Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients

dc.contributor.author

Bortz, C

dc.contributor.author

Passias, PG

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Pierce, KE

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Alas, H

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Brown, A

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Naessig, S

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Ahmad, W

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Lafage, R

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Ames, CP

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Diebo, BG

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Line, BG

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Klineberg, EO

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Burton, DC

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Eastlack, RK

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Kim, HJ

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Sciubba, DM

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Soroceanu, A

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Bess, S

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Shaffrey, CI

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Schwab, FJ

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Smith, JS

dc.contributor.author

Lafage, V

dc.date.accessioned

2023-06-20T11:58:19Z

dc.date.available

2023-06-20T11:58:19Z

dc.date.issued

2020-04-01

dc.date.updated

2023-06-20T11:58:18Z

dc.description.abstract

Purpose: The aim is to assess the relationship between cervicothoracic inflection point and baseline disability, as well as the relationship between clinical outcomes and pre- to postoperative changes in inflection point. Methods: Cervical deformity (CD) patients with baseline and 3-month (3M) postoperative radiographic, clinical, and inflection data were grouped by region of inflection point: C6 or above, C6-C7 to C7-T1, T1, or below. Inflection was defined as: Distal-most level where cervical lordosis (CL) changes to thoracic kyphosis (TK). Differences in alignment and patient factors across pre- and postoperative inflection point groups were assessed, as were outcomes by the inclusion of inflection in the CD-corrective fusion construct. Results: A total of 108 patients were included. Preoperative inflection breakdown: C6 or above (42%), C6-C7 to C7-T1 (44%), T1 or below (15%). Surgery was associated with a caudal migration of inflection by 3M: C6 or above (8%), C6-C7 to C7-T1 (58%), T1 or below (33%). For patients with preoperative inflection T1 or below, the inclusion of inflection in the fusion construct was associated with improvements in horizontal gaze (McGregor's Slope included: -11.3° vs. not included: 1.6°, P = 0.038). The inclusion of preoperative inflection in fusion was associated with the superior cervical sagittal vertical axis (cSVA) changes for C6-C7 to C7-T1 patients (-5.2 mm vs. 3.2 mm, P = 0.018). The location of postoperative inflection was associated with variation in 3M alignment: Inflection C6 or above was associated with less Pelvic Tilt (PT), PT and a trend of larger cSVA. Location of inflection or inclusion in fusion was not associated with reoperation or distal junctional kyphosis. Conclusions: Incorporating the inflection point between CL and TK in the fusion construct was associated with superior restoration of cervical alignment and horizontal gaze for surgical CD patients.

dc.identifier.issn

0974-8237

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0976-9285

dc.identifier.uri

https://hdl.handle.net/10161/28155

dc.language

en

dc.publisher

Medknow

dc.relation.ispartof

Journal of Craniovertebral Junction and Spine

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10.4103/jcvjs.JCVJS_57_20

dc.title

Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients

dc.type

Journal article

duke.contributor.orcid

Shaffrey, CI|0000-0001-9760-8386

pubs.begin-page

131

pubs.end-page

138

pubs.issue

2

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

11

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