Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery

Peter G. Passias, Cole Bortz, Samantha Horn, Frank Segreto, Gregory Poorman, Cyrus Jalai, Alan Daniels, D. Kojo Hamilton, Han Jo Kim, Daniel Sciubba, Justin S. Smith, Brian Neuman, Christopher Shaffrey, Virginie Lafage, Renaud Lafage, Themistocles Protopsaltis, Christopher Ames, Robert Hart, Gregory Mundis, Robert Eastlack

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Objective: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. Methods: Inclusion: radiographic CD, age >18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. Results: A total of 73 patients (mean age, 61.8 years; 59% female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3%; CTJ, 31.5%; thoracic, 13.7%; and spinopelvic, 2.7%. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0%; +, 0.0%; ++, 80.0%). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26%; not, 0%; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. Conclusions: CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD.

Original languageEnglish (US)
JournalWorld Neurosurgery
DOIs
StateAccepted/In press - Jan 1 2018
Externally publishedYes

Fingerprint

Thorax
Quality of Life
Lordosis
Spine
Orthopedics
Thoracic Vertebrae
Cervical Vertebrae
Chin
Group Processes
Neck
Therapeutics
Surveys and Questionnaires

Keywords

  • Alignment
  • Cervical deformity
  • Cervical spine
  • Outcomes
  • Primary driver
  • Surgical correction

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery. / Passias, Peter G.; Bortz, Cole; Horn, Samantha; Segreto, Frank; Poorman, Gregory; Jalai, Cyrus; Daniels, Alan; Hamilton, D. Kojo; Kim, Han Jo; Sciubba, Daniel; Smith, Justin S.; Neuman, Brian; Shaffrey, Christopher; Lafage, Virginie; Lafage, Renaud; Protopsaltis, Themistocles; Ames, Christopher; Hart, Robert; Mundis, Gregory; Eastlack, Robert.

In: World Neurosurgery, 01.01.2018.

Research output: Contribution to journalArticle

Passias, PG, Bortz, C, Horn, S, Segreto, F, Poorman, G, Jalai, C, Daniels, A, Hamilton, DK, Kim, HJ, Sciubba, D, Smith, JS, Neuman, B, Shaffrey, C, Lafage, V, Lafage, R, Protopsaltis, T, Ames, C, Hart, R, Mundis, G & Eastlack, R 2018, 'Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery', World Neurosurgery. https://doi.org/10.1016/j.wneu.2017.12.024
Passias, Peter G. ; Bortz, Cole ; Horn, Samantha ; Segreto, Frank ; Poorman, Gregory ; Jalai, Cyrus ; Daniels, Alan ; Hamilton, D. Kojo ; Kim, Han Jo ; Sciubba, Daniel ; Smith, Justin S. ; Neuman, Brian ; Shaffrey, Christopher ; Lafage, Virginie ; Lafage, Renaud ; Protopsaltis, Themistocles ; Ames, Christopher ; Hart, Robert ; Mundis, Gregory ; Eastlack, Robert. / Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery. In: World Neurosurgery. 2018.
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title = "Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery",
abstract = "Objective: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. Methods: Inclusion: radiographic CD, age >18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. Results: A total of 73 patients (mean age, 61.8 years; 59{\%} female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3{\%}; CTJ, 31.5{\%}; thoracic, 13.7{\%}; and spinopelvic, 2.7{\%}. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0{\%}; +, 0.0{\%}; ++, 80.0{\%}). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26{\%}; not, 0{\%}; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. Conclusions: CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD.",
keywords = "Alignment, Cervical deformity, Cervical spine, Outcomes, Primary driver, Surgical correction",
author = "Passias, {Peter G.} and Cole Bortz and Samantha Horn and Frank Segreto and Gregory Poorman and Cyrus Jalai and Alan Daniels and Hamilton, {D. Kojo} and Kim, {Han Jo} and Daniel Sciubba and Smith, {Justin S.} and Brian Neuman and Christopher Shaffrey and Virginie Lafage and Renaud Lafage and Themistocles Protopsaltis and Christopher Ames and Robert Hart and Gregory Mundis and Robert Eastlack",
year = "2018",
month = "1",
day = "1",
doi = "10.1016/j.wneu.2017.12.024",
language = "English (US)",
journal = "World Neurosurgery",
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TY - JOUR

T1 - Drivers of Cervical Deformity Have a Strong Influence on Achieving Optimal Radiographic and Clinical Outcomes at 1 Year After Cervical Deformity Surgery

AU - Passias, Peter G.

AU - Bortz, Cole

AU - Horn, Samantha

AU - Segreto, Frank

AU - Poorman, Gregory

AU - Jalai, Cyrus

AU - Daniels, Alan

AU - Hamilton, D. Kojo

AU - Kim, Han Jo

AU - Sciubba, Daniel

AU - Smith, Justin S.

AU - Neuman, Brian

AU - Shaffrey, Christopher

AU - Lafage, Virginie

AU - Lafage, Renaud

AU - Protopsaltis, Themistocles

AU - Ames, Christopher

AU - Hart, Robert

AU - Mundis, Gregory

AU - Eastlack, Robert

PY - 2018/1/1

Y1 - 2018/1/1

N2 - Objective: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. Methods: Inclusion: radiographic CD, age >18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. Results: A total of 73 patients (mean age, 61.8 years; 59% female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3%; CTJ, 31.5%; thoracic, 13.7%; and spinopelvic, 2.7%. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0%; +, 0.0%; ++, 80.0%). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26%; not, 0%; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. Conclusions: CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD.

AB - Objective: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. Methods: Inclusion: radiographic CD, age >18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. Results: A total of 73 patients (mean age, 61.8 years; 59% female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3%; CTJ, 31.5%; thoracic, 13.7%; and spinopelvic, 2.7%. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0%; +, 0.0%; ++, 80.0%). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26%; not, 0%; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. Conclusions: CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD.

KW - Alignment

KW - Cervical deformity

KW - Cervical spine

KW - Outcomes

KW - Primary driver

KW - Surgical correction

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