Preoperative Cervical Hyperlordosis and C2–T3 Angle are Correlated to Increased Risk of Post-Op Sagittal Spinal Pelvic Malalignment in Adult Spinal Deformity Patients at 2-Year Follow-Up

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<jats:sec><jats:title>Introduction</jats:title><jats:p> Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment and achieving optimal TL alignment in ASD surgery is unclear. This study assesses the relationship between preoperative cervical spinal parameters and global alignment following thoracolumbar ASD surgery at 2-year follow-up. </jats:p></jats:sec><jats:sec><jats:title>Patients and Methods</jats:title><jats:p> Using a multicenter prospective database of surgical patients with ASD, we included patients with 2-year follow-up and cervical X-rays. SRS-Schwab sagittal modifiers (PT, GA, and PI–LL) were assessed at 2-year postoperative as either normal (0) or abnormal (“ + ” or “ + +”). Patients were classified in the aligned group (AG) or maligned group (MG) if all the three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2–C7 SVA > 4 cm, C2–C7 SVA < 4 cm, cervical kyphosis (CL > 0), cervical lordosis (CL < 0), any deformity (C2C7 SVA > 4 cm or CL > 0), and both CD (C2C7 SVA > 4 cm and CL > 0). Univariate testing was performed using t test or chi-square test, looking at the following pre-op parameters: CD, C2–C7 SVA, C2–T3 SVA, CL, T1S, T1S–CL, C2–T3 angle, LL, TK, PT, C7–S1 SVA, and PI–LL. </jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p> A total of 184 patients met initial inclusion criteria with 70 in the AG and 34 in MG. Pre-op, patients in the MG had a higher cervical lordosis (11.7 vs. 4.9, p = 0.03), higher C2–T3 angle (13.59 vs. 4.9 p = 0.01), and higher PT ( p < 0.0001), higher SVA ( p < 0.0001), and higher PI–LL ( p < 0.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both the groups: MG and AG. There was no statistically significant difference in the amount of improvement over 2 years on the ODI or the SF-36 PCS. </jats:p></jats:sec><jats:sec><jats:title>Conclusion</jats:title><jats:p> Patients with 2-year sagittal TL malalignment also have preoperative sagittal TL malalignment and concomitant cervical hyperlordosis as a compensatory mechanism to maintain horizontal gaze. Cervical radiographs suggestive of cervical hyperlordosis should be followed up with complete standing radiographs to asses for sagittal TL malalignment. </jats:p></jats:sec>






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Passias, P, S Yang, A Soroceanu, J Scheer, F Schwab, C Shaffrey, HJ Kim, T Protopsaltis, et al. (2015). Preoperative Cervical Hyperlordosis and C2–T3 Angle are Correlated to Increased Risk of Post-Op Sagittal Spinal Pelvic Malalignment in Adult Spinal Deformity Patients at 2-Year Follow-Up. Global Spine Journal, 5(1_suppl). 10.1055/S-0035-1554519 Retrieved from

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Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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