Peter G Passias1, Alexandra Soroceanu2, Justin Scheer3, Sun Yang4, Anthony Boniello4, Justin S Smith5, Themistocles Protopsaltis4, Han J Kim6, Frank Schwab4, Munish Gupta7, Eric Klineberg7, Gregory Mundis8, Renaud Lafage4, Robert Hart9, Christopher Shaffrey3, Virginie Lafage4, Christopher Ames10. 1. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA. Electronic address: Peter.Passias@nyumc.org. 2. Department of Orthopaedic Surgery, University of Calgary, 3330 Hospital Dr NW, Calgary, AB T2N 4N1, Canada. 3. Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, 303 E Chicago Ave., Chicago, IL 60611, USA. 4. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, 301 E 17th St #1402, New York, NY 10003, USA. 5. Department of Neurosurgery, University of Virginia Medical Center, 1215 Lee St, Charlottesville, VA 22903, USA. 6. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA. 7. Department of Orthopaedic Surgery, University of California-Davis, 4860 Y St, Sacramento, CA 95817, USA. 8. San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr, La Jolla, CA 92037, USA. 9. Department of Orthopaedic Surgery, Oregon Health and Science University, 3181 S.W. Sam Jackson Park Rd, Portland, OR 97239, USA. 10. Department of Neurosurgery, University of California-San Francisco, 505 Parnassus Ave., San Francisco, CA 94143, USA.
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.
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 ASDpatients 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 ASDpatients 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.
Authors: Peter G Passias; Frank A Segreto; Kevin A Moattari; Renaud Lafage; Justin S Smith; Breton G Line; Robert K Eastlack; Douglas C Burton; Robert A Hart; Shay Bess; Christopher I Shaffrey; Christopher P Ames; Virginie Lafage Journal: Spine Deform Date: 2022-03-09
Authors: Peter G Passias; Cyrus M Jalai; Nancy Worley; Shaleen Vira; Justin K Scheer; Justin S Smith; Subaraman Ramachandran; Alexandra Soroceanu; Samantha R Horn; Gregory W Poorman; Themistocles S Protopsaltis; Eric O Klineberg; Daniel M Sciubba; Han Jo Kim; D Kojo Hamilton; Renaud Lafage; Virginie Lafage; Christopher P Ames Journal: Int J Spine Surg Date: 2018-12-21
Authors: Kenny Yat Hong Kwan; J Naresh-Babu; Wilco Jacobs; Marinus de Kleuver; David W Polly; Caglar Yilgor; Yabin Wu; Jong-Beom Park; Manabu Ito; Miranda L van Hooff Journal: Neurosurgery Date: 2021-05-13 Impact factor: 4.654
Authors: 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 Journal: J Craniovertebr Junction Spine Date: 2019 Jul-Sep
Authors: Katherine E Pierce; Peter Gust Passias; Avery E Brown; Cole A Bortz; Haddy Alas; Renaud Lafage; Oscar Krol; Dean Chou; Douglas C Burton; Breton Line; Eric Klineberg; Robert Hart; Jeffrey Gum; Alan Daniels; Kojo Hamilton; Shay Bess; Themistocles Protopsaltis; Christopher Shaffrey; Frank A Schwab; Justin S Smith; Virginie Lafage; Christopher Ames Journal: J Craniovertebr Junction Spine Date: 2021-09-08
Authors: Brandon P Hirsch; Max Vaynrub; Matthew Siow; Anthony Zou; Utkarsh Anil; Dennis Vasquez Montes; Themistocles S Protopsaltis Journal: Global Spine J Date: 2020-07-07
Authors: Peter Gust Passias; Katherine E Pierce; Avery E Brown; Cole A Bortz; Haddy Alas; Renaud Lafage; Virginie Lafage; Breton Line; Eric O Klineberg; Douglas C Burton; Robert Hart; Alan H Daniels; Shay Bess; Bassel Diebo; Themistocles Protopsaltis; Robert Eastlack; Christopher I Shaffrey; Frank J Schwab; Justin S Smith; Christopher Ames Journal: J Craniovertebr Junction Spine Date: 2021-06-10