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Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up.
Spine J. 2015 Aug 01; 15(8):1756-63.SJ

Abstract

BACKGROUND CONTEXT

Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear.

PURPOSE

This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up.

STUDY DESIGN/SETTING

This study is a retrospective review of a multicenter, prospective database.

PATIENT SAMPLE

Surgical ASD patients with 2-year follow-up and cervical X-rays were included.

OUTCOME MEASURES

The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]).

METHODS

Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20° and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ("0") or abnormal ("+" or "++"). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL.

RESULTS

One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36.

CONCLUSIONS

Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.

Authors+Show Affiliations

Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA. Electronic address: Peter.Passias@nyumc.org.Department of Orthopaedic Surgery, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada.Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 303 E Chicago Ave., Chicago, IL 60611, USA.Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.Department of Neurosurgery, University of Virginia Medical Center, 1215 Lee St, Charlottesville, VA 22903, USA.Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.Department of Orthopaedic Surgery, University of California-Davis, 4860 Y St, Sacramento, CA 95817, USA.Department of Orthopaedic Surgery, University of California-Davis, 4860 Y St, Sacramento, CA 95817, USA.San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr, La Jolla, CA 92037, USA.Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.Department of Orthopaedic Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR 97239, USA.Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 303 E Chicago Ave., Chicago, IL 60611, USA.Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA.Department of Neurosurgery, University of California-San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA.No affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, Non-U.S. Gov't

Language

eng

PubMed ID

25862507

Citation

Passias, Peter G., et al. "Magnitude of Preoperative Cervical Lordotic Compensation and C2-T3 Angle Are Correlated to Increased Risk of Postoperative Sagittal Spinal Pelvic Malalignment in Adult Thoracolumbar Deformity Patients at 2-year Follow-up." The Spine Journal : Official Journal of the North American Spine Society, vol. 15, no. 8, 2015, pp. 1756-63.
Passias PG, Soroceanu A, Scheer J, et al. Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up. Spine J. 2015;15(8):1756-63.
Passias, P. G., Soroceanu, A., Scheer, J., Yang, S., Boniello, A., Smith, J. S., Protopsaltis, T., Kim, H. J., Schwab, F., Gupta, M., Klineberg, E., Mundis, G., Lafage, R., Hart, R., Shaffrey, C., Lafage, V., & Ames, C. (2015). Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up. The Spine Journal : Official Journal of the North American Spine Society, 15(8), 1756-63. https://doi.org/10.1016/j.spinee.2015.04.007
Passias PG, et al. Magnitude of Preoperative Cervical Lordotic Compensation and C2-T3 Angle Are Correlated to Increased Risk of Postoperative Sagittal Spinal Pelvic Malalignment in Adult Thoracolumbar Deformity Patients at 2-year Follow-up. Spine J. 2015 Aug 1;15(8):1756-63. PubMed PMID: 25862507.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up. AU - Passias,Peter G, AU - Soroceanu,Alexandra, AU - Scheer,Justin, AU - Yang,Sun, AU - Boniello,Anthony, AU - Smith,Justin S, AU - Protopsaltis,Themistocles, AU - Kim,Han J, AU - Schwab,Frank, AU - Gupta,Munish, AU - Klineberg,Eric, AU - Mundis,Gregory, AU - Lafage,Renaud, AU - Hart,Robert, AU - Shaffrey,Christopher, AU - Lafage,Virginie, AU - Ames,Christopher, AU - ,, Y1 - 2015/04/08/ PY - 2014/10/15/received PY - 2015/02/26/revised PY - 2015/04/02/accepted PY - 2015/4/12/entrez PY - 2015/4/12/pubmed PY - 2016/2/26/medline KW - Adult spinal deformity KW - Alignment KW - Cervical deformity KW - HRQOL KW - Outcome KW - Radiographic parameter SP - 1756 EP - 63 JF - The spine journal : official journal of the North American Spine Society JO - Spine J VL - 15 IS - 8 N2 - BACKGROUND CONTEXT: Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear. PURPOSE: This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. STUDY DESIGN/SETTING: This study is a retrospective review of a multicenter, prospective database. PATIENT SAMPLE: Surgical ASD patients with 2-year follow-up and cervical X-rays were included. OUTCOME MEASURES: The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]). METHODS: Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20° and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ("0") or abnormal ("+" or "++"). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL. RESULTS: One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. CONCLUSIONS: Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction. SN - 1878-1632 UR - https://www.unboundmedicine.com/medline/citation/25862507/Magnitude_of_preoperative_cervical_lordotic_compensation_and_C2_T3_angle_are_correlated_to_increased_risk_of_postoperative_sagittal_spinal_pelvic_malalignment_in_adult_thoracolumbar_deformity_patients_at_2_year_follow_up_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1529-9430(15)00347-2 DB - PRIME DP - Unbound Medicine ER -