The Effect of C2 Muscular Exposure Technique on Radiographic and Clinical Outcomes After C2–T2 Posterior Cervical Fusion

Author:

Levy Hannah A.1,Pinter Zachariah W.1,Pumford Andrew1,Salmons Harold I.1,Townsley Sarah1,Katsos Konstantinos2,Reed Ryder1,Chen Selby3,Abode-Iyamah Kingsley3,Deen H. Gordon3,Clarke Michelle2,Bydon Mohamad2,Fogelson Jeremy L.2,Elder Benjamin D.2,Currier Bradford1,Freedman Brett A.1,Nassr Ahmad N.1,Karamian Brian A.4,Sebastian Arjun S.1

Affiliation:

1. Department of Orthopedic Surgery

2. Department of Neurologic Surgery, Mayo Clinic, Rochester, MN

3. Department of Neurologic Surgery, Mayo Clinic, Jacksonville, FL

4. Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah

Abstract

Study Design: Retrospective cohort analysis. Objective: To determine whether the C2 exposure technique was a predictor of change in cervical alignment and patient-reported outcomes measures (PROMs) after posterior cervical decompression and fusion (PCDF) for degenerative indications. Background: In PCDF handling of the C2 posterior paraspinal musculature during the operative approach varies by surgeon technique. To date, no studies have investigated whether maintenance of the upper cervical semispinalis cervicis attachments as compared with complete reflection of upper cervical paraspinal musculature from the posterior bony elements is associated with superior radiographic and clinical outcomes after PCDF. Patients and Methods: All adult patients who underwent C2–T2 PCDF for myelopathy or myeloradiculopathy at multi-institutional academic centers between 2013 and 2020 were retrospectively identified. Patients were dichotomized by the C2 exposure technique into semispinalis preservation or midline muscular reflection groups. Preoperative and short and long-term postoperative radiographic outcomes (upper cervical alignment, global alignment, and fusion status) and PROMs (Visual Analog Scale–Neck, Neck Disability Index, and Short Form-12) were collected. Univariate analysis compared patient factors, radiographic measures, and PROMs across C2 exposure groups. Results: A total of 129 patients met the inclusion/exclusion criteria (73 muscle preservation and 56 muscle reflection). Patients in the muscular preservation group were on average younger (P= 0.005) and more likely to have bone morphogenic protein (P< 0.001) and C2 pars screws (P= 0.006) used during surgery. Preoperative to postoperative changes in C2 slope, C2 tilt, C2–C3 segmental lordosis, C2–C3 listhesis, C0–C2 Cobb angle, proximal junctional kyphosis, ADI, C1 lamina-occiput distance, C2 sagittal vertical axis, C2–C7 lordosis, and PROMs at all follow-up intervals did not vary significantly by C2 exposure technique. Likewise, there were no significant differences in fusion status, C2–C3 pseudoarthrosis, C2 screw loosening, and complication and revision rates between C2 exposure groups. Conclusions: Preservation of C2 semispinalis attachments versus muscular reflection did not significantly impact cervical alignment, clinical outcomes, or proximal junction complications in long-segment PCDF. Level of Evidence: Level III.

Publisher

Ovid Technologies (Wolters Kluwer Health)

同舟云学术

1.学者识别学者识别

2.学术分析学术分析

3.人才评估人才评估

"同舟云学术"是以全球学者为主线,采集、加工和组织学术论文而形成的新型学术文献查询和分析系统,可以对全球学者进行文献检索和人才价值评估。用户可以通过关注某些学科领域的顶尖人物而持续追踪该领域的学科进展和研究前沿。经过近期的数据扩容,当前同舟云学术共收录了国内外主流学术期刊6万余种,收集的期刊论文及会议论文总量共计约1.5亿篇,并以每天添加12000余篇中外论文的速度递增。我们也可以为用户提供个性化、定制化的学者数据。欢迎来电咨询!咨询电话:010-8811{复制后删除}0370

www.globalauthorid.com

TOP

Copyright © 2019-2024 北京同舟云网络信息技术有限公司
京公网安备11010802033243号  京ICP备18003416号-3