Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity

Justin S. Smith, Virginie Lafage, Frank J. Schwab, Christopher I. Shaffrey, Themistocles Protopsaltis, Eric Otto Klineberg, Munish Gupta, Justin K. Scheer, Kai Ming G Fu, Gregory Mundis, Richard Hostin, Vedat Deviren, Robert Hart, Douglas C. Burton, Shay Bess, Christopher P. Ames

Research output: Contribution to journalArticle

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Abstract

STUDY DESIGN.: Multicenter, prospective, consecutive case series. OBJECTIVE.: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA.: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. METHODS.: Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°-30°, ++: >30°), C7-S1SVA (0: <4 cm, +: 4-9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10-20°, ++: >20°). RESULTS.: A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION.: Cervical deformity is highly prevalent (53%) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact.

Original languageEnglish (US)
JournalSpine
Volume39
Issue number17
DOIs
StatePublished - Aug 1 2014

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Lordosis
Kyphosis
Scoliosis
Incidence
Thorax
Research

Keywords

  • adult
  • cervical
  • deformity
  • lordosis
  • prevalence
  • sagittal imbalance
  • spine

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine

Cite this

Smith, J. S., Lafage, V., Schwab, F. J., Shaffrey, C. I., Protopsaltis, T., Klineberg, E. O., ... Ames, C. P. (2014). Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. Spine, 39(17). https://doi.org/10.1097/BRS.0000000000000432

Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. / Smith, Justin S.; Lafage, Virginie; Schwab, Frank J.; Shaffrey, Christopher I.; Protopsaltis, Themistocles; Klineberg, Eric Otto; Gupta, Munish; Scheer, Justin K.; Fu, Kai Ming G; Mundis, Gregory; Hostin, Richard; Deviren, Vedat; Hart, Robert; Burton, Douglas C.; Bess, Shay; Ames, Christopher P.

In: Spine, Vol. 39, No. 17, 01.08.2014.

Research output: Contribution to journalArticle

Smith, JS, Lafage, V, Schwab, FJ, Shaffrey, CI, Protopsaltis, T, Klineberg, EO, Gupta, M, Scheer, JK, Fu, KMG, Mundis, G, Hostin, R, Deviren, V, Hart, R, Burton, DC, Bess, S & Ames, CP 2014, 'Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity', Spine, vol. 39, no. 17. https://doi.org/10.1097/BRS.0000000000000432
Smith, Justin S. ; Lafage, Virginie ; Schwab, Frank J. ; Shaffrey, Christopher I. ; Protopsaltis, Themistocles ; Klineberg, Eric Otto ; Gupta, Munish ; Scheer, Justin K. ; Fu, Kai Ming G ; Mundis, Gregory ; Hostin, Richard ; Deviren, Vedat ; Hart, Robert ; Burton, Douglas C. ; Bess, Shay ; Ames, Christopher P. / Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity. In: Spine. 2014 ; Vol. 39, No. 17.
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abstract = "STUDY DESIGN.: Multicenter, prospective, consecutive case series. OBJECTIVE.: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA.: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. METHODS.: Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°-30°, ++: >30°), C7-S1SVA (0: <4 cm, +: 4-9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10-20°, ++: >20°). RESULTS.: A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31{\%} and 29{\%}, respectively, and prevalence of CK and/or CPSM was 53{\%}. CK prevalence differed by curve type (N = 15{\%}, L = 27{\%}, D = 37{\%}, T = 49{\%}; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40{\%}, += 27{\%}, ++= 15{\%}; P < 0.001) but greater CPSM prevalence (0 = 23{\%}, += 28{\%}, ++= 45{\%}; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40{\%}, += 23{\%}, ++= 11{\%}; P < 0.001) but greater CPSM prevalence (0 = 24{\%}, += 24{\%}, ++= 48{\%}; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35{\%}, += 31{\%}, ++= 22{\%}; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION.: Cervical deformity is highly prevalent (53{\%}) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact.",
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TY - JOUR

T1 - Prevalence and type of cervical deformity among 470 adults with thoracolumbar deformity

AU - Smith, Justin S.

AU - Lafage, Virginie

AU - Schwab, Frank J.

AU - Shaffrey, Christopher I.

AU - Protopsaltis, Themistocles

AU - Klineberg, Eric Otto

AU - Gupta, Munish

AU - Scheer, Justin K.

AU - Fu, Kai Ming G

AU - Mundis, Gregory

AU - Hostin, Richard

AU - Deviren, Vedat

AU - Hart, Robert

AU - Burton, Douglas C.

AU - Bess, Shay

AU - Ames, Christopher P.

PY - 2014/8/1

Y1 - 2014/8/1

N2 - STUDY DESIGN.: Multicenter, prospective, consecutive case series. OBJECTIVE.: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA.: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. METHODS.: Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°-30°, ++: >30°), C7-S1SVA (0: <4 cm, +: 4-9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10-20°, ++: >20°). RESULTS.: A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION.: Cervical deformity is highly prevalent (53%) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact.

AB - STUDY DESIGN.: Multicenter, prospective, consecutive case series. OBJECTIVE.: To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. SUMMARY OF BACKGROUND DATA.: Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. METHODS.: Multicenter, prospective, consecutive series of adult (age >18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0° (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20°, +: 20°-30°, ++: >30°), C7-S1SVA (0: <4 cm, +: 4-9.5 cm, ++: >9.5 cm), and PI-LL mismatch (0: <10°, +: 10-20°, ++: >20°). RESULTS.: A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8° and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, += 27%, ++= 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, += 28%, ++= 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, += 23%, ++= 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, += 24%, ++= 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, += 31%, ++= 22%; P = 0.034) but no CPSM association (P = 0.46). CONCLUSION.: Cervical deformity is highly prevalent (53%) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact.

KW - adult

KW - cervical

KW - deformity

KW - lordosis

KW - prevalence

KW - sagittal imbalance

KW - spine

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DO - 10.1097/BRS.0000000000000432

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