Peter G Passias1, Cyrus M Jalai1, Virginie Lafage2, Renaud Lafage2, Themistocles Protopsaltis1, Subaraman Ramchandran1, Samantha R Horn1, Gregory W Poorman1, Munish Gupta3, Robert A Hart4, Vedat Deviren5, Alexandra Soroceanu6, Justin S Smith7, Frank Schwab2, Christopher I Shaffrey7, Christopher P Ames8. 1. Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York. 2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. 3. Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri. 4. Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon. 5. Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California. 6. Department of Neurological Surgery, University of Calgary, Calgary, Alberta, Canada. 7. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia. 8. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Abstract
BACKGROUND: Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction. OBJECTIVE: To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms. METHODS: Primary cervical deformity driver/vertebral apex level were determined: CS = cervical; CTJ = cervicothoracic junction; TH = thoracic; SP = spinopelvic. Patients were evaluated if surgery included PD apex, based on the lowest instrumented vertebra (LIV): CS: LIV ≤ C7, CTJ: LIV ≤ T3, TH: LIV ≤ T12. Cervical and thoracolumbar alignment was measured preoperatively and 3 mo (3M) postoperatively. PD groups were compared with analysis of variance/Pearson χ2, paired t-tests. RESULTS: Eighty-four ACD patients met inclusion criteria. Thoracic drivers (n = 26) showed greatest preoperative cervical and global malalignment against other PD: higher thoracic kyphosis, pelvic incidence-lumbar lordosis (PI-LL), T1 slope C2-T3 sagittal vertical axis (SVA), and C0-2 angle (P < .05). Differences in baseline-3M alignment changes were observed between surgical PD groups, in PI-LL, LL, T1 slope minus cervical lordosis (TS-CL), cervical SVA, C2-T3 SVA (P < .05). Main changes were between TH and CS driver groups: TH patients had greater PI-LL (4.47° vs -0.87°, P = .049), TS-CL (-19.12° vs -4.30, P = .050), C2-C7 SVA (-18.12 vs -4.30 mm, P = .007), and C2-T3 SVA (-24.76 vs 8.50 mm, P = .002) baseline-3M correction. CTJ drivers trended toward greater LL correction compared to CS drivers (-6.00° vs 0.88°, P = .050). Patients operated at CS driver level had a difference in the prevalence of 3M TS-CL modifier grades (0 = 35.7%, 1 = 0.0%, 2 = 13.3%, P = .030). There was a significant difference in 3M chin-brow vertical angle modifier grade distribution in TH drivers (0 = 0.0%, 1 = 35.9%, 2 = 14.3%, P = .049). CONCLUSION: Characterizing ACD patients by PD type reveals differences in pre- and postoperative alignment. Evaluating surgical alignment outcomes based on PD inclusion is important in understanding alignment goals for ACD correction.
BACKGROUND: Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction. OBJECTIVE: To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms. METHODS: Primary cervical deformity driver/vertebral apex level were determined: CS = cervical; CTJ = cervicothoracic junction; TH = thoracic; SP = spinopelvic. Patients were evaluated if surgery included PD apex, based on the lowest instrumented vertebra (LIV): CS: LIV ≤ C7, CTJ: LIV ≤ T3, TH: LIV ≤ T12. Cervical and thoracolumbar alignment was measured preoperatively and 3 mo (3M) postoperatively. PD groups were compared with analysis of variance/Pearson χ2, paired t-tests. RESULTS: Eighty-four ACD patients met inclusion criteria. Thoracic drivers (n = 26) showed greatest preoperative cervical and global malalignment against other PD: higher thoracic kyphosis, pelvic incidence-lumbar lordosis (PI-LL), T1 slope C2-T3 sagittal vertical axis (SVA), and C0-2 angle (P < .05). Differences in baseline-3M alignment changes were observed between surgical PD groups, in PI-LL, LL, T1 slope minus cervical lordosis (TS-CL), cervical SVA, C2-T3 SVA (P < .05). Main changes were between TH and CS driver groups: THpatients had greater PI-LL (4.47° vs -0.87°, P = .049), TS-CL (-19.12° vs -4.30, P = .050), C2-C7 SVA (-18.12 vs -4.30 mm, P = .007), and C2-T3 SVA (-24.76 vs 8.50 mm, P = .002) baseline-3M correction. CTJ drivers trended toward greater LL correction compared to CS drivers (-6.00° vs 0.88°, P = .050). Patients operated at CS driver level had a difference in the prevalence of 3M TS-CL modifier grades (0 = 35.7%, 1 = 0.0%, 2 = 13.3%, P = .030). There was a significant difference in 3M chin-brow vertical angle modifier grade distribution in TH drivers (0 = 0.0%, 1 = 35.9%, 2 = 14.3%, P = .049). CONCLUSION: Characterizing ACD patients by PD type reveals differences in pre- and postoperative alignment. Evaluating surgical alignment outcomes based on PD inclusion is important in understanding alignment goals for ACD correction.
Authors: Cole Bortz; Peter G Passias; Katherine Elizabeth Pierce; Haddy Alas; Avery Brown; Sara Naessig; Waleed Ahmad; Renaud Lafage; Christopher P Ames; Bassel G Diebo; Breton G Line; Eric O Klineberg; Douglas C Burton; Robert K Eastlack; Han Jo Kim; Daniel M Sciubba; Alex Soroceanu; Shay Bess; Christopher I Shaffrey; Frank J Schwab; Justin S Smith; Virginie Lafage Journal: J Craniovertebr Junction Spine Date: 2020-06-05
Authors: H Koller; C Ames; H Mehdian; R Bartels; R Ferch; V Deriven; H Toyone; C Shaffrey; J Smith; W Hitzl; J Schröder; Yohan Robinson Journal: Eur Spine J Date: 2018-11-27 Impact factor: 3.134
Authors: Peter Gust Passias; Lara Passfall; Samantha R Horn; Katherine E Pierce; Virginie Lafage; Renaud Lafage; Justin S Smith; Breton G Line; Gregory M Mundis; Robert Eastlack; Bassel G Diebo; Themistocles S Protopsaltis; Han Jo Kim; Justin Scheer; Douglas C Burton; Robert A Hart; Frank J Schwab; Shay Bess; Christopher P Ames; Christopher I Shaffrey Journal: J Craniovertebr Junction Spine Date: 2021-09-08
Authors: Peter Gust Passias; Haddy Alas; Katherine E Pierce; Matthew Galetta; Oscar Krol; Lara Passfall; Nicholas Kummer; Sara Naessig; Waleed Ahmad; Bassel G Diebo; Renaud Lafage; Virginie Lafage Journal: J Craniovertebr Junction Spine Date: 2021-09-08
Authors: Peter Gust Passias; Avery E Brown; Haddy Alas; Katherine E Pierce; Cole A Bortz; Bassel Diebo; Renaud Lafage; Virginie Lafage; Douglas C Burton; Robert Hart; Han Jo Kim; Shay Bess; Kevin Moattari; Rachel Joujon-Roche; Oscar Krol; Tyler Williamson; Peter Tretiakov; Bailey Imbo; Themistocles S Protopsaltis; Christopher Shaffrey; Frank Schwab; Robert Eastlack; Breton Line; Eric Klineberg; Justin Smith; Christopher Ames Journal: J Craniovertebr Junction Spine Date: 2021-12-11