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The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery

Publication ,  Journal Article
Passias, PG; Horn, SR; Raman, T; Brown, AE; Lafage, V; Lafage, R; Smith, JS; Bortz, CA; Segreto, FA; Pierce, KE; Alas, H; Line, BG; Diebo, BG ...
Published in: Journal of Craniovertebral Junction and Spine
July 1, 2019

Introduction: Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes. Methods: Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, C2-C7 sagittal vertical axis (cSVA) >4 cm, and chin-brow vertical angle > 25°. Patients were evaluated for level and type of cervical osteotomy. Results: 86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m2). 141 osteotomies were in the cervical spine and 79 were in the thoracic spine. There were 19 major osteotomies performed, with 47% at T1. Patients with an osteotomy in the cervical spine improved in T1 slope minus CL (TS - CL), CL, and C2 slope (all P < 0.05). Patients with upper thoracic osteotomies improved in TS - CL, cSVA, C2-T3, C2-T3 sagittal vertical axis (SVA), and C2 slope (all P < 0.05). Minor osteotomies in the upper thoracic spine showed improvement in cSVA (63 mm to 49 mm, P = 0.022), C2-T3 ( P = 0.007), and SVA (-16 mm to 27 mm, P < 0.001). The greatest amount of C2-T3 angular change occurred for patients with a major osteotomy at T2 (39.1° change), then T3 (15.7°), C7 (16.9°°), and T1 (13.5°°). Patients with a major osteotomy in the upper thoracic spine showed similar radiographic changes from pre- to post-operative as patients with three or more minor osteotomies, although C2-T3 SVA trended toward greater improvement with a major osteotomy (-22.5 mm vs. +5.9 mm, P = 0.058) due to lever arm effect. Conclusions: CD patients undergoing osteotomies in the cervical and upper thoracic spine experienced improvement in TS - CL and C2 slope. In the upper thoracic spine, multiple minor osteotomies achieved similar alignment changes to major osteotomies at a single level, while a major osteotomy focused at T2 had the greatest overall impact in cervicothoracic and global alignment in CD patients.

Duke Scholars

Published In

Journal of Craniovertebral Junction and Spine

DOI

EISSN

0976-9285

ISSN

0974-8237

Publication Date

July 1, 2019

Volume

10

Issue

3

Start / End Page

160 / 166

Related Subject Headings

  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

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Chicago
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Passias, P. G., Horn, S. R., Raman, T., Brown, A. E., Lafage, V., Lafage, R., … Ames, C. P. (2019). The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery. Journal of Craniovertebral Junction and Spine, 10(3), 160–166. https://doi.org/10.4103/jcvjs.JCVJS_53_19
Passias, P. G., S. R. Horn, T. Raman, A. E. Brown, V. Lafage, R. Lafage, J. S. Smith, et al. “The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery.” Journal of Craniovertebral Junction and Spine 10, no. 3 (July 1, 2019): 160–66. https://doi.org/10.4103/jcvjs.JCVJS_53_19.
Passias PG, Horn SR, Raman T, Brown AE, Lafage V, Lafage R, et al. The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery. Journal of Craniovertebral Junction and Spine. 2019 Jul 1;10(3):160–6.
Passias, P. G., et al. “The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery.” Journal of Craniovertebral Junction and Spine, vol. 10, no. 3, July 2019, pp. 160–66. Scopus, doi:10.4103/jcvjs.JCVJS_53_19.
Passias PG, Horn SR, Raman T, Brown AE, Lafage V, Lafage R, Smith JS, Bortz CA, Segreto FA, Pierce KE, Alas H, Line BG, Diebo BG, Daniels AH, Kim HJ, Soroceanu A, Mundis GM, Protopsaltis TS, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery. Journal of Craniovertebral Junction and Spine. 2019 Jul 1;10(3):160–166.

Published In

Journal of Craniovertebral Junction and Spine

DOI

EISSN

0976-9285

ISSN

0974-8237

Publication Date

July 1, 2019

Volume

10

Issue

3

Start / End Page

160 / 166

Related Subject Headings

  • 3209 Neurosciences
  • 3202 Clinical sciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences