TY - JOUR
T1 - Cervical compensatory alignment changes following correction of adult thoracic deformity
T2 - A multicenter experience in 57 patients with a 2-year follow-up
AU - International Spine Study Group
AU - Oh, Taemin
AU - Scheer, Justin K.
AU - Eastlack, Robert
AU - Smith, Justin S.
AU - Lafage, Virginie
AU - Protopsaltis, Themistocles S.
AU - Klineberg, Eric
AU - Passias, Peter G.
AU - Deviren, Vedat
AU - Hostin, Richard
AU - Gupta, Munish
AU - Bess, Shay
AU - Schwab, Frank
AU - Shaffrey, Christopher I.
AU - Ames, Christopher P.
N1 - Funding Information:
The International Spine Study Group Foundation, through which this study was conducted, is funded through research grants from DePuy Spine and individual donations. Dr. Klineberg has received speaker's fees from DePuy Synthes and AOSpine and has received clinical or research support from OREF, DePuy Synthes, and AOSpine for the study described. Dr. Bess is a consultant for K2 Medical and Allosource; has received clinical or research support from DePuy Synthes Spine for the study described; and has received support from Medtronic for non-study-related clinical or research effort. Dr. Ames is a consultant for DePuy, Stryker, and Medtronic; has direct stock ownership in Doctors Research Group and Baxano Surgical; holds a patent with Fish & Richardson, P.C.; and has received royalties from Aesculap and Biomet Spine. Dr. Lafage has direct stock ownership in and is an employee of Nemaris Inc.; has been a speaker for MSD, K2 Medical, DePuy, and NuVasive; and has received support from DePuy, SRS, ISSG, and NIH for non-study-related clinical or research effort. Dr. Schwab has direct stock ownership in Nemaris Inc.; holds a patent with MSD, K2 Medical, NuVasive, and Nemaris Inc.; is a consultant for MSD, DePuy, K2 Medical, and Medicrea; has been a speaker for MSD, Nemaris Inc., and K2 Medical; and has received support from DePuy, MSD, and AO for non-study-related clinical or research effort. Dr. Smith is a consultant for Biomet, NuVasive, Cerapedics, DePuy, and Medtronic; has received clinical or research support from DePuy/ISSG for the study described; has received support from DePuy/ISSG for non-study-related clinical or research effort; and has received royalties from Biomet. Dr. Gupta has direct stock ownership in Johnson & Johnson, Proctor & Gamble, Pfizer, and Pioneer; has received royalties from DePuy; and is a consultant for Medtronic, Medicrea, DePuy Synthes, and Orthofix. Dr. Deviren is a consultant for NuVasive, Guidepoint, and Stryker. Dr. Shaffrey is a consultant for Biomet, Globus, Medtronic, NuVasive, and Stryker; has direct stock ownership in NuVasive; and holds patents with and receives royalties from Biomet, Medtronic, and NuVasive. Dr. Eastlack is a consultant for NuVasive, Alphatec, Don Joy, DePuy/Synthes, Aesculap, Stryker, Invuity, Carevature, DiFusion, and K2 Medical; holds patents with Invuity, NuTech, and Globus; has direct stock ownership in NuVasive and Alphatec; has received clinical or research support from NuVasive and Pioneer/RTI for the study described; and is part of the speaker's bureau for Eli Lilly. Dr. Hostin is a consultant for DePuy Spine and has received clinical or research support from NuVasive, Seeger, DJO, DePuy Spine, and K2 Medical for the study described. Dr. Protopsaltis is a consultant for Medicrea, Biomet Spine, and DePuy Synthes Spine and has received support from Zimmer Spine for non-study-related clinical or research effort.
Publisher Copyright:
©AANS, 2015.
PY - 2015/6
Y1 - 2015/6
N2 - 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.
AB - 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.
KW - 3-Column osteotomy
KW - Adult spinal deformity
KW - Cervical deformity
KW - Reciprocal change
KW - Sharp angular kyphosis
KW - Thoracic deformity
UR - http://www.scopus.com/inward/record.url?scp=84938945048&partnerID=8YFLogxK
U2 - 10.3171/2014.10.SPINE14829
DO - 10.3171/2014.10.SPINE14829
M3 - Article
C2 - 25793468
AN - SCOPUS:84938945048
SN - 1547-5654
VL - 22
SP - 658
EP - 665
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 6
ER -