Browsing by Author "Tishelman, Jared C"
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Item Open Access Should Sagittal Spinal Alignment Targets for Adult Spinal Deformity Correction Depend on Pelvic Incidence and Age?(Spine, 2020-02) Protopsaltis, Themistocles S; Soroceanu, Alexandra; Tishelman, Jared C; Buckland, Aaron J; Mundis, Gregory M; Smith, Justin S; Daniels, Alan; Lenke, Lawrence G; Kim, Han Jo; Klineberg, Eric O; Ames, Christopher P; Hart, Robert A; Bess, Shay; Shaffrey, Christopher I; Schwab, Frank J; Lafage, Virginie; International Spine Study Group (ISSG)Study design
Retrospective analysis.Objective
Determine whether deformity corrections should vary by pelvic incidence (PI).Summary of background data
Alignment targets for deformity correction have been reported for various radiographic parameters. The T1 pelvic-angle (TPA) has gained in applications for adult spinal deformity (ASD) surgical-planning since it directly measures spinal alignment separate from pelvic- and lower-extremity compensation. Recent studies have demonstrated that ASD corrections should be age specific.Methods
A prospective database of consecutive ASD patients was analyzed in conjunction with a normative spine database. Clinical measures of disability included the Oswestry Disability Index (ODI) and Short Form 36 Survey (SF-36) Physical Component Score (PCS). Baseline relationships between TPA, age, PI, and ODI/SF-36 PCS scores were analyzed in the ASD and asymptomatic patients. Linear regression modeling was used to determine alignment targets based on PI and age-specific normative SF-36-PCS values.Results
Nine hundred three ASD patients (mean 53.7 yr) and 111 normative subjects (mean 50.7 yr) were included. Patients were subanalyzed by PI: low, medium, high (<40, 40-75, >75); and age: elderly (>65 yr, n = 375), middle age (45-65 yr, n = 387), and young (18-45 yr, n = 141). TPA and SRS-Schwab parameters correlated with age and PI in ASD and normative subjects (r = 0.42, P < 0.0001). ODI correlated with PCS (r = 0.71, P < 0.0001). Linear regression analysis using age-normative SF-36-PCS values demonstrated that ideal spinopelvic alignment is less strict with increasing PI and age.Conclusion
Targets for ASD correction should vary by age and PI. This is demonstrated in both asymptomatic and ASD subjects. Using age-normative SF-36 PCS values, alignment targets are described for different age and PI categories. High-PI patients do not require as rigorous realignments to attain age-specific normative levels of health status. As such, sagittal spinal alignment targets increase with increasing age as well as PI.Level of evidence
3.Item Open Access The Importance of C2 Slope, a Singular Marker of Cervical Deformity, Correlates With Patient-reported Outcomes.(Spine, 2020-02) Protopsaltis, Themistocles S; Ramchandran, Subaraman; Tishelman, Jared C; Smith, Justin S; Neuman, Brian J; Jr, Gregory M Mundis; Lafage, Renaud; Klineberg, Eric O; Hamilton, D Kojo; LaFage, Virginie; Gupta, Munish C; Hart, Robert A; Schwab, Frank J; Burton, Douglas C; Bess, Shay; Shaffrey, Christopher I; Ames, Christopher P; International Spine Study GroupStudy design
Retrospective review of a prospectively collected database.Objective
To define a simplified singular measure of cervical deformity (CD), C2 slope (C2S), which correlates with postoperative outcomes.Summary of background data
Sagittal malalignment of the cervical spine, defined by the cervical sagittal vertical axis (cSVA) has been associated with poor outcomes following surgical correction of the deformity. There has been a proliferation of parameters to describe CD. This added complexity can lead to confusion in classifying, treating, and assessing outcomes of CD surgery.Methods
A prospective database of CD patients was analyzed. Inclusion criteria were cervical kyphosis>10°, cervical scoliosis>10°, cSVA>4 cm, or chin-brow vertical angle >25°. Patients were categorized into two groups and compared based on whether the apex of the deformity was in the cervical (C) or the cervicothoracic (CT) region. Radiographic parameters were correlated to C2S, T1 slope (T1S) and 1-year health-related quality-of-life outcomes as measured by the EuroQol 5 Dimension questionnaire (EQ5D), modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and the Neck Disability Index (NDI).Results
One hundred four CD patients (C = 74, CT = 30; mean age 61 yr, 56% women, 42% revisions) were included. CT patients had higher baseline cSVA and T1S (P < 0.05). C2S correlated with T1 slope minus cervical lordosis (TS-CL) (r = 0.98, P < 0.001) and C0-C2 angle, cSVA, CL, T1S (r = 0.37-0.65, P < 0.001). Correlation of cSVA with C0-C2 was weaker (r = 0.48, P < 0.001). At 1-year postoperatively, higher C2S correlated with worse EQ-5D (r = 0.28, P = 0.02); in CT patients, higher C2S correlated with worse NDI, modified Japanese Orthopedic Association Scale, numeric rating scale for neck pain, and EQ5D (all r > 0.5, P≤0.05). Using linear regression, moderate disability by EQ5D corresponded to C2S of 20°(r = 0.08). For CT patients, C2S = 17° corresponded to moderate disability by NDI (r = 0.4), and C2S = 20° by EQ5D (r = 0.25).Conclusion
C2S correlated with upper-cervical and subaxial alignment. C2S correlated strongly with TS-CL (R = 0.98, P < 0.001) because C2S is a mathematical approximation of TS-CL. C2S is a useful marker of CD, linking the occipitocervical and cervico-thoracic spine. C2S defines the presence of a mismatch between cervical lordosis and thoracolumbar alignment. Worse 1-year postoperative C2 slope correlated with worse health outcomes.Level of evidence
3.