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At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery?

Publication ,  Journal Article
Passias, PG; Pierce, KE; Naessig, S; Ahmad, W; Passfall, L; Lafage, R; Lafage, V; Kim, HJ; Daniels, A; Eastlack, R; Klineberg, E; Line, B ...
Published in: Spine (Phila Pa 1976)
October 15, 2021

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to investigate the impact of cervical to thoracolumbar ratios on poor outcomes in cervical deformity (CD) corrective surgery. SUMMARY OF BACKGROUND DATA: Consideration of distal regional and global alignment is a critical determinant of outcomes in CD surgery. For operative CD patients, it is unknown whether certain thoracolumbar parameters play a significant role in poor outcomes and whether addressing such parameters is warranted. METHODS: Included: surgical CD patients (C2-C7 Cobb >10°, cervical lordosis [CL] >10°, C2-C7 sagittal vertical axis (cSVA) >4 cm, or chin-brow vertical angle >25°) with baseline and 1-year data. Patients were assessed for ratios of preop cervical and global parameters including: C2 Slope/T1 slope, T1 slope minus C2-C7 lordosis (TS-CL)/mismatch between pelvic incidence and lumbar lordosis (PI-LL), cSVA/sagittal vertical axis (SVA). Deformity classification ratios of cervical (Ames-ISSG) to spinopelvic (SRS-Schwab) were investigated: cSVA modifier/SVA modifier, TS-CL modifier/PI-LL modifier. Cervical to thoracic ratios included C2-C7 lordosis/T4-T12 kyphosis. Correlations assessed the relationship between ratios and poor outcomes (major complication, reoperation, distal junctional kyphosis (DJK), or failure to meet minimal clinically important difference [MCID]). Decision tree analysis through multiple iterations of multivariate regressions assessed cut-offs for ratios for acquiring suboptimal outcomes. RESULTS: A total of 110 CD patients were included (61.5 years, 66% F, 28.8 kg/m2). Mean preoperative radiographic ratios calculated: C2 slope/T1 slope of 1.56, TS-CL/PI-LL of 11.1, cSVA/SVA of 5.4, CL/thoracic kyphosis (TK) of 0.26. Ames-ISSG and SRS-Schwab modifier ratios: cSVA/SVA of 0.1 and TS-CL/PI-LL of 0.35. Pearson correlations demonstrated a relationship between major complications and baseline TS-CL/PI-LL, Ames TS-CL/Schwab PI-LL modifiers, and the CL/TK ratios (P < 0.050). Reoperation had significant correlation with TS-CL/PI-LL and cSVA/SVA ratios. Postoperative DJK correlated with C2 slope/T1 slope and CL/TK ratios. Not meeting MCID for Neck Disability Index (NDI) correlated with CL/TK ratio and not meeting MCID for EQ5D correlated with Ames TS-CL/Schwab PI-LL. CONCLUSION: Consideration of cervical to global alignment is a critical determinant of outcomes in CD corrective surgery. Key ratios of cervical to global alignment correlate with suboptimal clinical outcomes. A larger cervical lordosis to TK predicted postoperative complication, DJK, and not meeting MCID for NDI.Level of Evidence: 4.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2021

Volume

46

Issue

20

Start / End Page

E1113 / E1118

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Postoperative Period
  • Orthopedics
  • Lordosis
  • Kyphosis
  • Humans
  • Cervical Vertebrae
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
  • 3202 Clinical sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Passias, P. G., Pierce, K. E., Naessig, S., Ahmad, W., Passfall, L., Lafage, R., … International Spine Study Group, . (2021). At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery? Spine (Phila Pa 1976), 46(20), E1113–E1118. https://doi.org/10.1097/BRS.0000000000004045
Passias, Peter G., Katherine E. Pierce, Sara Naessig, Waleed Ahmad, Lara Passfall, Renaud Lafage, Virginie Lafage, et al. “At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery?Spine (Phila Pa 1976) 46, no. 20 (October 15, 2021): E1113–18. https://doi.org/10.1097/BRS.0000000000004045.
Passias PG, Pierce KE, Naessig S, Ahmad W, Passfall L, Lafage R, et al. At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery? Spine (Phila Pa 1976). 2021 Oct 15;46(20):E1113–8.
Passias, Peter G., et al. “At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery?Spine (Phila Pa 1976), vol. 46, no. 20, Oct. 2021, pp. E1113–18. Pubmed, doi:10.1097/BRS.0000000000004045.
Passias PG, Pierce KE, Naessig S, Ahmad W, Passfall L, Lafage R, Lafage V, Kim HJ, Daniels A, Eastlack R, Klineberg E, Line B, Mummaneni P, Hart R, Burton D, Bess S, Schwab F, Shaffrey C, Smith JS, Ames CP, International Spine Study Group. At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery? Spine (Phila Pa 1976). 2021 Oct 15;46(20):E1113–E1118.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

October 15, 2021

Volume

46

Issue

20

Start / End Page

E1113 / E1118

Location

United States

Related Subject Headings

  • Retrospective Studies
  • Postoperative Period
  • Orthopedics
  • Lordosis
  • Kyphosis
  • Humans
  • Cervical Vertebrae
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
  • 3202 Clinical sciences