A Comparison of Three Different Positioning Techniques on Surgical Corrections and Postoperative Alignment in Cervical Spinal Deformity (CD) Surgery.

dc.contributor.author

Morse, Kyle W

dc.contributor.author

Lafage, Renaud

dc.contributor.author

Passias, Peter

dc.contributor.author

Ames, Christopher P

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Hart, Robert

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Shaffrey, Christopher I

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Mundis, Gregory

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Protopsaltis, Themistocles

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Gupta, Munish

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Klineberg, Eric

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Burton, Doug

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Lafage, Virginie

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Kim, Han Jo

dc.contributor.author

International Spine Study Group

dc.date.accessioned

2023-06-19T18:36:19Z

dc.date.available

2023-06-19T18:36:19Z

dc.date.issued

2021-05

dc.date.updated

2023-06-19T18:36:18Z

dc.description.abstract

Study design

Retrospective review of a prospective multicenter cervical deformity database.

Objective

To examine the differences in sagittal alignment correction between three positioning methods in cervical spinal deformity surgery (CD).

Summary of background data

Surgical correction for CD is technically demanding and various techniques are utilized to achieve sagittal alignment objectives. The effect of different patient positioning techniques on sagittal alignment correction following CD remains unknown.

Methods

Patients with sagittal deformity who underwent a posterior approach (with and without anterior approach) with an upper instrumented vertebra of C6 or above. Patients with Grade 5, 6, or 7 osteotomies were excluded. Positioning groups were Mayfield skull clamp, bivector traction, and halo ring. Preoperative lower surgical sagittal curve (C2-C7), C2-C7 sagittal vertical axis (cSVA), cervical scoliosis, T1 slope minus cervical lordosis (TS-CL), T1 slope (T1S), chin-brow vertebral angle (CBVA), C2-T3 curve, and C2-T3 SVA was assessed and compared with postoperative radiographs. Segmental changes were analyzed using the Fergusson method.

Results

Eighty patients (58% female) with a mean age of 60.6 ± 10.5 years (range, 31-83) were included. The mean postoperative C2-C7 lordosis was 7.8° ± 14 and C2-C7 SVA was 34.1 mm ± 15. There were overall significant changes in cervical alignment across the entire cohort, with improvements in T1 slope (P < 0.001), C2-C7 (P < 0.001), TS-CL (P < 0.001), and cSVA (P = 0.006). There were no differences postoperatively of any radiographic parameter between positioning groups (P > 0.05). The majority of segmental lordotic correction was achieved at C4-5-6 (mean 6.9° ± 11). Additionally, patients who had bivector traction applied had had significantly more segmental correction at C7-T1-T2 compared with Mayfield and halo traction (4.2° vs. 0.3° vs. -1.7° respectively, P < 0.027).

Conclusion

Postoperative cervical sagittal correction or alignment was not affected by patient position. The majority of segmental correction occurred at C4-5-6 across all positioning methods, while bivector traction had the largest corrective ability at the cervicothoracic junction.Level of Evidence: 4.
dc.identifier

00007632-202105010-00004

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28106

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0000000000003851

dc.subject

International Spine Study Group

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Cervical Vertebrae

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Humans

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Scoliosis

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Postoperative Care

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Osteotomy

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Retrospective Studies

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Prospective Studies

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Adult

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Aged

dc.subject

Aged, 80 and over

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Middle Aged

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Female

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Male

dc.subject

Patient Positioning

dc.title

A Comparison of Three Different Positioning Techniques on Surgical Corrections and Postoperative Alignment in Cervical Spinal Deformity (CD) Surgery.

dc.type

Journal article

duke.contributor.orcid

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

duke.contributor.orcid

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

pubs.begin-page

567

pubs.end-page

570

pubs.issue

9

pubs.organisational-group

Duke

pubs.organisational-group

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

46

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