Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment.
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2018-10
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Abstract
Background
Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction.Objective
To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms.Methods
Primary cervical deformity driver/vertebral apex level were determined: CS = cervical; CTJ = cervicothoracic junction; TH = thoracic; SP = spinopelvic. Patients were evaluated if surgery included PD apex, based on the lowest instrumented vertebra (LIV): CS: LIV ≤ C7, CTJ: LIV ≤ T3, TH: LIV ≤ T12. Cervical and thoracolumbar alignment was measured preoperatively and 3 mo (3M) postoperatively. PD groups were compared with analysis of variance/Pearson χ2, paired t-tests.Results
Eighty-four ACD patients met inclusion criteria. Thoracic drivers (n = 26) showed greatest preoperative cervical and global malalignment against other PD: higher thoracic kyphosis, pelvic incidence-lumbar lordosis (PI-LL), T1 slope C2-T3 sagittal vertical axis (SVA), and C0-2 angle (P < .05). Differences in baseline-3M alignment changes were observed between surgical PD groups, in PI-LL, LL, T1 slope minus cervical lordosis (TS-CL), cervical SVA, C2-T3 SVA (P < .05). Main changes were between TH and CS driver groups: TH patients had greater PI-LL (4.47° vs -0.87°, P = .049), TS-CL (-19.12° vs -4.30, P = .050), C2-C7 SVA (-18.12 vs -4.30 mm, P = .007), and C2-T3 SVA (-24.76 vs 8.50 mm, P = .002) baseline-3M correction. CTJ drivers trended toward greater LL correction compared to CS drivers (-6.00° vs 0.88°, P = .050). Patients operated at CS driver level had a difference in the prevalence of 3M TS-CL modifier grades (0 = 35.7%, 1 = 0.0%, 2 = 13.3%, P = .030). There was a significant difference in 3M chin-brow vertical angle modifier grade distribution in TH drivers (0 = 0.0%, 1 = 35.9%, 2 = 14.3%, P = .049).Conclusion
Characterizing ACD patients by PD type reveals differences in pre- and postoperative alignment. Evaluating surgical alignment outcomes based on PD inclusion is important in understanding alignment goals for ACD correction.Type
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Passias, Peter G, Cyrus M Jalai, Virginie Lafage, Renaud Lafage, Themistocles Protopsaltis, Subaraman Ramchandran, Samantha R Horn, Gregory W Poorman, et al. (2018). Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment. Neurosurgery, 83(4). pp. 651–659. 10.1093/neuros/nyx438 Retrieved from https://hdl.handle.net/10161/28246.
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Christopher Ignatius Shaffrey
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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