Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up

Peter G. Passias, Alexandra Soroceanu, Justin Scheer, Sun Yang, Anthony Boniello, Justin S. Smith, Themistocles Protopsaltis, Han J. Kim, Frank Schwab, Munish Gupta, Eric Otto Klineberg, Gregory Mundis, Renaud Lafage, Robert Hart, Christopher Shaffrey, Virginie Lafage, Christopher Ames

Research output: Contribution to journalArticle

15 Citations (Scopus)

Abstract

Background context Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear. Purpose This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. Study design/setting This study is a retrospective review of a multicenter, prospective database. Patient sample Surgical ASD patients with 2-year follow-up and cervical X-rays were included. Outcome measures The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]). Methods Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20°and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ("0") or abnormal ("+" or "++"). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL. Results One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. Conclusions Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.

Original languageEnglish (US)
Pages (from-to)1756-1763
Number of pages8
JournalSpine Journal
Volume15
Issue number8
DOIs
StatePublished - Aug 1 2015

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Lordosis
Kyphosis
Scoliosis
Incidence
Thorax
Outcome Assessment (Health Care)
Chi-Square Distribution
Quality of Life
X-Rays
Databases
Research

Keywords

  • Adult spinal deformity
  • Alignment
  • Cervical deformity
  • HRQOL
  • Outcome
  • Radiographic parameter

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up. / Passias, Peter G.; Soroceanu, Alexandra; Scheer, Justin; Yang, Sun; Boniello, Anthony; Smith, Justin S.; Protopsaltis, Themistocles; Kim, Han J.; Schwab, Frank; Gupta, Munish; Klineberg, Eric Otto; Mundis, Gregory; Lafage, Renaud; Hart, Robert; Shaffrey, Christopher; Lafage, Virginie; Ames, Christopher.

In: Spine Journal, Vol. 15, No. 8, 01.08.2015, p. 1756-1763.

Research output: Contribution to journalArticle

Passias, PG, Soroceanu, A, Scheer, J, Yang, S, Boniello, A, Smith, JS, Protopsaltis, T, Kim, HJ, Schwab, F, Gupta, M, Klineberg, EO, Mundis, G, Lafage, R, Hart, R, Shaffrey, C, Lafage, V & Ames, C 2015, 'Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up', Spine Journal, vol. 15, no. 8, pp. 1756-1763. https://doi.org/10.1016/j.spinee.2015.04.007
Passias, Peter G. ; Soroceanu, Alexandra ; Scheer, Justin ; Yang, Sun ; Boniello, Anthony ; Smith, Justin S. ; Protopsaltis, Themistocles ; Kim, Han J. ; Schwab, Frank ; Gupta, Munish ; Klineberg, Eric Otto ; Mundis, Gregory ; Lafage, Renaud ; Hart, Robert ; Shaffrey, Christopher ; Lafage, Virginie ; Ames, Christopher. / Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up. In: Spine Journal. 2015 ; Vol. 15, No. 8. pp. 1756-1763.
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abstract = "Background context Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear. Purpose This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. Study design/setting This study is a retrospective review of a multicenter, prospective database. Patient sample Surgical ASD patients with 2-year follow-up and cervical X-rays were included. Outcome measures The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]). Methods Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20°and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ({"}0{"}) or abnormal ({"}+{"} or {"}++{"}). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL. Results One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. Conclusions Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.",
keywords = "Adult spinal deformity, Alignment, Cervical deformity, HRQOL, Outcome, Radiographic parameter",
author = "Passias, {Peter G.} and Alexandra Soroceanu and Justin Scheer and Sun Yang and Anthony Boniello and Smith, {Justin S.} and Themistocles Protopsaltis and Kim, {Han J.} and Frank Schwab and Munish Gupta and Klineberg, {Eric Otto} and Gregory Mundis and Renaud Lafage and Robert Hart and Christopher Shaffrey and Virginie Lafage and Christopher Ames",
year = "2015",
month = "8",
day = "1",
doi = "10.1016/j.spinee.2015.04.007",
language = "English (US)",
volume = "15",
pages = "1756--1763",
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TY - JOUR

T1 - Magnitude of preoperative cervical lordotic compensation and C2-T3 angle are correlated to increased risk of postoperative sagittal spinal pelvic malalignment in adult thoracolumbar deformity patients at 2-year follow-up

AU - Passias, Peter G.

AU - Soroceanu, Alexandra

AU - Scheer, Justin

AU - Yang, Sun

AU - Boniello, Anthony

AU - Smith, Justin S.

AU - Protopsaltis, Themistocles

AU - Kim, Han J.

AU - Schwab, Frank

AU - Gupta, Munish

AU - Klineberg, Eric Otto

AU - Mundis, Gregory

AU - Lafage, Renaud

AU - Hart, Robert

AU - Shaffrey, Christopher

AU - Lafage, Virginie

AU - Ames, Christopher

PY - 2015/8/1

Y1 - 2015/8/1

N2 - Background context Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear. Purpose This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. Study design/setting This study is a retrospective review of a multicenter, prospective database. Patient sample Surgical ASD patients with 2-year follow-up and cervical X-rays were included. Outcome measures The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]). Methods Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20°and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ("0") or abnormal ("+" or "++"). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL. Results One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. Conclusions Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.

AB - Background context Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment on achieving optimal thoracolumbar alignment in ASD surgery is unclear. Purpose This study assesses the relationship between preoperative (preop) cervical spinal parameters and global alignment after thoracolumbar ASD surgery at 2-year follow-up. Study design/setting This study is a retrospective review of a multicenter, prospective database. Patient sample Surgical ASD patients with 2-year follow-up and cervical X-rays were included. Outcome measures The outcome measures were radiographic parameters and self-reported health-related quality-of-life measures (Short-Form 36 [SF-36], Oswestry Disability Index [ODI], and Scoliosis Research Society 22 [SRS-22]). Methods Surgical ASD patients of 18 years and older with scoliosis greater than or equal to 20°and one of the following radiographic parameters were included: sagittal vertical axis (SVA) greater than or equal to 5 cm, pelvic tilt (PT) greater than or equal to 25°, or thoracic kyphosis (TK) greater than 60°. The SRS-Schwab sagittal modifiers (PT, global alignment, and pelvic incidence and lumbar lordosis [PI-LL]) were assessed at 2-year postoperatively as either normal ("0") or abnormal ("+" or "++"). Patients were classified in the aligned group (AG) or malaligned group (MG) at 2-year follow-up if all three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2-C7 SVA greater than 4 cm, C2-C7 SVA less than 4 cm, cervical kyphosis (CL greater than 0), cervical lordosis (CL less than 0), any deformity (C2-C7 SVA greater than 4 cm or CL greater than 0), and both CD (C2-C7 SVA greater than 4 cm and CL greater than 0). Univariate testing was performed using t or chi-square test, looking at the following preop parameters: CD, C2-C7 SVA, C2-T3 SVA, CL, T1 slope (T1S), T1S-CL, C2-T3 angle, LL, TK, PT, C7-S1 SVA, and PI-LL. Results One hundred four patients met the initial inclusion criteria with 70 in the AG and 34 in MG. Preoperative, patients in the MG had a higher CL (11.7 vs. 4.9, p=.03), higher C2-T3 angle (13.59 vs 4.9 p=.01), higher PT (p<.0001), higher SVA (p<.0001), and higher PI-LL (p<.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both groups. There was no statistically significant difference among groups in the amount of improvement more than 2 years on the ODI or the Physical Component Summary of SF-36. Conclusions Patients with sagittal spinal malalignment associated with significant cervical compensatory lordosis are at increased risk of realignment failure at 2-year follow-up. Assessment of the degree of cervical compensation may be helpful in preop evaluation to assist in realignment outcome prediction.

KW - Adult spinal deformity

KW - Alignment

KW - Cervical deformity

KW - HRQOL

KW - Outcome

KW - Radiographic parameter

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