Peter Gust Passias1, Haddy Alas1, Nicholas Kummer1, Peter Tretiakov1, Bassel G Diebo2, Renaud Lafage3, Christopher P Ames4, Breton Line5, Eric O Klineberg6, Douglas C Burton7, Juan S Uribe8, Han Jo Kim3, Alan H Daniels9, Shay Bess5, Themistocles Protopsaltis1, Gregory M Mundis10, Christopher I Shaffrey11, Frank J Schwab3, Justin S Smith11, Virginie Lafage3. 1. Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Orthopaedic Hospital, New York Spine Institute, Brooklyn, USA. 2. Department of Orthopaedic Surgery, State University of New York Downstate Medical Center, Brooklyn, USA. 3. Department of Orthopaedic Surgery, Hospital for Special Surgery, NY, USA. 4. Department of Neurological Surgery, University of California San Francisco, San Francisco, USA. 5. Rocky Mountain Scoliosis and Spine, Denver, CO, USA. 6. Department of Orthopaedic Surgery, University of California Davis, Davis, USA. 7. Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, USA. 8. Department of Neurosurgery, University of South Florida, Tampa, FL, USA. 9. Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA. 10. San Diego Center for Spinal Disorders, La Jolla, CA, USA. 11. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
Abstract
Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL). Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes. Materials and Methods: Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2-C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (-6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (<-28.43°) depending on directionality. Patients within 1SD were considered control group. Results: 102 surgical CD patients (61 years, 65% F, 30 kg/m2) with BL and 1Y radiographic data were included. 20 patients met definitions for HK and 21 patients met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with posterior approach. Operative time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-SVA (10.8 vs. 7.0 vs. -47.8 mm, P = 0.001). HL patients had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had 3x revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL patients had higher cSVA and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK patients had higher McGregor's slope (MGS) (16.1° vs. 3.3°, P = 0.002) and C0-C2 Cobb (43.3° vs. 26.9°, P < 0.001), however, postoperative differences in MGS and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary CT (38.1%), UT (23.8%), and C (14.3%) drivers. Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1-year postoperative, perhaps due to undercorrection compared to kyphotic etiologies. Copyright:
Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL). Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes. Materials and Methods: Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2-C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (-6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (<-28.43°) depending on directionality. Patients within 1SD were considered control group. Results: 102 surgical CD patients (61 years, 65% F, 30 kg/m2) with BL and 1Y radiographic data were included. 20 patients met definitions for HK and 21 patients met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with posterior approach. Operative time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-SVA (10.8 vs. 7.0 vs. -47.8 mm, P = 0.001). HL patients had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had 3x revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL patients had higher cSVA and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK patients had higher McGregor's slope (MGS) (16.1° vs. 3.3°, P = 0.002) and C0-C2 Cobb (43.3° vs. 26.9°, P < 0.001), however, postoperative differences in MGS and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary CT (38.1%), UT (23.8%), and C (14.3%) drivers. Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1-year postoperative, perhaps due to undercorrection compared to kyphotic etiologies. Copyright:
Authors: Michael P Steinmetz; Todd J Stewart; Christopher D Kager; Edward C Benzel; Alexander R Vaccaro Journal: Neurosurgery Date: 2007-01 Impact factor: 4.654
Authors: D E Harrison; D D Harrison; R Cailliet; S J Troyanovich; T J Janik; B Holland Journal: Spine (Phila Pa 1976) Date: 2000-08-15 Impact factor: 3.468
Authors: Justin S Smith; Christopher I Shaffrey; Virginie Lafage; Benjamin Blondel; Frank Schwab; Richard Hostin; Robert Hart; Brian O'Shaughnessy; Shay Bess; Serena S Hu; Vedat Deviren; Christopher P Ames Journal: J Neurosurg Spine Date: 2012-08-03