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A Lower T1 Slope as a Predictor of Subsidence in Anterior Cervical Discectomy and Fusion with Stand-Alone Cages.

Abstract：

OBJECTIVE:Preoperative parameters including the T1 slope (T1S) and C2-C7 sagittal vertical axis (SVA) have been recognized as predictors of kyphosis after laminoplasty, which is accompanied by posterior neck muscle damage. The importance of preoperative parameters has been under-estimated in anterior cervical discectomy and fusion (ACDF) because there is no posterior neck muscle damage. We aimed to determine whether postoperative subsidence and pseudarthrosis could be predicted according to specific parameters on preoperative plain radiographs. METHODS:We retrospectively analyzed 41 consecutive patients (male: female, 22: 19; mean age, 51.15±9.25 years) who underwent ACDF with a stand-alone polyether-ether-ketone (PEEK) cage (>1 year follow-up). Parameters including SVA, T1S, segmental angle and range of motion (ROM), C2-C7 cervical angle and ROM, and segmental inter-spinous distance were measured on preoperative plain radiographs. Risk factors of subsidence and pseudarthrosis were determined using multivariate logistic regression. RESULTS:Fifty-five segments (27 single-segment and 14 two-segment fusions) were included. The subsidence and pseudarthrosis rates based on the number of segments were 36.4% and 29.1%, respectively. Demographic data and fusion level were unrelated to subsidence. A greater T1S was associated with a lower risk of subsidence (p=0.017, odds ratio=0.206). A cutoff value of T1S<28° significantly predicted subsidence (sensitivity: 70%, specificity: 68.6%). There were no preoperative predictors of pseudarthrosis except old age. CONCLUSION:A lower T1S (T1S<28°) could be a risk factor of subsidence following ACDF. Surgeons need to be aware of this risk factor and should consider various supportive procedures to reduce the subsidence rates for such cases.

journal_name

J Korean Neurosurg Soc

journal_title

Journal of Korean Neurosurgical Society

authors

Lee SH,Lee JS,Sung SK,Son DW,Lee SW,Song GS

doi

10.3340/jkns.2017.0404.001

subject

Has Abstract

pub_date

2017-09-01 00:00:00

pages

567-576

issue

eissn

2005-3711

issn

1598-7876

pii

jkns-60-5-567

journal_volume

pub_type

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A Lower T1 Slope as a Predictor of Subsidence in Anterior Cervical Discectomy and Fusion with Stand-Alone Cages.