title: Sagittal range of motion after extensive cervical fusion.
abstract: BACKGROUND
  Complicated cervical spine revision and deformity correction surgeries are becoming increasingly common. These challenging operations often necessitate fusion of the entire cervical spine. Patients frequently express concern over the likely loss of range of motion (ROM) of the neck postoperatively. However, we are aware of no study that specifically examines the sagittal cervical ROM after extensive cervical fusion.
  
  
  OBJECTIVE
  To characterize sagittal ROM after extensive cervical fusion.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Thirty patients were included.
  
  
  METHODS
  Radiographs at final follow-up were measured for cervical ROM by the occipitocervical and cervicosternal angles with the neck in full flexion and extension.
  
  
  METHODS
  The surgical and medical records at one tertiary referral academic institution were used to identify adults who had undergone extensive cervical fusion between 1996 and 2008. An "extensive cervical fusion" entailed an upper instrumented vertebra proximal to C3 and lower instrumented vertebra distal to C7. Radiographs at final follow-up were measured for cervical ROM by the occipitocervical and cervicosternal angles with the neck in full flexion and extension.
  
  
  RESULTS
  The average age at surgery was 58.3±10.0 years. The surgical levels were occiput-T1 (one patient), occiput-T4 (one patient), occiput-T6 (one patient), C1-T1 (one patient), C1-T2 (one patient), C2-T1 (nine patients), C2-T2 (eight patients), C2-T3 (six patients), and C2-T4 (two patients). Twenty-seven of the procedures were revisions. The other surgical indications were chin-on-chest deformity (one patient), cervical scoliosis (one patient), and multilevel cervical myelopathy (one patient). The mean follow-up period was 34.5±30.9 months (range, 6-154 months). The mean cervical ROM values by the occipitocervical and cervicosternal angles were 29.5±11.0° and 7.5±5.0°, respectively. The mean total cervical ROM value was 34.1±14.7°.
  
  
  CONCLUSIONS
  A substantial degree of sagittal ROM can be maintained after extensive surgical fusion of the cervical spine.
authors.affiliation: Department of Orthopaedic Surgery, Medical College of Hallym University, 896, Pyeongchon-dong, Dongan-gu, Anyang-si, Gyeonggi-do 431-070, Republic of Korea.
authors.forename: Moon Soo
authors.initials: MS
authors.lastname: Park
authors.affiliation: Department of Orthopaedic Surgery, University of Rochester School of Medicine and Dentistry, 601 Elmwood Ave., Rochester, NY 14642, USA.
authors.forename: Addisu
authors.initials: A
authors.lastname: Mesfin
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Geoffrey E
authors.initials: GE
authors.lastname: Stoker
authors.affiliation: Department of Orthopaedic Surgery, Chung-Ang University Hospital, Heukseok-dong, Dongjak-gu, 224-1, Seoul 156-861, Republic of Korea.
authors.forename: Kwang-Sup
authors.initials: KS
authors.lastname: Song
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA.
authors.forename: Carie
authors.initials: C
authors.lastname: Kennedy
authors.affiliation: Department of Orthopedic Surgery, Washington University School of Medicine, One Barnes-Jewish Hospital Plaza, Suite 11300, West Pavilion, Campus Box 8233, St. Louis, MO 63110, USA. Electronic address: riewd@wudosis.wustl.edu.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D011859:Radiography; D016059:Range of Motion, Articular / Q000502:physiology*; D012189:Retrospective Studies; D013123:Spinal Fusion / Q000009:adverse effects*; D016896:Treatment Outcome
keywords: Cervical ROM; cervicosternal angle; cervicothoracic fusion; craniocervical fusion; loss of cervical motion; occipitocervical fusion; occipitocervicothoracic fusion