Cervicothoracic Lordosis Can Influence Outcome After Posterior Cervical Spine Surgery

Albert Vincent Berthier Brasil*, Pablo Ramon Fruett da Costa, Antonio Delacy Martini Vial, Gabriel da Costa Barcellos, Eduardo Balverdu Zauk, Paulo Valdeci Worm, Marcelo Paglioli Ferreira, Nelson Pires Ferreira
Department of Neurosurgery, Hospital São José – Santa Casa de Misericórdia de Porto Alegre, Porto Alegre, Rio Grande do Sul, Brazil

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Creative Commons License
© 2018 Brasilet al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Neurosurgery, Hospital São José – Santa Casa de Misericórdia de Porto Alegre, Rua Annes Dias, 295, Centro Histórico, CEP 90020-090, Porto Alegre, RS, Brazil; Tel: +55-51-81289946; Email:



Previous studies on the correlation between cervical sagittal balance with improvement in quality of life showed significant results only for parameters of the anterior translation of the cervical spine (such as C2-C7 SVA).


We test whether a new parameter, cervicothoracic lordosis, can predict clinical success in this type of surgery.


The focused group involved patients who underwent surgical treatment of cervical degenerative disk disease by the posterior approach, due to myelopathy, radiculopathy or a combination of both. Neurologic deficit was measured before and after surgery with the Nurick Scale, postoperative quality of life, physical and mental components of SF-36 and NDI. Cervicothoracic lordosis and various sagittal balance parameters were also measured. Cervicothoracic lordosis was defined as the angle between: a) the line between the centroid of C2 and the centroid of C7; b) the line between the centroid of C7 and the centroid of T6. Correlations between postoperative quality of life and sagittal parameters were calculated.


Twenty-nine patients between 27 and 78 years old were evaluated. Surgery types were simple decompression (laminectomy or laminoforaminotomy) (3 patients), laminoplasty (4 patients) and laminectomy with fusion in 22 patients. Significant correlations were found for C2-C7 SVA and cervicothoracic lordosis. C2-C7 SVA correlated negatively with MCS (r=-0.445, p=0.026) and PCS (r=-0.405, p=0.045). Cervicothoracic lordosis correlated positively with MCS (r=0.554, p= 0.004) and PCS (r=0.462, p=0.020) and negatively with NDI (r=-0.416, p=0.031).


The parameter cervicothoracic lordosis correlates with improvement of quality life after surgery for cervical degenerative disk disease by the posterior approach.

Keywords: Cervicothoracic Lordosis, C2-C7 SVA, HRQOL, Posterior Approach, Cervical sagittal balance, Quality of life.