Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes

dc.contributor.author

Passias, Peter Gust

dc.contributor.author

Alas, Haddy

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Kummer, Nicholas

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Tretiakov, Peter

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Diebo, Bassel G

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Lafage, Renaud

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Ames, Christopher P

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Line, Breton

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Klineberg, Eric O

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Burton, Douglas C

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Uribe, Juan S

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Kim, Han Jo

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Daniels, Alan H

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Bess, Shay

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Protopsaltis, Themistocles

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Mundis, Gregory M

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Shaffrey, Christopher I

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Schwab, Frank J

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Smith, Justin S

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Lafage, Virginie

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International Spine Study Group

dc.date.accessioned

2023-06-15T17:26:42Z

dc.date.available

2023-06-15T17:26:42Z

dc.date.issued

2022-07-01

dc.date.updated

2023-06-15T17:26:42Z

dc.description.abstract

Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL). Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes. Materials and Methods: Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2-C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (-6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (<-28.43°) depending on directionality. Patients within 1SD were considered control group. Results: 102 surgical CD patients (61 years, 65% F, 30 kg/m 2) with BL and 1Y radiographic data were included. 20 patients met definitions for HK and 21 patients met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with posterior approach. Operative time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-SVA (10.8 vs. 7.0 vs. -47.8 mm, P = 0.001). HL patients had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had 3x revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL patients had higher cSVA and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK patients had higher McGregor's slope (MGS) (16.1° vs. 3.3°, P = 0.002) and C0-C2 Cobb (43.3° vs. 26.9°, P < 0.001), however, postoperative differences in MGS and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary CT (38.1%), UT (23.8%), and C (14.3%) drivers. Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1-year postoperative, perhaps due to undercorrection compared to kyphotic etiologies.

dc.identifier.issn

0974-8237

dc.identifier.issn

0976-9285

dc.identifier.uri

https://hdl.handle.net/10161/28009

dc.language

en

dc.publisher

Medknow

dc.relation.ispartof

Journal of Craniovertebral Junction and Spine

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10.4103/jcvjs.jcvjs_66_21

dc.title

Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes

dc.type

Journal article

duke.contributor.orcid

Passias, Peter Gust|0000-0002-1479-4070|0000-0003-2635-2226

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

271

pubs.end-page

277

pubs.issue

3

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

13

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