Global spinal deformity from the upper cervical perspective. What is 'Abnormal' in the upper cervical spine?

Peter G. Passias, Haddy Alas, Renaud Lafage, Bassel G. Diebo, Irene Chern, Christopher P. Ames, Paul Park, Khoi D. Than, Alan H. Daniels, D. Kojo Hamilton, Douglas C. Burton, Robert A. Hart, Shay Bess, Breton G. Line, Eric O. Klineberg, Christopher I. Shaffrey, Justin S. Smith, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

Abstract

Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers. Design: This was a retrospective review. Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity. Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] <45° and lumbar lordosis [LL] apex below L4; Type 2: PI <45° and LL apex above L4; Type 3:45°<PI <65°; and Type 4: PI >65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups. Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2-4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = -0.131, P = 0.015), CBVA (r = -0.473, P < 0.001), and C0S (r = -0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948-0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12-1.38], P < 0.001). Conclusions: Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes.

Original languageEnglish (US)
Pages (from-to)152-159
Number of pages8
JournalJournal of Craniovertebral Junction and Spine
Volume10
Issue number3
DOIs
StatePublished - Jul 1 2019

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Spine
Odds Ratio
Lordosis
Analysis of Variance
Thorax
Incidence

Keywords

  • Cervical spine
  • global spinal deformity
  • Roussouly classification
  • Schwab classification

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Global spinal deformity from the upper cervical perspective. What is 'Abnormal' in the upper cervical spine? / Passias, Peter G.; Alas, Haddy; Lafage, Renaud; Diebo, Bassel G.; Chern, Irene; Ames, Christopher P.; Park, Paul; Than, Khoi D.; Daniels, Alan H.; Hamilton, D. Kojo; Burton, Douglas C.; Hart, Robert A.; Bess, Shay; Line, Breton G.; Klineberg, Eric O.; Shaffrey, Christopher I.; Smith, Justin S.; Schwab, Frank J.; Lafage, Virginie.

In: Journal of Craniovertebral Junction and Spine, Vol. 10, No. 3, 01.07.2019, p. 152-159.

Research output: Contribution to journalArticle

Passias, PG, Alas, H, Lafage, R, Diebo, BG, Chern, I, Ames, CP, Park, P, Than, KD, Daniels, AH, Hamilton, DK, Burton, DC, Hart, RA, Bess, S, Line, BG, Klineberg, EO, Shaffrey, CI, Smith, JS, Schwab, FJ & Lafage, V 2019, 'Global spinal deformity from the upper cervical perspective. What is 'Abnormal' in the upper cervical spine?', Journal of Craniovertebral Junction and Spine, vol. 10, no. 3, pp. 152-159. https://doi.org/10.4103/jcvjs.JCVJS_71_19
Passias, Peter G. ; Alas, Haddy ; Lafage, Renaud ; Diebo, Bassel G. ; Chern, Irene ; Ames, Christopher P. ; Park, Paul ; Than, Khoi D. ; Daniels, Alan H. ; Hamilton, D. Kojo ; Burton, Douglas C. ; Hart, Robert A. ; Bess, Shay ; Line, Breton G. ; Klineberg, Eric O. ; Shaffrey, Christopher I. ; Smith, Justin S. ; Schwab, Frank J. ; Lafage, Virginie. / Global spinal deformity from the upper cervical perspective. What is 'Abnormal' in the upper cervical spine?. In: Journal of Craniovertebral Junction and Spine. 2019 ; Vol. 10, No. 3. pp. 152-159.
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TY - JOUR

T1 - Global spinal deformity from the upper cervical perspective. What is 'Abnormal' in the upper cervical spine?

AU - Passias, Peter G.

AU - Alas, Haddy

AU - Lafage, Renaud

AU - Diebo, Bassel G.

AU - Chern, Irene

AU - Ames, Christopher P.

AU - Park, Paul

AU - Than, Khoi D.

AU - Daniels, Alan H.

AU - Hamilton, D. Kojo

AU - Burton, Douglas C.

AU - Hart, Robert A.

AU - Bess, Shay

AU - Line, Breton G.

AU - Klineberg, Eric O.

AU - Shaffrey, Christopher I.

AU - Smith, Justin S.

AU - Schwab, Frank J.

AU - Lafage, Virginie

PY - 2019/7/1

Y1 - 2019/7/1

N2 - Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers. Design: This was a retrospective review. Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity. Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] <45° and lumbar lordosis [LL] apex below L4; Type 2: PI <45° and LL apex above L4; Type 3:45°<PI <65°; and Type 4: PI >65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups. Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2-4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = -0.131, P = 0.015), CBVA (r = -0.473, P < 0.001), and C0S (r = -0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948-0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12-1.38], P < 0.001). Conclusions: Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes.

AB - Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers. Design: This was a retrospective review. Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity. Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] <45° and lumbar lordosis [LL] apex below L4; Type 2: PI <45° and LL apex above L4; Type 3:45°<PI <65°; and Type 4: PI >65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups. Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2-4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = -0.131, P = 0.015), CBVA (r = -0.473, P < 0.001), and C0S (r = -0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948-0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12-1.38], P < 0.001). Conclusions: Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes.

KW - Cervical spine

KW - global spinal deformity

KW - Roussouly classification

KW - Schwab classification

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