Assessment of Surgical Treatment Strategies for Moderate to Severe Cervical Spinal Deformity Reveals Marked Variation in Approaches, Osteotomies, and Fusion Levels.

dc.contributor.author

Smith, Justin S

dc.contributor.author

Klineberg, Eric

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Shaffrey, Christopher I

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Lafage, Virginie

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Schwab, Frank J

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Protopsaltis, Themistocles

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Scheer, Justin K

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Ailon, Tamir

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Ramachandran, Subaraman

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Daniels, Alan

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Mundis, Gregory

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Gupta, Munish

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Hostin, Richard

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Deviren, Vedat

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Eastlack, Robert

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Passias, Peter

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Hamilton, D Kojo

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Hart, Robert

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Burton, Douglas C

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Bess, Shay

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Ames, Christopher P

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International Spine Study Group

dc.date.accessioned

2023-07-20T14:21:01Z

dc.date.available

2023-07-20T14:21:01Z

dc.date.issued

2016-07

dc.date.updated

2023-07-20T14:19:45Z

dc.description.abstract

Objective

Although previous reports suggest that surgery can improve the pain and disability of cervical spinal deformity (CSD), techniques are not standardized. Our objective was to assess for consensus on recommended surgical plans for CSD treatment.

Methods

Eighteen CSD cases were assembled, including a clinical vignette, cervical imaging (radiography, computed tomography/magnetic resonance imaging), and full-length standing radiography. Fourteen deformity surgeons (10 orthopedic, 4 neurosurgery) were queried regarding recommended surgical plans.

Results

There was marked variation in treatment plans across all deformity types. Even for the least complex deformities (moderate midcervical apex kyphosis), there was lack of agreement on approach (50% combined anterior-posterior, 25% anterior only, 25% posterior only), number of anterior (range, 2-6) and posterior (range, 4-16) fusion levels, and types of osteotomies. As the kyphosis apex moved caudally (cervical-thoracic junction/upper thoracic spine) and for cases with chin-on-chest kyphosis, >80% of surgeons agreed on a posterior-only approach and >70% recommended a pedicle subtraction osteotomy or vertebral column resection, but the range in number of anterior (4-8) and posterior (4-27) fusion levels was exceptionally broad. Cases of cervical/cervical-thoracic scoliosis had the least agreement for approach (48% posterior only, 33% combined anterior-posterior, 17% anterior-posterior-anterior or posterior-anterior-posterior, 2% anterior only) and had broad variation in the number of anterior (2-5) and posterior (6-19) fusion levels, and recommended osteotomies (41% pedicle subtraction osteotomy/vertebral column resection).

Conclusions

Among a panel of deformity surgeons, there was marked lack of consensus on recommended surgical approach, osteotomies, and fusion levels for CSD. Further study is warranted to assess whether specific surgical treatment approaches are associated with better outcomes.
dc.identifier

S1878-8750(16)30093-6

dc.identifier.issn

1878-8750

dc.identifier.issn

1878-8769

dc.identifier.uri

https://hdl.handle.net/10161/28465

dc.language

eng

dc.publisher

Elsevier BV

dc.relation.ispartof

World neurosurgery

dc.relation.isversionof

10.1016/j.wneu.2016.04.020

dc.subject

International Spine Study Group

dc.subject

Humans

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Spinal Curvatures

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Spinal Fusion

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Osteotomy

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Severity of Illness Index

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Consensus

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Aged

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Middle Aged

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Female

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Male

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Neurosurgeons

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Orthopedic Surgeons

dc.title

Assessment of Surgical Treatment Strategies for Moderate to Severe Cervical Spinal Deformity Reveals Marked Variation in Approaches, Osteotomies, and Fusion Levels.

dc.type

Journal article

duke.contributor.orcid

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

duke.contributor.orcid

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

pubs.begin-page

228

pubs.end-page

237

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

91

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