Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.

Abstract

OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2-7 cervical lordosis (CL), C2-7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2-12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2-7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities and, unlike after lumbar corrective surgery, does not appear to normalize after thoracic corrective surgery. Cervical sagittal malalignment (C2-7 SVA) also increases postoperatively. Surgeons should be aware that spontaneous cervical alignment normalization might not occur following thoracic deformity correction.

Department

Description

Provenance

Subjects

International Spine Study Group, Thoracic Vertebrae, Humans, Kyphosis, Scoliosis, Postoperative Complications, Spinal Fusion, Osteotomy, Retrospective Studies, Follow-Up Studies, Adult, Aged, Aged, 80 and over, Middle Aged, Female, Male, Young Adult

Citation

Published Version (Please cite this version)

10.3171/2014.10.spine14829

Publication Info

Oh, Taemin, Justin K Scheer, Robert Eastlack, Justin S Smith, Virginie Lafage, Themistocles S Protopsaltis, Eric Klineberg, Peter G Passias, et al. (2015). Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. Journal of neurosurgery. Spine, 22(6). pp. 658–665. 10.3171/2014.10.spine14829 Retrieved from https://hdl.handle.net/10161/28504.

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Scholars@Duke

Passias

Peter Passias

Instructor in the Department of Orthopaedic Surgery

Throughout my medical career, I have remained dedicated to improving my patients' quality of life. As a specialist in adult cervical and spinal deformity surgery, I understand the significant impact our interventions have on individuals suffering from debilitating pain and physical and mental health challenges. Spinal deformity surgery merges the complexities of spinal biomechanics with the needs of an aging population. My research focuses on spinal alignment, biomechanics, innovative surgical techniques, and health economics to ensure value-based care that enhances patient outcomes.


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