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The change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis.
Clin Neurol Neurosurg. 2018 08; 171:21-25.CN

Abstract

OBJECTIVE

The postoperative change in cervical sagittal alignment has an impact on health-related quality of life in adolescent idiopathic scoliosis (AIS) patients who have undergone deformity correction. However, the effect of deformity correction on sagittal cervical profile is still controversial in the literatures. The objective of this study was to investigate the postoperative change in the cervical sagittal alignment of patients with AIS.

PATIENTS AND METHODS

A total of 46 AIS patients treated by posterior instrumentation and fusion with pedicle screw constructs were included in the study. Radiographs were collected preoperatively, immediate postoperatively and at the final follow-up. The C2-C7 Cobb angle and C2-C7 sagittal vertical axis (cSVA) were used to assess the cervical sagittal alignment. Spinopelvic alignment parameters, such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA), were also measured. The correlations between the cervical sagittal parameters and spinopelvic parameters were analyzed.

RESULTS

The incidence of cervical kyphosis was 67.4% preoperatively but increased to 87% postoperatively and 69.5% at the final follow-up. The C2-C7 Cobb angle significantly increased from pre-operation (-1.5° ± 15°) to post-operation (-5.4° ± 7.3°; P < 0.05) and spontaneously decreased to -2.9° ± 10.5° at the final follow up. The cSVA was 18.1 ± 13 mm preoperatively, 17 ± 12.3 mm after surgery and 18.5 ± 9.5 mm at the last follow-up, but the change was not statistically significant (P > 0.05). TK decreased significantly from pre-operation (17.7° ± 14.4°) to post-operation (14.2° ± 7.6°) and spontaneously improved to 16.9° ± 8.2° at the final follow-up. TK showed a significant correlation with the C2-C7 Cobb angle, but not with cSVA, in the preoperative (r = 0.709, P < 0.01), postoperative (r = 0.472, P < 0.01), and last follow-up measurements(r = 0.505, P < 0.01). Compared with patients with preoperative thoracic hypokyphosis or hyperkyphosis, patients with a normal thoracic spine had more significant postoperative changes in the C2-C7 Cobb angle and TK.

CONCLUSIONS

Cervical sagittal alignment after deformity correction is altered in AIS patients. An increase in cervical kyphosis after surgery is correlated with a loss of thoracic kyphosis. The change in the cervical sagittal profile may be a compensatory mechanism in response to an abnormal thoracic sagittal profile.

Authors+Show Affiliations

Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China. Electronic address: shiganluo@yahoo.com.Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China. Electronic address: zhongzm@smu.edu.cn.Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China. Electronic address: 409725683@qq.com.Department of Spinal Surgery, Nanfang Hospital, Southern Medical University, 1838 North Guangzhou Avenue, Guangzhou, 510515, China. Electronic address: chenjt99@tom.com.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

29803090

Citation

Luo, Shi-Gan, et al. "The Change of Cervical Sagittal Alignment After Surgery for Adolescent Idiopathic Scoliosis." Clinical Neurology and Neurosurgery, vol. 171, 2018, pp. 21-25.
Luo SG, Zhong ZM, Zhu SY, et al. The change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis. Clin Neurol Neurosurg. 2018;171:21-25.
Luo, S. G., Zhong, Z. M., Zhu, S. Y., & Chen, J. T. (2018). The change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis. Clinical Neurology and Neurosurgery, 171, 21-25. https://doi.org/10.1016/j.clineuro.2018.04.019
Luo SG, et al. The Change of Cervical Sagittal Alignment After Surgery for Adolescent Idiopathic Scoliosis. Clin Neurol Neurosurg. 2018;171:21-25. PubMed PMID: 29803090.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The change of cervical sagittal alignment after surgery for adolescent idiopathic scoliosis. AU - Luo,Shi-Gan, AU - Zhong,Zhao-Ming, AU - Zhu,Si-Yuan, AU - Chen,Jian-Ting, Y1 - 2018/04/22/ PY - 2018/01/04/received PY - 2018/04/07/revised PY - 2018/04/21/accepted PY - 2018/5/29/pubmed PY - 2019/10/18/medline PY - 2018/5/27/entrez KW - Adolescent idiopathic scoliosis KW - Cervical lordosis KW - Sagittal alignment KW - Thoracic kyphosis SP - 21 EP - 25 JF - Clinical neurology and neurosurgery JO - Clin Neurol Neurosurg VL - 171 N2 - OBJECTIVE: The postoperative change in cervical sagittal alignment has an impact on health-related quality of life in adolescent idiopathic scoliosis (AIS) patients who have undergone deformity correction. However, the effect of deformity correction on sagittal cervical profile is still controversial in the literatures. The objective of this study was to investigate the postoperative change in the cervical sagittal alignment of patients with AIS. PATIENTS AND METHODS: A total of 46 AIS patients treated by posterior instrumentation and fusion with pedicle screw constructs were included in the study. Radiographs were collected preoperatively, immediate postoperatively and at the final follow-up. The C2-C7 Cobb angle and C2-C7 sagittal vertical axis (cSVA) were used to assess the cervical sagittal alignment. Spinopelvic alignment parameters, such as thoracic kyphosis (TK), lumbar lordosis (LL), pelvic incidence (PI), sacral slope (SS), pelvic tilt (PT), and sagittal vertical axis (SVA), were also measured. The correlations between the cervical sagittal parameters and spinopelvic parameters were analyzed. RESULTS: The incidence of cervical kyphosis was 67.4% preoperatively but increased to 87% postoperatively and 69.5% at the final follow-up. The C2-C7 Cobb angle significantly increased from pre-operation (-1.5° ± 15°) to post-operation (-5.4° ± 7.3°; P < 0.05) and spontaneously decreased to -2.9° ± 10.5° at the final follow up. The cSVA was 18.1 ± 13 mm preoperatively, 17 ± 12.3 mm after surgery and 18.5 ± 9.5 mm at the last follow-up, but the change was not statistically significant (P > 0.05). TK decreased significantly from pre-operation (17.7° ± 14.4°) to post-operation (14.2° ± 7.6°) and spontaneously improved to 16.9° ± 8.2° at the final follow-up. TK showed a significant correlation with the C2-C7 Cobb angle, but not with cSVA, in the preoperative (r = 0.709, P < 0.01), postoperative (r = 0.472, P < 0.01), and last follow-up measurements(r = 0.505, P < 0.01). Compared with patients with preoperative thoracic hypokyphosis or hyperkyphosis, patients with a normal thoracic spine had more significant postoperative changes in the C2-C7 Cobb angle and TK. CONCLUSIONS: Cervical sagittal alignment after deformity correction is altered in AIS patients. An increase in cervical kyphosis after surgery is correlated with a loss of thoracic kyphosis. The change in the cervical sagittal profile may be a compensatory mechanism in response to an abnormal thoracic sagittal profile. SN - 1872-6968 UR - https://www.unboundmedicine.com/medline/citation/29803090/The_change_of_cervical_sagittal_alignment_after_surgery_for_adolescent_idiopathic_scoliosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0303-8467(18)30159-8 DB - PRIME DP - Unbound Medicine ER -