Cervical alignment in the obese population following posterior cervical fusion for cervical myelopathy
Retrospective cohort study The aim of this study was to investigate the effect of body mass index (BMI) on the reoperation rate and cervical sagittal alignment of patients who underwent posterior cervical decompression and fusion for cervical spondylotic myelopathy (CSM). Cervical sagittal balance h...
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| Veröffentlicht in: | Clinical neurology and neurosurgery 2022-01, Vol.212, p.107059-107059, Article 107059 |
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| creator | Perez, Eli A. Woodroffe, Royce W. Park, Brian Gold, Colin Helland, Logan C. Seaman, Scott C. Hitchon, Patrick W. |
| description | Retrospective cohort study
The aim of this study was to investigate the effect of body mass index (BMI) on the reoperation rate and cervical sagittal alignment of patients who underwent posterior cervical decompression and fusion for cervical spondylotic myelopathy (CSM).
Cervical sagittal balance has been correlated with postoperative clinical outcomes. Previous studies have shown worse postoperative sagittal alignment and higher reoperation rates in patients with high BMI undergoing anterior decompression and fusion. Similar evidence for the impact of obesity in postoperative sagittal alignment for patients with (CSM) undergoing posterior cervical decompression and fusion (PCF) is lacking.
A retrospective analysis of 198 patients who underwent PCF for cervical myelopathy due to degenerative spine disease was performed. Demographics, need for reoperation, and perioperative radiographic parameters were collected. Cervical lordosis (CL), C2–7 sagittal vertical axis (SVA), and T1 slope (T1S) was measured on standing lateral radiographs. Comparative analysis of the patient cohort was performed by stratifying the sample population into three BMI categories ( |
| doi_str_mv | 10.1016/j.clineuro.2021.107059 |
| format | Article |
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The aim of this study was to investigate the effect of body mass index (BMI) on the reoperation rate and cervical sagittal alignment of patients who underwent posterior cervical decompression and fusion for cervical spondylotic myelopathy (CSM).
Cervical sagittal balance has been correlated with postoperative clinical outcomes. Previous studies have shown worse postoperative sagittal alignment and higher reoperation rates in patients with high BMI undergoing anterior decompression and fusion. Similar evidence for the impact of obesity in postoperative sagittal alignment for patients with (CSM) undergoing posterior cervical decompression and fusion (PCF) is lacking.
A retrospective analysis of 198 patients who underwent PCF for cervical myelopathy due to degenerative spine disease was performed. Demographics, need for reoperation, and perioperative radiographic parameters were collected. Cervical lordosis (CL), C2–7 sagittal vertical axis (SVA), and T1 slope (T1S) was measured on standing lateral radiographs. Comparative analysis of the patient cohort was performed by stratifying the sample population into three BMI categories (<25, 25–30, ≥30).
Of the 198 patients that met inclusion criteria, 53 had BMI normal (<25), 65 were overweight (25−30), and 80 were obese (≥30). Mean SVA increased postoperatively in all groups, 4 mm in the normal group, 13 mm in the overweight group, and 13 mm in the obese group (p = 0.003). There was no significant difference in the postoperative change of cervical lordosis or T1 slope between the groups. Multivariate analysis demonstrated fusions involving the cervicothoracic junction and those involving 5 or more levels significantly affected alignment parameters. There were 27 complications requiring reoperation (14%) with no significant differences among the groups stratified by BMI (p = 0.386).
Overweight patients (BMI>25) with CSM undergoing PCF had a greater increase in SVA than normal weight patients while reoperation rates were similar. In addition, preoperative CL increased with increasing BMI, although this trend was not Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation significant and there was not found to be a significant difference between the change in CL from baseline to post-fusion between BMI cohorts. This study further highlights the importance of considering BMI when attempting to optimize sagittal alignment in patients undergoing PCF.
•Increased BMI was correlated with increased SVA following surgery.•Obesity Class III did not have worse alignment following surgery compared to the rest of the study cohort.•Reoperation rates did not differ between BMI groups.</description><identifier>ISSN: 0303-8467</identifier><identifier>EISSN: 1872-6968</identifier><identifier>DOI: 10.1016/j.clineuro.2021.107059</identifier><identifier>PMID: 34861469</identifier><language>eng</language><publisher>Netherlands: Elsevier B.V</publisher><subject>Adult ; Aged ; Back surgery ; Body Mass Index ; Body weight ; Central nervous system diseases ; Cervical Vertebrae - pathology ; Cervical Vertebrae - surgery ; Comorbidity ; Comparative analysis ; Decompression ; Decompression, Surgical ; Demography ; Electronic health records ; Female ; Follow-Up Studies ; Humans ; Male ; Medical records ; Middle Aged ; Multivariate analysis ; Neurology ; Obesity ; Obesity - epidemiology ; Outcome Assessment, Health Care ; Overweight ; Overweight - epidemiology ; Patients ; Reoperation ; Retrospective Studies ; Spinal cord ; Spinal Cord Diseases - epidemiology ; Spinal Cord Diseases - etiology ; Spinal Cord Diseases - surgery ; Spinal Fusion ; Spondylosis - complications ; Spondylosis - epidemiology ; Spondylosis - surgery ; Statistical analysis ; Variance analysis</subject><ispartof>Clinical neurology and neurosurgery, 2022-01, Vol.212, p.107059-107059, Article 107059</ispartof><rights>2021 Elsevier B.V.</rights><rights>Copyright © 2021 Elsevier B.V. All rights reserved.</rights><rights>2021. Elsevier B.V.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c396t-13c4fcb4be70d9a2475da919dd9b6172ba1abf4e0320ebc07ae12c939668d113</citedby><cites>FETCH-LOGICAL-c396t-13c4fcb4be70d9a2475da919dd9b6172ba1abf4e0320ebc07ae12c939668d113</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.proquest.com/docview/2615295408?pq-origsite=primo$$EHTML$$P50$$Gproquest$$H</linktohtml><link.rule.ids>315,781,785,3551,27929,27930,46000,64390,64392,64394,72474</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/34861469$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Perez, Eli A.</creatorcontrib><creatorcontrib>Woodroffe, Royce W.</creatorcontrib><creatorcontrib>Park, Brian</creatorcontrib><creatorcontrib>Gold, Colin</creatorcontrib><creatorcontrib>Helland, Logan C.</creatorcontrib><creatorcontrib>Seaman, Scott C.</creatorcontrib><creatorcontrib>Hitchon, Patrick W.</creatorcontrib><title>Cervical alignment in the obese population following posterior cervical fusion for cervical myelopathy</title><title>Clinical neurology and neurosurgery</title><addtitle>Clin Neurol Neurosurg</addtitle><description>Retrospective cohort study
The aim of this study was to investigate the effect of body mass index (BMI) on the reoperation rate and cervical sagittal alignment of patients who underwent posterior cervical decompression and fusion for cervical spondylotic myelopathy (CSM).
Cervical sagittal balance has been correlated with postoperative clinical outcomes. Previous studies have shown worse postoperative sagittal alignment and higher reoperation rates in patients with high BMI undergoing anterior decompression and fusion. Similar evidence for the impact of obesity in postoperative sagittal alignment for patients with (CSM) undergoing posterior cervical decompression and fusion (PCF) is lacking.
A retrospective analysis of 198 patients who underwent PCF for cervical myelopathy due to degenerative spine disease was performed. Demographics, need for reoperation, and perioperative radiographic parameters were collected. Cervical lordosis (CL), C2–7 sagittal vertical axis (SVA), and T1 slope (T1S) was measured on standing lateral radiographs. Comparative analysis of the patient cohort was performed by stratifying the sample population into three BMI categories (<25, 25–30, ≥30).
Of the 198 patients that met inclusion criteria, 53 had BMI normal (<25), 65 were overweight (25−30), and 80 were obese (≥30). Mean SVA increased postoperatively in all groups, 4 mm in the normal group, 13 mm in the overweight group, and 13 mm in the obese group (p = 0.003). There was no significant difference in the postoperative change of cervical lordosis or T1 slope between the groups. Multivariate analysis demonstrated fusions involving the cervicothoracic junction and those involving 5 or more levels significantly affected alignment parameters. There were 27 complications requiring reoperation (14%) with no significant differences among the groups stratified by BMI (p = 0.386).
Overweight patients (BMI>25) with CSM undergoing PCF had a greater increase in SVA than normal weight patients while reoperation rates were similar. In addition, preoperative CL increased with increasing BMI, although this trend was not Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation significant and there was not found to be a significant difference between the change in CL from baseline to post-fusion between BMI cohorts. This study further highlights the importance of considering BMI when attempting to optimize sagittal alignment in patients undergoing PCF.
•Increased BMI was correlated with increased SVA following surgery.•Obesity Class III did not have worse alignment following surgery compared to the rest of the study cohort.•Reoperation rates did not differ between BMI groups.</description><subject>Adult</subject><subject>Aged</subject><subject>Back surgery</subject><subject>Body Mass Index</subject><subject>Body weight</subject><subject>Central nervous system diseases</subject><subject>Cervical Vertebrae - pathology</subject><subject>Cervical Vertebrae - surgery</subject><subject>Comorbidity</subject><subject>Comparative analysis</subject><subject>Decompression</subject><subject>Decompression, Surgical</subject><subject>Demography</subject><subject>Electronic health records</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Humans</subject><subject>Male</subject><subject>Medical records</subject><subject>Middle Aged</subject><subject>Multivariate analysis</subject><subject>Neurology</subject><subject>Obesity</subject><subject>Obesity - epidemiology</subject><subject>Outcome Assessment, Health Care</subject><subject>Overweight</subject><subject>Overweight - epidemiology</subject><subject>Patients</subject><subject>Reoperation</subject><subject>Retrospective Studies</subject><subject>Spinal cord</subject><subject>Spinal Cord Diseases - epidemiology</subject><subject>Spinal Cord Diseases - etiology</subject><subject>Spinal Cord Diseases - surgery</subject><subject>Spinal Fusion</subject><subject>Spondylosis - complications</subject><subject>Spondylosis - epidemiology</subject><subject>Spondylosis - surgery</subject><subject>Statistical analysis</subject><subject>Variance analysis</subject><issn>0303-8467</issn><issn>1872-6968</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2022</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>8G5</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><sourceid>GNUQQ</sourceid><sourceid>GUQSH</sourceid><sourceid>M2O</sourceid><recordid>eNqFkUtLxDAUhYMoOo7-BSm4cdMxj07a7JTBFwhu3Ic0vdUMaVKTVpl_b4bOiLhxdeHwnXsv5yB0QfCCYMKv1wttjYMx-AXFlCSxxEtxgGakKmnOBa8O0QwzzPKq4OUJOo1xjTFmjFfH6IQVFScFFzPUriB8Gq1spqx5cx24ITMuG94h8zVEyHrfj1YNxrus9db6L-PekhgHCMaHTO_t7Rgn5pfWbcD6Xg3vmzN01Cob4Xw35-j1_u519Zg_vzw8rW6fc80EH3LCdNHquqihxI1QtCiXjRJENI2oOSlprYiq2wIwoxhqjUsFhGqRvLxqCGFzdDWt7YP_GCEOsjNRg7XKgR-jpBxzQWkpWEIv_6BrPwaXnksUWVKxLHCVKD5ROvgYA7SyD6ZTYSMJltsi5Frui5DbIuRURDJe7NaPdQfNj22ffAJuJgBSHJ8GgozagNPQmAB6kI03_934BlrZnuw</recordid><startdate>202201</startdate><enddate>202201</enddate><creator>Perez, Eli A.</creator><creator>Woodroffe, Royce W.</creator><creator>Park, Brian</creator><creator>Gold, Colin</creator><creator>Helland, Logan C.</creator><creator>Seaman, Scott C.</creator><creator>Hitchon, Patrick W.</creator><general>Elsevier B.V</general><general>Elsevier Limited</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TK</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>88G</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>8G5</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>GNUQQ</scope><scope>GUQSH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>M2M</scope><scope>M2O</scope><scope>MBDVC</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PSYQQ</scope><scope>Q9U</scope><scope>7X8</scope></search><sort><creationdate>202201</creationdate><title>Cervical alignment in the obese population following posterior cervical fusion for cervical myelopathy</title><author>Perez, Eli A. ; 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The aim of this study was to investigate the effect of body mass index (BMI) on the reoperation rate and cervical sagittal alignment of patients who underwent posterior cervical decompression and fusion for cervical spondylotic myelopathy (CSM).
Cervical sagittal balance has been correlated with postoperative clinical outcomes. Previous studies have shown worse postoperative sagittal alignment and higher reoperation rates in patients with high BMI undergoing anterior decompression and fusion. Similar evidence for the impact of obesity in postoperative sagittal alignment for patients with (CSM) undergoing posterior cervical decompression and fusion (PCF) is lacking.
A retrospective analysis of 198 patients who underwent PCF for cervical myelopathy due to degenerative spine disease was performed. Demographics, need for reoperation, and perioperative radiographic parameters were collected. Cervical lordosis (CL), C2–7 sagittal vertical axis (SVA), and T1 slope (T1S) was measured on standing lateral radiographs. Comparative analysis of the patient cohort was performed by stratifying the sample population into three BMI categories (<25, 25–30, ≥30).
Of the 198 patients that met inclusion criteria, 53 had BMI normal (<25), 65 were overweight (25−30), and 80 were obese (≥30). Mean SVA increased postoperatively in all groups, 4 mm in the normal group, 13 mm in the overweight group, and 13 mm in the obese group (p = 0.003). There was no significant difference in the postoperative change of cervical lordosis or T1 slope between the groups. Multivariate analysis demonstrated fusions involving the cervicothoracic junction and those involving 5 or more levels significantly affected alignment parameters. There were 27 complications requiring reoperation (14%) with no significant differences among the groups stratified by BMI (p = 0.386).
Overweight patients (BMI>25) with CSM undergoing PCF had a greater increase in SVA than normal weight patients while reoperation rates were similar. In addition, preoperative CL increased with increasing BMI, although this trend was not Powered by Editorial Manager® and ProduXion Manager® from Aries Systems Corporation significant and there was not found to be a significant difference between the change in CL from baseline to post-fusion between BMI cohorts. This study further highlights the importance of considering BMI when attempting to optimize sagittal alignment in patients undergoing PCF.
•Increased BMI was correlated with increased SVA following surgery.•Obesity Class III did not have worse alignment following surgery compared to the rest of the study cohort.•Reoperation rates did not differ between BMI groups.</abstract><cop>Netherlands</cop><pub>Elsevier B.V</pub><pmid>34861469</pmid><doi>10.1016/j.clineuro.2021.107059</doi><tpages>1</tpages></addata></record> |
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| source | MEDLINE; Elsevier ScienceDirect Journals Complete; ProQuest Central UK/Ireland |
| subjects | Adult Aged Back surgery Body Mass Index Body weight Central nervous system diseases Cervical Vertebrae - pathology Cervical Vertebrae - surgery Comorbidity Comparative analysis Decompression Decompression, Surgical Demography Electronic health records Female Follow-Up Studies Humans Male Medical records Middle Aged Multivariate analysis Neurology Obesity Obesity - epidemiology Outcome Assessment, Health Care Overweight Overweight - epidemiology Patients Reoperation Retrospective Studies Spinal cord Spinal Cord Diseases - epidemiology Spinal Cord Diseases - etiology Spinal Cord Diseases - surgery Spinal Fusion Spondylosis - complications Spondylosis - epidemiology Spondylosis - surgery Statistical analysis Variance analysis |
| title | Cervical alignment in the obese population following posterior cervical fusion for cervical myelopathy |
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