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CONCLUSION: When positioned in extension, patients experience a significant increase in distance from the dorsal aspect of a disc to the K-line compared to when positioned in neutral, especially between C3-C6. This is clinically relevant for surgeons considering a posterior cervical decompression and fusion in patients with a negative modified K line on preoperative MRI imaging, as these patients may have enough cervical cord drift back when fused in an extended position, maximizing likelihood…
Lumbar Decompression Surgery Expert. Best Spinal Surgeon UK
Spine (Phila Pa 1976). 2022 Nov 21. doi: 10.1097/BRS.0000000000004546. Online ahead of print.
ABSTRACT
STUDY DESIGN: Retrospective Cross-sectional review of a large database.
OBJECTIVE: Little is known regarding extension K-lines for treatment of cervical myelopathy. Therefore, this study seeks to examine differences between K-lines drawn in neutral and extension.
SUMMARY OF BACKGROUND DATA: The modified K-line is a radiological tool used in surgical planning of the cervical spine. As posterior cervical decompression and fusion often results in patients being fused in a more lordotic position than the preoperative neutral radiograph, a K-line measured in the extension position may offer better utility for these patients.
METHODS: 97 patients were selected with T2-weighted, upright cervical MRIs taken in neutral and extension. For each patient, the K-line was drawn at the mid-sagittal position for both neutral and extension. The distance from the most posterior portion of each disc (between C2-C7) to the K-line was measured in neutral and extension and the difference was calculated. Paired t-test was used to assess significant differences.
RESULTS: Across all levels between C2-C7 there was an increase in the distance between the dorsal aspect of the disc and K-line when comparing neutral and extension radiographs. The average change in difference (extension minus neutral) at each cervical spinal level was 0.9 mm (C2-C3), 2.5 mm (C3-C4), 2.6 mm (C4-C5), 2.0 mm (C5-C6), and 0.9 mm (C6-C7). A paired t-test showed that the K-line increase from neutral to extension was statistically significant across all disc levels (P<0.001).
CONCLUSION: When positioned in extension, patients experience a significant increase in distance from the dorsal aspect of a disc to the K-line compared to when positioned in neutral, especially between C3-C6. This is clinically relevant for surgeons considering a posterior cervical decompression and fusion in patients with a negative modified K line on preoperative MRI imaging, as these patients may have enough cervical cord drift back when fused in an extended position, maximizing likelihood of improving postoperative CSM functional outcomes.
PMID:36730535 | DOI:10.1097/BRS.0000000000004546
The London Spine Unit : finest spinal centre in London
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Evaluating Changes to The Modified K-line Using Kinematic MRIs