Relationship between degree of focal kyphosis correction and neurological outcomes for patients undergoing cervical deformity correction surgery

Journal of Neurosurgery: Spine - Tập 18 Số 6 - Trang 537-544 - 2013
Matthew J. Grosso1, Roy Hwang2, Thomas E. Mroz1, Edward Benzel1, Michael P. Steinmetz3,4
1Cleveland Clinic, Center for Spine Health, Cleveland, Ohio;
2Department of Neurosurgery, West Virginia University, Morgantown, West Virginia
3Department of Neuroscience, MetroHealth Medical Center; and
4Department of Neurosurgery, Case Western Reserve University, Cleveland, Ohio

Tóm tắt

Object Reversal of the normal cervical spine curvature, as seen in cervical kyphosis, can lead to mechanical pain, neurological dysfunction, and functional disabilities. Surgical intervention is warranted in patients with sufficiently symptomatic deformities in an attempt to correct the deformed cervical spine. In theory, improved outcomes should accompany a greater degree of correction toward lordosis, although there are few data available to test this relationship. The purpose of this study is to determine if the degree of deformity correction correlates with improvement in neurological symptoms following surgery for cervical kyphotic deformity. Methods A retrospective review of 36 patients with myelopathic symptoms who underwent cervical deformity correction surgery between 2001 and 2009 was performed. Preoperative and postoperative radiographic findings related to the degree of kyphosis were collected and compared with functional outcome measures. The minimum follow-up time was 2 years. Results A significant relationship was observed between a greater degree of focal kyphosis correction and improved neurological outcomes according to the modified Japanese Orthopaedic Association (mJOA) score (r = −0.46, p = 0.032). For patients with severe neurological symptoms (mJOA score < 12) a trend toward improved outcomes with greater global kyphosis correction was observed (r = −0.56, p = 0.057). Patients with an mJOA score less than 16 who attained lordosis postoperatively had a significantly greater improvement in total mJOA score than patients who maintained a kyphotic position (achieved lordosis: 2.7 ± 2.0 vs maintained kyphosis: 1.1 ± 2.1, p = 0.044). Conclusions The authors' results suggest that the degree of correction of focal kyphosis deformity correlates with improved neurological outcomes. The authors also saw a positive relationship between attainment of global lordosis and improved mJOA scores. With consideration for the risks involved in correction surgery, this information can be used to help guide surgical strategy decision making.

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Thông tin xuất bản

Journal of Neurosurgery: Spine

Tập 18 Số 6

537-544

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