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Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity.

Publication ,  Journal Article
Smith, JS; Lafage, V; Schwab, FJ; Shaffrey, CI; Protopsaltis, T; Klineberg, E; Gupta, M; Scheer, JK; Fu, K-MG; Mundis, G; Hostin, R; Hart, R ...
Published in: Spine (Phila Pa 1976)
August 1, 2014

STUDY DESIGN: Multicenter, prospective, consecutive case series. OBJECTIVE: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. METHODS: Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°-30°, ++: >30°), C7-S1SVA (0: <4 cm, +: 4-9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10-20°, ++: >20°). RESULTS: A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION: Cervical deformity is highly prevalent (53%) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact. LEVEL OF EVIDENCE: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

August 1, 2014

Volume

39

Issue

17

Start / End Page

E1001 / E1009

Location

United States

Related Subject Headings

  • Young Adult
  • Spine
  • Scoliosis
  • Quality of Life
  • Prospective Studies
  • Prevalence
  • Orthopedics
  • Middle Aged
  • Male
  • Lordosis
 

Citation

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Smith, J. S., Lafage, V., Schwab, F. J., Shaffrey, C. I., Protopsaltis, T., Klineberg, E., … International Spine Study Group, . (2014). Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine (Phila Pa 1976), 39(17), E1001–E1009. https://doi.org/10.1097/BRS.0000000000000432
Smith, Justin S., Virginie Lafage, Frank J. Schwab, Christopher I. Shaffrey, Themistocles Protopsaltis, Eric Klineberg, Munish Gupta, et al. “Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity.Spine (Phila Pa 1976) 39, no. 17 (August 1, 2014): E1001–9. https://doi.org/10.1097/BRS.0000000000000432.
Smith JS, Lafage V, Schwab FJ, Shaffrey CI, Protopsaltis T, Klineberg E, et al. Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine (Phila Pa 1976). 2014 Aug 1;39(17):E1001–9.
Smith, Justin S., et al. “Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity.Spine (Phila Pa 1976), vol. 39, no. 17, Aug. 2014, pp. E1001–09. Pubmed, doi:10.1097/BRS.0000000000000432.
Smith JS, Lafage V, Schwab FJ, Shaffrey CI, Protopsaltis T, Klineberg E, Gupta M, Scheer JK, Fu K-MG, Mundis G, Hostin R, Deviren V, Hart R, Burton DC, Bess S, Ames CP, International Spine Study Group. Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine (Phila Pa 1976). 2014 Aug 1;39(17):E1001–E1009.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

August 1, 2014

Volume

39

Issue

17

Start / End Page

E1001 / E1009

Location

United States

Related Subject Headings

  • Young Adult
  • Spine
  • Scoliosis
  • Quality of Life
  • Prospective Studies
  • Prevalence
  • Orthopedics
  • Middle Aged
  • Male
  • Lordosis