A Comparison of Three Different Positioning Techniques on Surgical Corrections and Postoperative Alignment in Cervical Spinal Deformity (CD) Surgery

Kyle W. Morse, MD; Renaud Lafage, MS; Peter Passias, MD; Christopher P. Ames, MD; Robert Hart, MD; Christopher I. Shaffrey, MD; Gregory Mundis, MD; Themistocles Protopsaltis, MD; Munish Gupta, MD; Eric Klineberg, MD; Doug Burton, MD; Virginie Lafage, PhD; Han Jo. Kim, MD


Spine. 2021;46(9):567-570. 

In This Article


Baseline Characteristics and Postoperative Radiographic Parameters

There were no differences in baseline cervical radiographic parameters, demographics, primary versus revision surgery, or preoperative sagittal flexibility between groups (P > 0.05). The most common Upper Instrumented Vertebral (UIV) levels were C2 (59%) and C3 (28%). The bivector traction group had the most levels fused compared with halo ring and Mayfield (13.8 vs. 8.9 vs. 8.9 levels, P < 0.004, respectively).

Cervical alignment improved across the entire cohort, however, neither the difference between preoperative to postoperative radiographic parameters nor postoperative alignment achieved were different amongst position groups (Table 4). Lastly, while there was a trend towards smaller postoperative C2–T3 SVA in the halo ring group, the difference was not statistically significant compared with bivector traction and Mayfield.

Segmental Correction

There was lordotic correction in the cervical spine with the majority of segmental correction achieved at C4–5–6 (Figure 1). Patients who had bivector traction applied had significantly more segmental correction at C7–T1–T2 compared with Mayfield and halo (Figure 1). No significant correlations existed between the number of levels fused and segmental correction (Pearson r, P > 0.05).

Figure 1.

Comparison of segmental correction between three different intraoperative positions: Mayfield skull clamp, bivector traction, and halo traction.