title: Correlation between cervical spine sagittal alignment and clinical outcome after anterior cervical discectomy and fusion.
abstract: Studies have shown that maintenance of lordosis improves outcomes after anterior cervical discectomy and fusion (ACDF). The relationship between maintenance or restoration of lordosis after ACDF and health-related quality of life (HRQOL) measures has not been evaluated.     Preoperative and 2-year postoperative cervical lordosis (C2-C7) and segmental lordosis were measured from upright lateral cervical spine radiographs in patients who had ACDF. Data on the Neck Disability Index (NDI), Short- Form-36 Physical Composite Summary Score, arm, and neck pain scores were also collected. Paired t-tests were used to compare preoperative and 2-year postoperative radiographic measures and HRQOL measures. Receiver operating characteristic curves were constructed to identify sagittal parameters that predict achievement of a Minimum Clinically Important Difference (MCID) in outcome measures.    One hundred one patients (75 female; mean age, 52 years) were included. There was improvement in all HRQOL measures from preoperative to 2 years postoperative. There was no significant difference in preoperative and 2-year postoperative sagittal alignment. Receiver operating characteristic curve analysis showed that a postoperative cervical lordosis of at least 6° predicted achievement of MCID for NDI (8 point change in NDI).    This suggests that maintenance or restoration of overall cervical lordosis is important in achieving a successful result after ACDF.
authors: Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, Kentucky, USA.
authors: Jeffrey L
authors: JL
authors: Gum
authors: Steven D
authors: SD
authors: Glassman
authors: Lonnie R
authors: LR
authors: Douglas
authors: Leah Y
authors: LY
authors: Carreon
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D017586:Diskectomy; D005260:Female; D006801:Humans; D008141:Lordosis / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D019547:Neck Pain / Q000000981:diagnostic imaging / Q000601:surgery; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D013123:Spinal Fusion; D016896:Treatment Outcome