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Correlation of fused segmental and total cervical spine alignment in patients with subaxial cervical spine traumatic injury in late postoperative period.

Sagittal balance of operated cervical spine has a great influence on the intensity of pain syndrome, the overall quality of life, the speed and quality of consolidation, and the rate of progression of adjacent segment degeneration.


AIM
The aim of this study was to determine the correlation of the local segmental and the total sagittal alignment of cervical spine when performing anterior cervical corpectomy and fusion (ACCF) using different vertebral body replacement systems.


MATERIALS AND METHODS
A retrospective analysis of late postoperative radiographs of 260 patients, who underwent ACCF due to subaxial traumatic injury of the cervical spine, was performed. Total cervical lordosis (TCL) and operated segment lordosis (OSL) were measured. Patients were divided into 2 groups depending on type of fusion system (first group: mesh + ventral plate, second: telescopic implant).


RESULTS
The average TCL value in patients of the first group was 14.52o (95% CI 11.75o; 17.29o), while in the second group it was 21.58o (95% CI 19.58o; 23.58o), with the range of values being significantly wider in the first group (- 3.5o ..35o) as compared to the second one (3.5o..33.5o). In the first group, the range of OSL varies from 0o to 5.5o, with mean 3.406o (95% CI 2.9354o; 3.8786o) and in second group OSL = 4.153o (95% CI 3.8453o; 4.4608o) and range from 2o to 6o. The difference between the groups is statistically significant (p = 0.0093). Moderate correlation of TCL and OSL (r = 0.702) is recorded in the first group, whereas strong (r = 0.883) the second one.


CONCLUSIONS
OSL and TCL in patients one year after performing ACCF may have a linear correlation. The use of monoconstruction probably ensures greater safety of the intraoperatively formed OSL and provides more lordotic TCL. With OSL having equal values, the use of monoconstruction can provide higher TCL indices in comparison with the usage of the combination of a cylinder titanium mesh implant and a ventral plate.