• Nathan Evaniew, Raphaële Charest-Morin, W Bradley Jacobs, Michael Johnson, Christopher S Bailey, Sean Christie, Jérôme Paquet, Andrew Nataraj, David W Cadotte, Jefferson R Wilson, Michael Craig, Mark Xu, Neil Manson, Hamilton Hall, Ken C Thomas, Y Raja Rampersaud, Greg McIntosh, Charles G Fisher, Nicolas Dea, and Canadian Spine Outcomes and Research Network (CSORN).
• University of Calgary Spine Program, University of Calgary, Calgary, Alberta, Canada.
• Spine. 2022 Mar 1; 47 (5): E177E186E177-E186.

Study DesignProspective cohort study.ObjectiveAmong patients with CSM, we aimed to evaluate the extent to which: (1) Preoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms; (2) Surgery leads to changes in cervical sagittal alignment; and (3) Postoperative cervical sagittal alignment is associated with health-related quality of life, function, and symptoms at 12 months of follow-up.Summary Of Background DataThe importance of maintaining or improving cervical sagittal alignment in the surgical management of patients with CSM has not been established.MethodsWe measured C2-C7 Cobb angle, T1 slope, and C2-C7 cervical sagittal vertical axis (cSVA). We tested for associations with Neck Disability Index, Pain Scales for neck and arm pain, EuroQol 5D, Short Form 12 Physical and Mental Component Summaries, and modified Japanese Orthopaedic Association scores. We adjusted for potential confounders using multiple linear regression, and we performed various prespecified subgroup (cSVA > 40 mm, surgical approach) and sensitivity analyses.ResultsAmong 250 patients, adjusted analyses yielded significant inverse associations prior to surgery between each of cSVA and T1 slope with SF12 Physical Component Summaries (T1 slope: -0.14, 95% CI -0.26 to -0.01, P = 0.03; C2-C7 cSVA: -0.13, 95% CI --0.21 to -0.05 P < 0.01). Surgery was associated with a small but statistically significant increase in cSVA across the cohort (+5.8 mm [SD 11.7], P < 0.01) but no change in Cobb angle or T1 slope. At 12-months after surgery, there were no significant associations between alignment parameters or change in alignment and any measures of health-related quality of life, function, or symptoms. Results were consistent across subgroup and sensitivity analyses.ConclusionIncreased cSVA and T1 slope were associated with inferior health-related quality of life at presentation among patients with CSM, but no significant associations were observed following surgical treatment.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

12 keywords...

hide…