Objective To evaluate the correlation between different occipitocervical angle (C0~C2), C1~C2 angle and postoperative lower cervical curvature (C2~C7 angle) after posterior atlantoaxial fixation fusion, and to explore the best angle of atlantoaxial fixation and assess the reliability of the influence of these two indexes on the lower cervical curvature, so as to provide theoretical basis for clinical treatment. Methods From January 2016 to June 2018, 78 patients with disorders of the upper cervical spine who underwent posterior atlantoaxial fixation fusion were followed up. C0~C2, C1~C2 and C2~C7 angles on lateral radiographs of cervical spine were measured respectively. Lordosis was "+" value, kyphosis was "-" value, and the correlation between the included angles was observed. Results All patients were followed up for 12 to 18 months, with an average of 16 months. The mean C0~C2 angles during preoperative and postoperative follow-up were (11.87±1.36)°and (20.14±5.20)°, respectively, with statistically significant differences (t=-14.635, P<0.001). The mean C1~C2 angles during preoperative and postoperative follow-up were (15.55±1.70)° and (26.67±7.70)°, respectively, the difference was statistically significant (t=-12.748, P<0.001). The mean C2~C7 angle during preoperative and postoperative follow-up were (18.16±2.81)° and (13.05±6.27)°, respectively, with statistical significance (t=7.500, P<0.001). The postoperative follow-up included 37 cases with the fixed angle of C0~C2 <20° (10°~20°) and 41 cases with the fixed angle ≥20°(20°~28°). There were 37 cases of C1~C2 fixation angle <25°(10°~25°), and 41 cases of C1~C2 fixation angle ≥25°(25°~42°). During follow-up, there was no clear correlation between C1~C2 angle <25°, C0~C2 angle <20° and C2~C7 angle (P=0.635 and 0.510, r=0.081 and 0.112). C1~C2 angle ≥25° and C0~C2 angle ≥20° were negatively correlated with C2~C7 angle (P=0.002 and 0.000, r=-0.466 and -0.872, respectively). C0~C2 angle fixing angle ≥20° is strongly correlated with C2~C7 angle (r=-0.872, absolute value > 0.8), while C1~C2 angle fixing angle ≥25° is not closely correlated with C2~C7 angle (r=-0.466, absolute value<0.5). Conclusion With posterior atlantoaxial fixation fusion, the fixation angle of C0~C2 ≥20° or the fixation angle of C1~C2 ≥25° may lead to the decrease of the postoperative curvature of the lower cervical spine, while the fixation angle of C1~C210°~25° and the fixation angle of C0~C2 10°~20° may better maintain the physiological curvature of the lower cervical spine. The fixed angle of C0~C2 is more reliable.
Key words
Posterior /
/
/
Atlantoaxial /
/
/
Fixed angle /
/
/
Lower cervical curvature
{{custom_sec.title}}
{{custom_sec.title}}
{{custom_sec.content}}
References
[1] Shao J, Gao Y, Gao K，et al. Posterior screw-rod fixation and selective axial loosening for the treatment of atlantoaxial iInstability or dislocation caused by os odontoideum: a case series for a single posterior approach.[J] .World Neurosurg, 2019, 132: e193-e201. DOI:10.1016/j.wneu.2019.08.208.
[2] Shao J, Gao Y, Gao K, et al. Comparison of imaging parameters pre- and post- reductive procedure for atlantoaxial dislocation via posterior fixation using pedicle screw and rod: a cross-sectional study[J]. BMC Musculoskelet Disord, 2019, 20: 451. DOI:10.1186/s12891-019-2842-3.
[3] Unni C, Pettakkandy V, P AJ, et al. Atlantoaxial stabilization by pPosterior C1 and C2 screw-rod fixation for various pathologies: case series and comprehensive review of literature[J]. J Neurosci Rural Pract, 2021, 12(2):228-235. DOI:10.1055/s-0041-1722838.
[4] Tang C, Li GZ, Liao YH, et al. Importance of the occipitoaxial angle and posterior occipitocervical angle in occipitocervical fusion[J].Orthop Surg, 2019, 11(6): 1054-1063. DOI:10.1111/os.12553.
[5] Zhang XR, Gao K, Xie HQ，et al. Characteristics of cervical sagittal alignment at different C0-C2 correcting angles in fusion treatment of atlantoaxial dislocations [J] .World Neurosurg, 2018, S1878-8750(18)32839-0.DOI:10.1016/j.wneu.2018.12.017.
[6] Yoshida G , Kamiya M , Yoshihara H , et al. Subaxial sagittal alignment and adjacent-segment degeneration after atlantoaxial fixation performed using C1 lateral mass and C2 pedicle screws or transarticular screws.[J]. J Neurosurg Spine, 2010, 13(4):443. DOI:10.3171/2010.4.SPINE09662.
[7] Nojiri K, Matsumoto M, Chiba K, et al. Relationship between alignment of upper and lower cervical spine in asymptomatic individuals.[J]. J Neurosurg, 2003, 99(1):80-3. DOI:10.4103/0028-3886.27149.
[8] Kato Y, Itoh T, Kanaya K, et al. Relation between atlantoaxial (C1/2) and cervical alignment (C2-C7) angles with Magerl and Brooks techniques for atlantoaxial subluxation in rheumatoid arthritis[J]. J Orthopaedic Sci, 2006, 11(4):347-352. DOI:10.1007/s00776-006-1033-x.
[9] Passias PG , Wang S , Kozanek M , et al. Relationship between the alignment of the occipitoaxial and subaxial cervical spine in patients with congenital atlantoxial dislocations[J]. J Spinal Disord Tech, 2013, 26(1):15-21. DOI:10.1097/BSD.0b013e31823097f9.
[10]Scheer JK , Tang JA , Smith JS , et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review[J]. J Neurosurg Spine, 2013, 19(2):141-159. DOI:10.3171/2013.4.SPINE12838.
[11]Tang JA, Scheer JK, Smith JS, et al. The impact of standing regional cervical sagittal alignment on outcomes in posterior cervical fusion surgery [J].Neurosurgery, 2015, 76(suppl 1): S14-21. DOI:10.1227/01.neu.0000462074.66077.2b.
[12]童杰,季伟,黄志平,等. 寰枢椎后路柔性固定的生物力学研究[J]. 中国临床解剖学杂志, 2022, 40(1):72-77. DOI:10.13418/j.issn.1001-165x.2022.1.14.
[13]刘少强, 黄清奇, 齐强, 等. 后路寰枢椎融合术后颈椎矢状面参数变化及相关因素分析[J]. 中国脊柱脊髓杂志, 2019, 29(4):336-342. DOI:10.3969/j.issn.1004-406X.2019.04.07.
[14]Clarke MJ , Cohen-Gadol AA , Ebersold MJ , et al. Long-term incidence of subaxial cervical spine instability following cervical arthrodesis surgery in patients with rheumatoid arthritis[J]. Surgical Neurology, 2006, 66(2):136-140.DOI:10.1016/j.surneu.2005.12.037.
[15]黄季晨, 钱邦平, 邱勇. 寰枢椎后路融合术后下颈椎曲度及退变影响因素的研究进展[J]. 中国脊柱脊髓杂志, 2016, 26(6):545-548. DOI:10.3969/j.issn.1004-406X.2016.06.10.
[16]Toyama Y, Matsumoto M, Chiba K, et al. Realignment of postoperative cervical kyphosis in children by vertebral remodeling[J] .Spine (Phila Pa 1976), 1994, 19: 2565-70. DOI:10.1097/00007632-199411001-00012.
[17] Passias PG ,Wang S , Kozanek M , et al. Relationship between the alignment of the occipitoaxial and subaxial cervical spine in patients with congenital atlantoxial dislocations[J]. J Spinal Disord Tech, 2013, 26(1):15-21. DOI:10.1097/BSD.0b013e31823097f9.
[18]Oshima S , Sudo H , Ito M , et al. Subaxial sagittal alignment after atlantoaxial fixation techniques[J]. J Spinal Disord Tech, 2015, 28(1):E49-E55. DOI:10.1097/BSD.0000000000000144.
[19]Passias PG ,Wang S, Zhao D , et al. The reversibility of swan neck deformity in chronic atlantoaxial dislocations[J]. Spine, 2013, 38(7):379-85. DOI:10.1097/BRS.0b013e31828625e4.
[20] Sherekar SK ,Yadav YR , Basoor AS , et al. Clinical implications of alignment of upper and lower cervical spine[J]. Neurology India, 2006, 54(3):264-267. DOI:10.1080/09638288.2019.1571638.
[21]Guo Q, Ni B, Yang J, et al. Relation between alignments of upper and subaxial cervical spine: a radiological study[J]. Arch Orthop Trauma Surg, 2011, 131(6):857-862. DOI:10.1007/s00402-011-1265-x.
PDF(2864 KB)
