Defining Cervical Sagittal Plane Deformity - When Are Sagittal Realignment Procedures Necessary in Patients Presenting Primarily With Radiculopathy or Myelopathy?

Abstract

Objective: It remains unclear whether cervical sagittal deformity (CSD) should be defined by radiographic parameters alone versus both clinical and radiographic factors, and whether radiographic malalignment by itself warrants a CSD corrective surgery in patients who present primarily with neurologic symptoms.

Methods: We administered a survey to a group of expert surgeons to evaluate whether radiographic parameters alone were sufficient to diagnose CSD, and in which scenarios surgeons recommend a CSD realignment procedure versus addressing the neurologic symptoms alone.

Results: No single radiographic criteria reached a 50% threshold as being sufficient to establish the diagnosis of CSD. When asymptomatic radiographic malalignment was present, a sagittal deformity correction was more likely to be recommended in patients with myelopathy versus those with radiculopathy alone. The majority of surgeons recommended deformity correction when symptoms of cervical deformity were present in addition to radiographic malalignment (85% with deformity symptoms and radiculopathy, 93% with deformity symptoms and myelopathy).

Conclusion: There is no consensus on which radiographic and/or clinical criteria are necessary to define the presence of CSD. We recommend that symptoms of cervical deformity, in addition to radiographic parameters, be considered when deciding whether to perform deformity correction in patients who present primarily with myelopathy or radiculopathy.

Keywords: Cervical spine deformity; Deformity correction; Kyphosis; Myelopathy; Radiculopathy; Spinal cord compression.

Fig. 1.

Representative patients all with symptoms of radiculopathy and/or myelopathy with radiographic malalignment. (A, B) Patient with cervical radiculopathy with no neck pain, C2–7 SVA > 4 cm, and C2–7 kyphosis > 10°. (C, D) Patient with cervical myelopathy with chronic axial neck pain, C2–7 SVA > 4 cm, C2–7 kyphosis > 10°, but no visual appearance of deformity and no difficulty with horizontal gaze or holding one’s head upright. (E, F) Patient with cervical myelopathy with axial neck pain, difficulty holding his head upright, unable to maintain horizontal gaze, C2–7 SVA > 4 cm, C2–7 kyphosis > 10°.