Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

dc.contributor.author

Smith, Justin S

dc.contributor.author

Lafage, Virginie

dc.contributor.author

Ryan, Devon J

dc.contributor.author

Shaffrey, Christopher I

dc.contributor.author

Schwab, Frank J

dc.contributor.author

Patel, Alpesh A

dc.contributor.author

Brodke, Darrel S

dc.contributor.author

Arnold, Paul M

dc.contributor.author

Riew, K Daniel

dc.contributor.author

Traynelis, Vincent C

dc.contributor.author

Radcliff, Kris

dc.contributor.author

Vaccaro, Alexander R

dc.contributor.author

Fehlings, Michael G

dc.contributor.author

Ames, Christopher P

dc.date.accessioned

2023-08-29T23:31:50Z

dc.date.available

2023-08-29T23:31:50Z

dc.date.issued

2013-10

dc.date.updated

2023-08-29T23:31:49Z

dc.description.abstract

Study design

Post hoc analysis of prospectively collected data.

Objective

Development of methods to determine in vivo spinal cord dimensions and application to correlate preoperative alignment, myelopathy, and health-related quality-of-life scores in patients with cervical spondylotic myelopathy (CSM).

Summary of background data

CSM is the leading cause of spinal cord dysfunction. The association between cervical alignment, sagittal balance, and myelopathy has not been well characterized.

Methods

This was a post hoc analysis of the prospective, multicenter AOSpine North America CSM study. Inclusion criteria for this study required preoperative cervical magnetic resonance imaging (MRI) and neutral sagittal cervical radiography. Techniques for MRI assessment of spinal cord dimensions were developed. Correlations between imaging and health-related quality-of-life scores were assessed.

Results

Fifty-six patients met inclusion criteria (mean age = 55.4 yr). The modified Japanese Orthopedic Association (mJOA) scores correlated with C2-C7 sagittal vertical axis (SVA) (r = -0.282, P = 0.035). Spinal cord volume correlated with cord length (r = 0.472, P < 0.001) and cord average cross-sectional area (r = 0.957, P < 0.001). For all patients, no correlations were found between MRI measurements of spinal cord length, volume, mean cross-sectional area or surface area, and outcomes. For patients with cervical lordosis, mJOA scores correlated positively with cord volume (r = 0.366, P = 0.022), external cord area (r = 0.399, P = 0.012), and mean cross-sectional cord area (r = 0.345, P = 0.031). In contrast, for patients with cervical kyphosis, mJOA scores correlated negatively with cord volume (r = -0.496, P = 0.043) and mean cross-sectional cord area (r = -0.535, P = 0.027).

Conclusion

This study is the first to correlate cervical sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment. It is interesting to note that sagittal balance but not kyphosis is tied to myelopathy score. Future work will correlate alignment changes to cord morphology changes and myelopathy outcomes. SUMMARY STATEMENTS: This is the first study to correlate sagittal balance (C2-C7 SVA) to myelopathy severity. We found a moderate negative correlation in kyphotic patients of cord volume and cross-sectional area to mJOA scores. The opposite (positive correlation) was found for lordotic patients, suggesting a relationship of cord volume to myelopathy that differs on the basis of sagittal alignment.
dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28817

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0b013e3182a7eb9e

dc.subject

Cervical Vertebrae

dc.subject

Spinal Cord

dc.subject

Humans

dc.subject

Kyphosis

dc.subject

Spinal Cord Diseases

dc.subject

Magnetic Resonance Imaging

dc.subject

Radiography

dc.subject

Treatment Outcome

dc.subject

Prospective Studies

dc.subject

Quality of Life

dc.subject

Adult

dc.subject

Aged

dc.subject

Middle Aged

dc.subject

Canada

dc.subject

United States

dc.subject

Female

dc.subject

Male

dc.subject

Spondylosis

dc.subject

Preoperative Period

dc.title

Association of myelopathy scores with cervical sagittal balance and normalized spinal cord volume: analysis of 56 preoperative cases from the AOSpine North America Myelopathy study.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

S161

pubs.end-page

S170

pubs.issue

22 Suppl 1

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

38

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
Association of Myelopathy Scores With Cervical Sagittal Balance and Normalized Spinal Cord Volume_Analysis of 56 Preoperative Cases From the AOSpine North America Myelopathy Study.pdf
Size:
2.04 MB
Format:
Adobe Portable Document Format