Themistocles Protopsaltis1, Nicolas Bronsard2, Alex Soroceanu3, Jensen K Henry3, Renaud Lafage3, Justin Smith4, Eric Klineberg5, Gregory Mundis6, Han Jo Kim7, Richard Hostin8, Robert Hart9, Christopher Shaffrey4, Shay Bess3, Christopher Ames10. 1. Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA. tprotopsaltis@gmail.com. 2. Hopital Saint-Roch, Nice, France. 3. Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA. 4. Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA. 5. Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA. 6. San Diego Center for Spinal Disorders, La Jolla, CA, USA. 7. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA. 8. Baylor Scoliosis Center, Plano, TX, USA. 9. Department of Orthopedic Surgery, University of Oregon Health Sciences Center, Portland, OR, USA. 10. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
Abstract
PURPOSE: To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical-thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA). METHODS: Multicenter, retrospective consecutive case series of ASD patients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis. Radiographs were analyzed at baseline and 1 year post-operatively. Patients were substratified into upper thoracic (UT; UIV T6 and above) and lower thoracic (LT; UIV below T6). PJK was defined by >10° angle between UIV and UIV + 2 and >10° change in the angle from baseline to post-op. RESULTS: PJK developed in 29 % (78 of 267) of patients. CTPA was linearly correlated with cervical plumbline (CPL) as a measure of cervical sagittal alignment (R = 0.826, p < 0.001). PJK patients had significantly greater post-operative CTPA and SVA than patients without PJK (NPJK) (p = 0.042; p = 0.021). For UT (n = 141) but not LT (n = 136), PJK patients at 1 year had larger CTPA (4.9° vs. 3.7°, p = 0.015) and CPL (5.1 vs. 3.8 cm, p = 0.022) than NPJK patients, despite similar corrections in PT and PI-LL. CONCLUSIONS: The prevalence of PJK was 29 % at 1 year follow-up. CTPA, which correlates with CPL as a global analog of cervical sagittal balance, and TPA describe relative proportions of cervical and thoracolumbar deformities. Patients who develop PJK in the upper thoracic spine after thoracolumbar 3CO also develop concomitant cervical sagittal deformity, with increases in CPL and CTPA.
PURPOSE: To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical-thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA). METHODS: Multicenter, retrospective consecutive case series of ASDpatients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis. Radiographs were analyzed at baseline and 1 year post-operatively. Patients were substratified into upper thoracic (UT; UIV T6 and above) and lower thoracic (LT; UIV below T6). PJK was defined by >10° angle between UIV and UIV + 2 and >10° change in the angle from baseline to post-op. RESULTS: PJK developed in 29 % (78 of 267) of patients. CTPA was linearly correlated with cervical plumbline (CPL) as a measure of cervical sagittal alignment (R = 0.826, p < 0.001). PJK patients had significantly greater post-operative CTPA and SVA than patients without PJK (NPJK) (p = 0.042; p = 0.021). For UT (n = 141) but not LT (n = 136), PJK patients at 1 year had larger CTPA (4.9° vs. 3.7°, p = 0.015) and CPL (5.1 vs. 3.8 cm, p = 0.022) than NPJK patients, despite similar corrections in PT and PI-LL. CONCLUSIONS: The prevalence of PJK was 29 % at 1 year follow-up. CTPA, which correlates with CPL as a global analog of cervical sagittal balance, and TPA describe relative proportions of cervical and thoracolumbar deformities. Patients who develop PJK in the upper thoracic spine after thoracolumbar 3CO also develop concomitant cervical sagittal deformity, with increases in CPL and CTPA.
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