Correlation analysis of preoperative T<sub>1</sub> slope in MRI and physiological curvature loss after expansive open-door laminoplasty _Chinese Journal of Reparative and Reconstructive Surgery

Authors：

CHENG Zhaojun ¹ , PENG Bing ² ,  ZHANG Lilong ³ , CUI Zijian ³ , REN Zhishuai ³ , ZHANG Xueli ³

1. Tianjin University of Traditional Chinese Medicine, Tianjin, 300193, P.R.China;
2. No.4 Department of Orthopedics, Liuyang Hospital of Traditional Chinese Medicine, Liuyang Hunan, 410300, P.R.China;
3. No.1 Department of Spine Surgery, Tianjin Union Medical Center, Tianjin, 300121, P.R.China;

Corresponding author：

ZHANG Lilong, Email: piaoxuezll@126.com

Keywords：

Cervical spondylotic myelopathy; expansive open-door laminoplasty; MRI; sagittal parameter; cervical curvature

DOI：

10.7507/1002-1892.201708116

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Objective To investigate whether preoperative T₁ slope (T₁S) in MRI can predict the changes of cervical curvature after expansive open-door laminoplasty (EOLP) in patients with cervical spondylotic myelopathy, so as to make up for the shortcomings of difficult measurement in X-ray film. Methods The clinical data of 36 patients with cervical spondylotic myelopathy who underwent EOLP were retrospectively analysed. There were 21 males and 15 females with an average age of 55.8 years (range, 37-73 years) and an average follow-up time of 14.3 months (range, 12-24 months). The preoperative X-ray films at dynamic position, CT, and MRI of cervical spine before operation, and the anteroposterior and lateral X-ray films at last follow-up were taken out to measure the following sagittal parameters. The parameters included C₂-C₇ Cobb angle and C₂-C₇ sagittal vertical axis (C₂-C₇ SVA) in all patients before operation and at last follow-up; preoperative T₁S were measured in MRI, and the patients were divided into larger T₁S group (T₁S>19°, group A) and small T₁S group (T₁S≤19°, group B) according to the median of T₁S, and the preoperative T₁S, C₂-C₇ Cobb angle, C₂-C₇ SVA, and the C₂-C₇ Cobb angle and C₂-C₇ SVA at last follow-up, difference in axial distance (the difference of C₂-C₇ SVA before and after operation), postoperative curvature loss (the difference of C₂-C₇ Cobb angle before and after operation), the number of patients whose curvature loss was more than 5° after operation, and the number of patients whose kyphosis changed (C₂-C₇ Cobb angle was less than 0° after operation). Results The C₂-C₇ Cobb angle at last follow-up was significantly decreased when compared with preoperative value (t=8.000, P=0.000), but there was no significant difference in C₂-C₇ SVA between pre- and post-operation (t=–1.842, P=0.074). The preoperative T₁S was (19.69±3.39)°; there were 17 cases in group A and 19 cases in group B with no significant difference in gender and age between 2 groups (P>0.05). The preoperative C₂-C₇ Cobb angle in group B was significantly lower than that in group A (t=–2.150, P=0.039), while there was no significant difference in preoperative C₂-C₇ SVA between 2 groups (t=0.206, P=0.838). At last follow-up, except for the curvature loss after operation in group B was significantly lower than that in group A (t=–2.723, P=0.010), there was no significant difference in the other indicators between 2 groups (P>0.05). Conclusion Preoperative larger T₁S (T₁S>19°) in MRI had a larger preoperative lordosis angle, but more postoperative physiological curvature was lost; preoperative T₁S in MRI can not predict postoperative curvature loss, but preoperative larger T₁S may be more prone to kyphosis.

Citation： CHENG Zhaojun, PENG Bing, ZHANG Lilong, CUI Zijian, REN Zhishuai, ZHANG Xueli. Correlation analysis of preoperative T₁ slope in MRI and physiological curvature loss after expansive open-door laminoplasty . Chinese Journal of Reparative and Reconstructive Surgery, 2018, 32(1): 64-68. doi: 10.7507/1002-1892.201708116 Copy

1.	李玉伟, 王海蛟, 严晓云, 等. 颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析. 中国脊柱脊髓杂志, 2013, 23(11): 973-978.
2.	Suk KS, Kim KT, Lee JH, et al. Sagittal alignment of the cervical spine after the laminoplasty. Spine (Phila Pa 1976), 2007, 32(23): E656-660.
3.	Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2012, 71(3): 662-669.
4.	Scheer JK, Passias PG, Sorocean AM, et al. Association between preoperative cervical sagittal deformity and inferior outcomes at 2-year follow-up in patients with adult thoracolumbar deformity: analysis of 182 patients. J Neurosurg Spine, 2016, 24(1): 108-115.
5.	Knott PT, Mardjetko SM, Techy F. The use of the T₁ sagittal angle in predicting overall sagittal balance of the spine. Spine J, 2010, 10(11): 994-998.
6.	Hyun SJ, Kim KJ, Jahng TA, et al. Relationship between T₁ slope and cervical alignment following multi-level posterior cervical fusion surgery: Impact of T₁ Slope Minus Cervical Lordosis. Spine (Phila Pa 1976), 2016, 41(7): E396-402.
7.	Zhang JT, Li JQ, Niu RJ, et al. Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy. Eur Spine J, 2017, 26(4): 1205-1210.
8.	福嘉欣, 江毅, 江汉, 等. T₁ 斜坡角度与颈后路单开门椎管扩大成形术后颈椎曲度变化关系的探讨. 中国矫形外科杂志, 2015, 23(15): 1360-1364.
9.	Jun HS, Chang IB, Song JH, et al. Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? Spine (Phila Pa 1976), 2014, 39(10): E630-636.
10.	Qiao J, Zhu F, Liu Z, et al. Measurement of Thoracic Inlet Alignment on MRI: Reliability and the Influence of Body Position. Clin Spine Surg, 2017, 30(4): E377-380.
11.	程招军, 彭兵, 范俊超, 等. 脊髓型颈椎病患者颈椎 MRI 与 X 线片矢状位参数的对比分析. 中国脊柱脊髓杂志, 2016, 26(7): 591-595.
12.	Kimura I, Shingu H, Nasu Y. Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Joint Surg (Br), 1995, 77(6): 956-961.
13.	Suda K, Abumi K, Ito M, et al. Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976), 2003, 28(12): 1258-1262.
14.	Aita I, Wadano Y, Yabuki T. Curvature and range of motion of the cervical spine after laminaplasty. J Bone Joint Surg (Am), 2000, 82-A(12): 1743-1748.
15.	Cho JH, Ha JK, Kim DG, et al. Does preoperative T₁ slope affect radiological and functional outcomes after cervical laminoplasty? Spine (Phila Pa 1976), 2014, 39(26): E1575-1581.
16.	Taniyama T, Hirai T, Yoshii T, et al. Modified K-line in magnetic resonance imaging predicts clinical outcome in patients with nonlordotic alignment after laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976), 2014, 39(21): E1261-1268.
17.	臧法智, 陈华江, 王建喜, 等. T₁ 倾斜角对颈椎后纵韧带骨化患者后路单开门椎板成形术后颈椎曲度的影响. 脊柱外科杂志, 2016, 14(1): 26-29.
18.	张浩, 周文超, 陈元元, 等. 颈椎后纵韧带骨化症单开门椎管扩大成形术后颈椎矢状位参数变化与疗效的关系. 中国脊柱脊髓杂志, 2016, 26(3): 206-210.
19.	Sakai K, Yoshii T, Hirai T, et al. Cervical Sagittal Imbalance is a Predictor of Kyphotic Deformity After Laminoplasty in Cervical Spondylotic Myelopathy Patients Without Preoperative Kyphotic Alignment. Spine (Phila Pa 1976), 2016, 41(4): 299-305.
20.	Kim TH, Lee SY, Kim YC, et al. T₁ slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(16): E992-997.
21.	苗洁, 申勇, 王林峰, 等. 颈椎后路三种手术方式对改善多节段颈椎病生理曲度及疗效的远期观察. 中国矫形外科杂志, 2012, 20(11): 978-981.

1. 李玉伟, 王海蛟, 严晓云, 等. 颈椎单开门椎管扩大成形术不同椎板固定方法治疗多节段脊髓型颈椎病的疗效分析. 中国脊柱脊髓杂志, 2013, 23(11): 973-978.
2. Suk KS, Kim KT, Lee JH, et al. Sagittal alignment of the cervical spine after the laminoplasty. Spine (Phila Pa 1976), 2007, 32(23): E656-660.
3. Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery. Neurosurgery, 2012, 71(3): 662-669.
4. Scheer JK, Passias PG, Sorocean AM, et al. Association between preoperative cervical sagittal deformity and inferior outcomes at 2-year follow-up in patients with adult thoracolumbar deformity: analysis of 182 patients. J Neurosurg Spine, 2016, 24(1): 108-115.
5. Knott PT, Mardjetko SM, Techy F. The use of the T₁ sagittal angle in predicting overall sagittal balance of the spine. Spine J, 2010, 10(11): 994-998.
6. Hyun SJ, Kim KJ, Jahng TA, et al. Relationship between T₁ slope and cervical alignment following multi-level posterior cervical fusion surgery: Impact of T₁ Slope Minus Cervical Lordosis. Spine (Phila Pa 1976), 2016, 41(7): E396-402.
7. Zhang JT, Li JQ, Niu RJ, et al. Predictors of cervical lordosis loss after laminoplasty in patients with cervical spondylotic myelopathy. Eur Spine J, 2017, 26(4): 1205-1210.
8. 福嘉欣, 江毅, 江汉, 等. T₁ 斜坡角度与颈后路单开门椎管扩大成形术后颈椎曲度变化关系的探讨. 中国矫形外科杂志, 2015, 23(15): 1360-1364.
9. Jun HS, Chang IB, Song JH, et al. Is it possible to evaluate the parameters of cervical sagittal alignment on cervical computed tomographic scans? Spine (Phila Pa 1976), 2014, 39(10): E630-636.
10. Qiao J, Zhu F, Liu Z, et al. Measurement of Thoracic Inlet Alignment on MRI: Reliability and the Influence of Body Position. Clin Spine Surg, 2017, 30(4): E377-380.
11. 程招军, 彭兵, 范俊超, 等. 脊髓型颈椎病患者颈椎 MRI 与 X 线片矢状位参数的对比分析. 中国脊柱脊髓杂志, 2016, 26(7): 591-595.
12. Kimura I, Shingu H, Nasu Y. Long-term follow-up of cervical spondylotic myelopathy treated by canal-expansive laminoplasty. J Bone Joint Surg (Br), 1995, 77(6): 956-961.
13. Suda K, Abumi K, Ito M, et al. Local kyphosis reduces surgical outcomes of expansive open-door laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976), 2003, 28(12): 1258-1262.
14. Aita I, Wadano Y, Yabuki T. Curvature and range of motion of the cervical spine after laminaplasty. J Bone Joint Surg (Am), 2000, 82-A(12): 1743-1748.
15. Cho JH, Ha JK, Kim DG, et al. Does preoperative T₁ slope affect radiological and functional outcomes after cervical laminoplasty? Spine (Phila Pa 1976), 2014, 39(26): E1575-1581.
16. Taniyama T, Hirai T, Yoshii T, et al. Modified K-line in magnetic resonance imaging predicts clinical outcome in patients with nonlordotic alignment after laminoplasty for cervical spondylotic myelopathy. Spine (Phila Pa 1976), 2014, 39(21): E1261-1268.
17. 臧法智, 陈华江, 王建喜, 等. T₁ 倾斜角对颈椎后纵韧带骨化患者后路单开门椎板成形术后颈椎曲度的影响. 脊柱外科杂志, 2016, 14(1): 26-29.
18. 张浩, 周文超, 陈元元, 等. 颈椎后纵韧带骨化症单开门椎管扩大成形术后颈椎矢状位参数变化与疗效的关系. 中国脊柱脊髓杂志, 2016, 26(3): 206-210.
19. Sakai K, Yoshii T, Hirai T, et al. Cervical Sagittal Imbalance is a Predictor of Kyphotic Deformity After Laminoplasty in Cervical Spondylotic Myelopathy Patients Without Preoperative Kyphotic Alignment. Spine (Phila Pa 1976), 2016, 41(4): 299-305.
20. Kim TH, Lee SY, Kim YC, et al. T₁ slope as a predictor of kyphotic alignment change after laminoplasty in patients with cervical myelopathy. Spine (Phila Pa 1976), 2013, 38(16): E992-997.
21. 苗洁, 申勇, 王林峰, 等. 颈椎后路三种手术方式对改善多节段颈椎病生理曲度及疗效的远期观察. 中国矫形外科杂志, 2012, 20(11): 978-981.

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Correlation analysis of preoperative T₁ slope in MRI and physiological curvature loss after expansive open-door laminoplasty

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Correlation analysis of preoperative T₁ slope in MRI and physiological curvature loss after expansive open-door laminoplasty