Primary drivers of adult cervical deformity: Prevalence, variations in presentation, and effect of surgical treatment strategies on early postoperative alignment

International Spine Study Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

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 χ 2 , 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.

Original languageEnglish (US)
Pages (from-to)651-659
Number of pages9
JournalClinical neurosurgery
Volume83
Issue number4
DOIs
StatePublished - Jan 1 2018

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Lordosis
Spine
Thorax
Incidence
Therapeutics
Chin
Kyphosis
Analysis of Variance

Keywords

  • Adult cervical deformity
  • Cervical spine
  • Cervicothoracic junction
  • Compensatory mechanisms
  • Postoperative alignment
  • Primary driver
  • Surgical correction

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Primary drivers of adult cervical deformity : Prevalence, variations in presentation, and effect of surgical treatment strategies on early postoperative alignment. / International Spine Study Group.

In: Clinical neurosurgery, Vol. 83, No. 4, 01.01.2018, p. 651-659.

Research output: Contribution to journalArticle

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title = "Primary drivers of adult cervical deformity: Prevalence, variations in presentation, and effect of surgical treatment strategies on early postoperative alignment",
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 χ 2 , 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.",
keywords = "Adult cervical deformity, Cervical spine, Cervicothoracic junction, Compensatory mechanisms, Postoperative alignment, Primary driver, Surgical correction",
author = "{International Spine Study Group} and Passias, {Peter G.} and Jalai, {Cyrus M.} and Virginie Lafage and Renaud Lafage and Themistocles Protopsaltis and Subaraman Ramchandran and Horn, {Samantha R.} and Poorman, {Gregory W.} and Munish Gupta and Robert Hart and Vedat Deviren and Alexandra Soroceanu and Smith, {Justin S.} and Frank Schwab and Shaffrey, {Christopher I.} and Ames, {Christopher P.}",
year = "2018",
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doi = "10.1093/neuros/nyx438",
language = "English (US)",
volume = "83",
pages = "651--659",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
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TY - JOUR

T1 - Primary drivers of adult cervical deformity

T2 - Prevalence, variations in presentation, and effect of surgical treatment strategies on early postoperative alignment

AU - International Spine Study Group

AU - Passias, Peter G.

AU - Jalai, Cyrus M.

AU - Lafage, Virginie

AU - Lafage, Renaud

AU - Protopsaltis, Themistocles

AU - Ramchandran, Subaraman

AU - Horn, Samantha R.

AU - Poorman, Gregory W.

AU - Gupta, Munish

AU - Hart, Robert

AU - Deviren, Vedat

AU - Soroceanu, Alexandra

AU - Smith, Justin S.

AU - Schwab, Frank

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

PY - 2018/1/1

Y1 - 2018/1/1

N2 - 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 χ 2 , 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.

AB - 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 χ 2 , 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.

KW - Adult cervical deformity

KW - Cervical spine

KW - Cervicothoracic junction

KW - Compensatory mechanisms

KW - Postoperative alignment

KW - Primary driver

KW - Surgical correction

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