Does Surgical Intervention on Posterior Cervical Muscles During Posterior Cranial Fossa Surgery Alter Cervical Sagittal Alignment?

Abstract

Introduction: Posterior cervical muscles play a crucial role in maintaining cervical lordosis and may be disrupted by posterior cervical surgery. Numerous studies have explored the relationship between muscle preservation and cervical lordosis following posterior cervical surgeries. However, limited attention has been paid to the changes in cervical sagittal alignment after posterior cranial fossa surgery. This study assessed the impact of posterior cranial fossa surgery on cervical sagittal alignment.

Materials and Methods: This study included 21 patients who underwent lateral suboccipital craniotomy at our institution. Radiographic assessments were performed preoperatively and at 12 and 24 months postoperatively, using cervical lateral radiographs. Cervical alignment parameters, including the Cobb angle between the C2 and C7 inferior endplate (C2–7 Cobb angle), were measured over time. Patients were divided into two groups: lordosis (C2–7 Cobb angle ≥ 10°, n = 14) and straight or kyphosis (C2–7 Cobb angle < 10°, n = 7) groups.

Results: The Wilcoxon signed-rank test showed no significant differences between the pre-and postoperative data across all measured parameters (p > 0.05). However, when patients were stratified by their preoperative C2–7 Cobb angle, the postoperative C0–7 Cobb angle was significantly smaller than the preoperative value in patients in the straight/kyphosis group relative to those in the lordosis group (p = 0.03, Wilcoxon signed-rank test).

Conclusion: Sagittal cervical alignment was preserved after lateral suboccipital craniotomy. However, in patients with a straight or kyphotic alignment, posterior cranial fossa surgery can significantly affect occipitocervical parameters, warranting careful postoperative monitoring.