Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up

International Spine Study Group., Munish Gupta

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)658-665
Number of pages8
JournalJournal of neurosurgery. Spine
Volume22
Issue number6
DOIs
StatePublished - Jun 1 2015

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Lordosis
Thorax
Kyphosis
Spine
Ilium
Osteotomy
Incidence
Thoracic Surgery

Keywords

  • 3-column osteotomy
  • 3CO = 3-column osteotomy
  • adult spinal deformity
  • ASD = adult spinal deformity
  • cervical deformity
  • CL = cervical lordosis
  • LIV = lower-most instrumented vertebra
  • LL =lumbar lordosis
  • PI = pelvic incidence
  • PSO = pedicle subtraction osteotomy
  • PT = pelvic tilt
  • reciprocal change
  • sharp angular kyphosis
  • SPI = spinopelvic inclination
  • SS = sacral slope
  • SVA = sagittal vertical axis
  • T1S = T-1 slope
  • thoracic deformity
  • TK = thoracic kyphosis
  • UIV = uppermost instrumented vertebra
  • VCR = vertebral column resection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

Cervical compensatory alignment changes following correction of adult thoracic deformity : a multicenter experience in 57 patients with a 2-year follow-up. / International Spine Study Group.; Gupta, Munish.

In: Journal of neurosurgery. Spine, Vol. 22, No. 6, 01.06.2015, p. 658-665.

Research output: Contribution to journalArticle

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title = "Cervical compensatory alignment changes following correction of adult thoracic deformity: a multicenter experience in 57 patients with a 2-year follow-up",
abstract = "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.",
keywords = "3-column osteotomy, 3CO = 3-column osteotomy, adult spinal deformity, ASD = adult spinal deformity, cervical deformity, CL = cervical lordosis, LIV = lower-most instrumented vertebra, LL =lumbar lordosis, PI = pelvic incidence, PSO = pedicle subtraction osteotomy, PT = pelvic tilt, reciprocal change, sharp angular kyphosis, SPI = spinopelvic inclination, SS = sacral slope, SVA = sagittal vertical axis, T1S = T-1 slope, thoracic deformity, TK = thoracic kyphosis, UIV = uppermost instrumented vertebra, VCR = vertebral column resection",
author = "{International Spine Study Group.} and Taemin Oh and Scheer, {Justin K.} and Robert Eastlack and Smith, {Justin S.} and Virginie Lafage and Protopsaltis, {Themistocles S.} and Klineberg, {Eric Otto} and Passias, {Peter G.} and Vedat Deviren and Munish Gupta and Munish Gupta and Shay Bess and Frank Schwab and Shaffrey, {Christopher I.} and Ames, {Christopher P.}",
year = "2015",
month = "6",
day = "1",
doi = "10.3171/2014.10.SPINE14829",
language = "English (US)",
volume = "22",
pages = "658--665",
journal = "Journal of neurosurgery. Spine",
issn = "1547-5654",
publisher = "American Association of Neurological Surgeons",
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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 Otto

AU - Passias, Peter G.

AU - Deviren, Vedat

AU - Gupta, Munish

AU - Gupta, Munish

AU - Bess, Shay

AU - Schwab, Frank

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

PY - 2015/6/1

Y1 - 2015/6/1

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 - 3CO = 3-column osteotomy

KW - adult spinal deformity

KW - ASD = adult spinal deformity

KW - cervical deformity

KW - CL = cervical lordosis

KW - LIV = lower-most instrumented vertebra

KW - LL =lumbar lordosis

KW - PI = pelvic incidence

KW - PSO = pedicle subtraction osteotomy

KW - PT = pelvic tilt

KW - reciprocal change

KW - sharp angular kyphosis

KW - SPI = spinopelvic inclination

KW - SS = sacral slope

KW - SVA = sagittal vertical axis

KW - T1S = T-1 slope

KW - thoracic deformity

KW - TK = thoracic kyphosis

KW - UIV = uppermost instrumented vertebra

KW - VCR = vertebral column resection

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