Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patients

Katherine Pierce, Peter Passias, Avery Brown, Cole Bortz, Haddy Alas, Renaud Lafage, Oscar Krol, Dean Chou, Douglas Burton, Breton Line, Eric Klineberg, Robert Hart, Jeffrey Gum, Alan Daniels, Kojo Hamilton, Shay Bess, Themistocles Protopsaltis, Christopher Shaffrey, Frank Schwab, Justin SmithVirginie Lafage, Christopher Ames

Research output: Contribution to journalArticlepeer-review


Background: To optimize quality of life in patients with cervical deformity (CD), there may be alignment targets to be prioritized. Objective: To prioritize the cervical parameter targets for alignment. Methods: Included: CD patients (C2-C7 Cobb >10 ° °, C2-C7 lordosis [CL] >10 ° °, cSVA > 4 cm, or chin-brow vertical angle >25 ° °) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical (C) or cervicothoracic (CT) Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA (<4 cm) and T1 slope minus CL (TS-CL) (<15 ° °) were excluded. Patients assessed: Meeting Minimal Clinically Important Difference (MCID) for NDI (<-15 ΔNDI). Ratios of correction were found for regional parameters categorized by Primary Ames Driver (C or CT). Decision tree analysis assessed cut-offs for differences associated with meeting NDI MCID at 1Y. Results: Seventy-seven CD patients (62.1 years, 64%F, 28.8 kg/m 2). 41.6% met MCID for NDI. A backward linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R 2 = 0.820 (P = 0.032) included TS-CL, cSVA, MGS, C2SS, C2-T3 angle, C2-T3 sagittal vertical axis (SVA), CL. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the two groups (P > 0.050). Decision tree analysis determined cut-offs for radiographic change, prioritizing in the following order: ≥42.5 ° C2-T3 angle, >35.4 ° CL, <-31.76 ° C2 slope, <-11.57 mm cSVA, <-2.16 ° MGS, >-30.8 mm C2-T3 SVA, and ≤-33.6 ° TS-CL. Conclusions: Certain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.

Original languageEnglish (US)
Pages (from-to)311-317
Number of pages7
JournalJournal of Craniovertebral Junction and Spine
Issue number3
StatePublished - Jul 1 2021


  • Cervical deformity
  • prioritization
  • realignment

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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