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Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.

Publication ,  Journal Article
Oh, T; Scheer, JK; Eastlack, R; Smith, JS; Lafage, V; Protopsaltis, TS; Klineberg, E; Passias, PG; Deviren, V; Hostin, R; Gupta, M; Bess, S ...
Published in: J Neurosurg Spine
June 2015

OBJECT Alignment changes in the cervical spine that occur following surgical correction for thoracic deformity remain poorly understood. The purpose of this study was to evaluate such changes in a cohort of adults with thoracic deformity treated surgically. METHODS The authors conducted a multicenter retrospective analysis of consecutive patients with thoracic deformity. Inclusion criteria for this study were as follows: corrective osteotomy for thoracic deformity, upper-most instrumented vertebra (UIV) between T-1 and T-4, lower-most instrumented vertebra (LIV) at or above L-5 (LIV ≥ L-5) or at the ilium (LIV-ilium), and a minimum radiographic follow-up of 2 years. Sagittal radiographic parameters were assessed preoperatively as well as at 3 months and 2 years postoperatively, including the C-7 sagittal vertical axis (SVA), C2-7 cervical lordosis (CL), C2-7 SVA, T-1 slope (T1S), T1S minus CL (T1S-CL), T2-12 thoracic kyphosis (TK), apical TK, lumbar lordosis (LL), pelvic incidence (PI), PI-LL, pelvic tilt (PT), and sacral slope (SS). RESULTS Fifty-seven patients with a mean age of 49.1 ± 14.6 years met the study inclusion criteria. The preoperative prevalence of increased CL (CL > 15°) was 48.9%. Both 3-month and 2-year apical TK improved from baseline (p < 0.05, statistically significant). At the 2-year follow-up, only the C2-7 SVA increased significantly from baseline (p = 0.01), whereas LL decreased from baseline (p < 0.01). The prevalence of increased CL was 35.3% at 3 months and 47.8% at 2 years, which did not represent a significant change. Postoperative cervical alignment changes were not significantly different from preoperative values regardless of the LIV (LIV ≥ L-5 or LIV-ilium, p > 0.05 for both). In a subset of patients with a maximum TK ≥ 60° (35 patients) and 3-column osteotomy (38 patients), no significant postoperative cervical changes were seen. CONCLUSION Increased CL is common in adult spinal deformity patients with thoracic deformities and, unlike after lumbar corrective surgery, does not appear to normalize after thoracic corrective surgery. Cervical sagittal malalignment (C2-7 SVA) also increases postoperatively. Surgeons should be aware that spontaneous cervical alignment normalization might not occur following thoracic deformity correction.

Duke Scholars

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

June 2015

Volume

22

Issue

6

Start / End Page

658 / 665

Location

United States

Related Subject Headings

  • Young Adult
  • Thoracic Vertebrae
  • Spinal Fusion
  • Scoliosis
  • Retrospective Studies
  • Postoperative Complications
  • Osteotomy
  • Orthopedics
  • Middle Aged
  • Male
 

Citation

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Oh, T., Scheer, J. K., Eastlack, R., Smith, J. S., Lafage, V., Protopsaltis, T. S., … International Spine Study Group, . (2015). Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine, 22(6), 658–665. https://doi.org/10.3171/2014.10.SPINE14829
Oh, Taemin, Justin K. Scheer, Robert Eastlack, Justin S. Smith, Virginie Lafage, Themistocles S. Protopsaltis, Eric Klineberg, et al. “Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.J Neurosurg Spine 22, no. 6 (June 2015): 658–65. https://doi.org/10.3171/2014.10.SPINE14829.
Oh T, Scheer JK, Eastlack R, Smith JS, Lafage V, Protopsaltis TS, et al. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine. 2015 Jun;22(6):658–65.
Oh, Taemin, et al. “Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up.J Neurosurg Spine, vol. 22, no. 6, June 2015, pp. 658–65. Pubmed, doi:10.3171/2014.10.SPINE14829.
Oh T, Scheer JK, Eastlack R, Smith JS, Lafage V, Protopsaltis TS, Klineberg E, Passias PG, Deviren V, Hostin R, Gupta M, Bess S, Schwab F, Shaffrey CI, Ames CP, International Spine Study Group. Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up. J Neurosurg Spine. 2015 Jun;22(6):658–665.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

June 2015

Volume

22

Issue

6

Start / End Page

658 / 665

Location

United States

Related Subject Headings

  • Young Adult
  • Thoracic Vertebrae
  • Spinal Fusion
  • Scoliosis
  • Retrospective Studies
  • Postoperative Complications
  • Osteotomy
  • Orthopedics
  • Middle Aged
  • Male