Peter G Passias1, Cole Bortz2, Samantha Horn2, Frank Segreto2, Gregory Poorman2, Cyrus Jalai2, Alan Daniels3, D Kojo Hamilton4, Han Jo Kim5, Daniel Sciubba6, Justin S Smith7, Brian Neuman6, Christopher Shaffrey7, Virginie Lafage5, Renaud Lafage5, Themistocles Protopsaltis2, Christopher Ames8, Robert Hart9, Gregory Mundis10, Robert Eastlack11. 1. Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, New York University Medical Center-New York University Langone Orthopedic Hospital, New York University School of Medicine, New York, New York, USA. Electronic address: Peter.Passias@nyumc.org. 2. Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA. 3. Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA. 4. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA. 5. Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA. 6. Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, Maryland, USA. 7. Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. 8. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA. 9. Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA. 10. San Diego Center for Spinal Disorders, La Jolla, California, USA. 11. Division of Orthopedic Surgery, Scripps Clinic, La Jolla, California, USA.
Abstract
OBJECTIVE: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. METHODS: Inclusion: radiographic CD, age >18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. RESULTS: A total of 73 patients (mean age, 61.8 years; 59% female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3%; CTJ, 31.5%; thoracic, 13.7%; and spinopelvic, 2.7%. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0%; +, 0.0%; ++, 80.0%). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26%; not, 0%; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. CONCLUSIONS: CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD.
OBJECTIVE: The primary driver (PD) of cervical malalignment is important in characterizing cervical deformity (CD) and should be included in fusion to achieve alignment and quality-of-life goals. This study aims to define how PDs improve understanding of the mechanisms of CD and assesses the impact of driver region on realignment/outcomes. METHODS: Inclusion: radiographic CD, age >18 years, 1 year follow-up. PD apex was classified by spinal region: cervical, cervicothoracic junction (CTJ), thoracic, or spinopelvic by a panel of spine deformity surgeons. Primary analysis evaluated PD groups meeting alignment goals (by Ames modifiers cervical sagittal vertical axis/T1 slope minus cervical lordosis/chin-brow vergical angle/modified Japanese Orthopaedics Association questionnaire) and health-related quality of life (HRQL) goals (EuroQol-5 Dimensions questionnaire/Neck Disability Index/modified Japanese Orthopaedics Association questionnaire) using t tests. Secondary analysis grouped interventions by fusion constructs including the primary or secondary apex based on lowest instrumented vertebra: cervical, lowest instrumented vertebra (LIV) ≤C7; CTJ, LIV ≤T3; and thoracic, LIV ≤T12. RESULTS: A total of 73 patients (mean age, 61.8 years; 59% female) were evaluated with the following PDs of their sagittal cervical deformity: cervical, 49.3%; CTJ, 31.5%; thoracic, 13.7%; and spinopelvic, 2.7%. Cervical drivers (n = 36) showed the greatest 1-year postoperative cervical and global alignment changes (improvement in T1S, CL, C0-C2, C1 slope). Thoracic drivers were more likely to have persistent severe T1 slope minus cervical lordosis modifier grade at 1 year (0, 20.0%; +, 0.0%; ++, 80.0%). Cervical deformity modifiers tended to improve in cervical patients whose construct included the PD apex (included, 26%; not, 0%; P = 0.068). Thoracic and cervicothoracic PD apex patients did not improve in HRQL goals when PD apex was not treated. CONCLUSIONS:CD structural drivers have an important effect on treatment and 1-year postoperative outcomes. Cervical or thoracic drivers not included in the construct result in residual deformity and inferior HRQL goals. These factors should be considered when discussing treatment plans for patients with CD.
Authors: Peter G Passias; Samantha R Horn; Tina Raman; Avery E Brown; Virginie Lafage; Renaud Lafage; Justin S Smith; Cole A Bortz; Frank A Segreto; Katherine E Pierce; Haddy Alas; Breton G Line; Bassel G Diebo; Alan H Daniels; Han Jo Kim; Alex Soroceanu; Gregory M Mundis; Themistocles S Protopsaltis; Eric O Klineberg; Douglas C Burton; Robert A Hart; Frank J Schwab; Shay Bess; Christopher I Shaffrey; Christopher P Ames Journal: J Craniovertebr Junction Spine Date: 2019 Jul-Sep
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