Themistocles Protopsaltis1, Jamie Terran1, Alex Soroceanu2, Michael J Moses1, Nicolas Bronsard3, Justin Smith4, Eric Klineberg5, Gregory Mundis6, Han Jo Kim7, Richard Hostin8, Robert Hart9, Christopher Shaffrey4, Shay Bess10, Christopher Ames11, Frank Schwab7, Virginie Lafage7. 1. New York University School of Medicine, Department of Orthopedic Surgery, New York, New York. 2. Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada. 3. Department of Orthopaedic, Trauma, and Spine Surgery, Institut Universitaire de l'appareil Locomoteur et du Sport, Hôpital Pasteur 2, Centre Hospitalier Universaire de Nice, Nice, France. 4. University of Virginia School of Medicine, Department of Neurosurgery, Charlottesville, Virginia. 5. University of California Davis, Department of Orthopedic Surgery, Sacramento, California. 6. San Diego Center for Spinal Disorders, La Jolla, California. 7. Hospital for Special Surgery, Department of Orthopedic Surgery, New York, New York. 8. Baylor Scoliosis Center, Plano, Texas. 9. University of Oregon Health Sciences Center, Department of Orthopedic Surgery, Portland, Oregon. 10. Rocky Mountain Hospital for Children, Presbyterian/St Luke's Medical Center, Denver, Colorado. 11. University of California San Francisco, Department of Neurosurgery, San Francisco, California.
Abstract
BACKGROUND: Cervical kyphosis and C2-C7 plumb line (CPL) are established descriptors of cervical sagittal deformity (CSD). Reciprocal changes in these parameters have been demonstrated in thoracolumbar deformity correction. The purpose of this study was to investigate the development of CSD, using T1 slope minus cervical lordosis (TS-CL) to define CSD and to correlate TS-CL and a novel global sagittal parameter, cervical-thoracic pelvic angle (CTPA), with CPL. METHODS: A multicenter, retrospective analysis of patients with thoracolumbar deformity undergoing three-column osteotomy was performed. Preoperative and postoperative cervical parameters were investigated. Linear regression for postoperative values resulted in a CPL of 4 cm corresponding to a TS-CL threshold of 17°. Patients were classified based on postoperative TS-CL into uncompensated (TS-CL > 17°) or compensated cohorts (TS-CL < 17°); the two were compared using an unpaired t test. Logistic regression modeling was used to determine predictors of postoperative CSD. RESULTS: A total of 223 patients with thoracolumbar deformity (mean age, 57.56 years) were identified. CTPA correlated with CPL (preoperative r = .85, postoperative r = .69). TS-CL correlated with CTPA (preoperative r = .52, postoperative r = .37) and CPL (preoperative r = .52; postoperative r = .37). CSD had greater preoperative CPL (P < .001) and CTPA (P < .001). The compensated cohort had a decrease in TS-CL (from 10.2 to 8.0) with sagittal vertical axis (SVA) correction, whereas the uncompensated had an increase in TS-CL (from 22.3 to 26.8) with all P < .001. Reciprocal change was demonstrated in the compensated group given that CL decreased with SVA correction (r = .39), but there was no such correlation in the uncompensated. Positive predictors of postoperative CSD included baseline TS-CL > 17° (P = .007), longer fusion (P = .033), and baseline CTPA (P = .029). CONCLUSIONS: TS-CL and CTPA correlated significantly with established sagittal balance measures. Whereas reciprocal change in cervical and thoracolumbar alignment was demonstrated in the compensated cohort, the uncompensated population had progression of their cervical deformities after three-column osteotomy. CLINICAL RELEVANCE: The balance between TS-CL mirrors the relationship between pelvic incidence minus lumbar lordosis in defining deformities of their respective spinal regions.
BACKGROUND: Cervical kyphosis and C2-C7 plumb line (CPL) are established descriptors of cervical sagittal deformity (CSD). Reciprocal changes in these parameters have been demonstrated in thoracolumbar deformity correction. The purpose of this study was to investigate the development of CSD, using T1 slope minus cervical lordosis (TS-CL) to define CSD and to correlate TS-CL and a novel global sagittal parameter, cervical-thoracic pelvic angle (CTPA), with CPL. METHODS: A multicenter, retrospective analysis of patients with thoracolumbar deformity undergoing three-column osteotomy was performed. Preoperative and postoperative cervical parameters were investigated. Linear regression for postoperative values resulted in a CPL of 4 cm corresponding to a TS-CL threshold of 17°. Patients were classified based on postoperative TS-CL into uncompensated (TS-CL > 17°) or compensated cohorts (TS-CL < 17°); the two were compared using an unpaired t test. Logistic regression modeling was used to determine predictors of postoperative CSD. RESULTS: A total of 223 patients with thoracolumbar deformity (mean age, 57.56 years) were identified. CTPA correlated with CPL (preoperative r = .85, postoperative r = .69). TS-CL correlated with CTPA (preoperative r = .52, postoperative r = .37) and CPL (preoperative r = .52; postoperative r = .37). CSD had greater preoperative CPL (P < .001) and CTPA (P < .001). The compensated cohort had a decrease in TS-CL (from 10.2 to 8.0) with sagittal vertical axis (SVA) correction, whereas the uncompensated had an increase in TS-CL (from 22.3 to 26.8) with all P < .001. Reciprocal change was demonstrated in the compensated group given that CL decreased with SVA correction (r = .39), but there was no such correlation in the uncompensated. Positive predictors of postoperative CSD included baseline TS-CL > 17° (P = .007), longer fusion (P = .033), and baseline CTPA (P = .029). CONCLUSIONS: TS-CL and CTPA correlated significantly with established sagittal balance measures. Whereas reciprocal change in cervical and thoracolumbar alignment was demonstrated in the compensated cohort, the uncompensated population had progression of their cervical deformities after three-column osteotomy. CLINICAL RELEVANCE: The balance between TS-CL mirrors the relationship between pelvic incidence minus lumbar lordosis in defining deformities of their respective spinal regions.
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Authors: Haddy Alas; Peter Gust Passias; Bassel G Diebo; Avery E Brown; Katherine E Pierce; Cole Bortz; Renaud Lafage; Christopher P Ames; Breton Line; Eric O Klineberg; Douglas C Burton; Juan S Uribe; Han Jo Kim; Alan H Daniels; Shay Bess; Themistocles Protopsaltis; Gregory M Mundis; Christopher I Shaffrey; Frank J Schwab; Justin S Smith; Virginie Lafage Journal: J Craniovertebr Junction Spine Date: 2021-09-08