7 sagittal vertical axis of 14.37 mm. The delta lordosis was less than 2° in group 1, between 2° or more and less than 7° in group 2 and more than 7° in group 3, according to results. Results also showed a delta sagittal vertical axis of less than 7.87 mm in group 1, between 7.87 mm and more to less than 27.82 mm in group 2 and more than 27.82 mm in group 3.
Truumees and colleagues found group 1 and group 3 had significant differences in VAS and Oswestry Disability Index on each measurement technique, and increased delta measurement was positively correlated with revision and complication rates.
“We saw that, while these patients do fine with their spinal cord symptoms, [thoracic flexibility] was a major predictor for not only ongoing pain, like neck and upper thoracic pain, but also fixation problems, like having the level below the surgery break down or lowest level implant failures,” Truumees said.
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Truumees E, et al. Does cervicothoracic flexibility affect clinical outcomes in patients undergoing multilevel posterior cervical fusions? Presented at: North American Spine Society Annual Meeting; Sept. 23-28, 2024; Chicago.
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