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 - The International Spine Study Group
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
N1 - Publisher Copyright:
© 2017 Elsevier Inc.
PY - 2018/4
Y1 - 2018/4
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
UR - http://www.scopus.com/inward/record.url?scp=85042363961&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85042363961&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2017.12.024
DO - 10.1016/j.wneu.2017.12.024
M3 - Article
C2 - 29248781
AN - SCOPUS:85042363961
SN - 1878-8750
VL - 112
SP - e61-e68
JO - World Neurosurgery
JF - World Neurosurgery
ER -