Does Coronal Plane Deformity Matter in Cervicothoracic Kyphosis Corrective Surgery? The Prevalence of Cervical Scoliosis and Influence on the Outcomes of Cervical Deformity Surgery.

STUDY DESIGN: Retrospective review of a prospective, multicenter adult cervical deformity (CD) database. OBJECTIVE: Investigate the prevalence and clinical significance of combined cervical scoliosis (CS) and cervical kyphosis (CK) among patients undergoing surgical management of CD. SUMMARY OF BACKGROUND DATA: Although adult CD patients may have both CS and CK, few studies have confirmed prevalence of CK and CS and associated radiographic and clinical findings. METHODS: Patients undergoing surgery for CD (defined as C2-C7 ≥10° kyphosis, cervical sagittal vertical axis (SVA) >4 cm, or C2-C7 coronal Cobb angle ≥10°) were included. CS was defined as C2-C7 coronal Cobb angle ≥10°. RESULTS: 114 patients were included (mean age 62.5 y, 51.8% female). 14 patients (12.3%) had combined CS and CK, and 100 patients (87.7%) had CK alone. Pre-operative maximum cervical coronal Cobb angle was 3.9° in the CK alone group and 14.6° in the combined CS and CK group. In the combined CS and CK group, this value improved to 8.1° post-operatively (P=0.0007 vs. pre-operative), but CS ≥10° was still present in 3 patients, with a mean correction percentage of only 48.0% of initial CS.No significant differences were observed between the CK only and combined CS and CK groups with regard to baseline sagittal parameters, change between immediate post-operative and baseline sagittal parameters, surgical approach, age, or baseline HRQOL. Patients with combined CS and CK were more frequently female than patients with CK alone (85.7% vs. 41.2%, P=0.0066). CONCLUSIONS: The vast majority of patients presented with CK alone (88%), and only 12% of adult CD patients had combined CS and CK. Because of the significant residual coronal plane deformity-approximately 50%-surgical correction should be focused on both coronal and sagittal plane deformity in the combined CS and CK group.

Duke Scholars

Author Christopher Ignatius Shaffrey Orthopaedic Surgery