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World Neurosurg. 2016 Jul;91:228-37. doi: 10.1016/j.wneu.2016.04.020. Epub 2016 Apr 13.

Assessment of Surgical Treatment Strategies for Moderate to Severe Cervical Spinal Deformity Reveals Marked Variation in Approaches, Osteotomies, and Fusion Levels.

Author information

1
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA. Electronic address: jss7f@virginia.edu.
2
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California, USA.
3
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, USA.
4
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York, USA.
5
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York, USA.
6
University of California San Diego, School of Medicine, San Diego, California, USA.
7
Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
8
Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California, USA.
9
Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA.
10
Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas, USA.
11
Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California, USA.
12
Department of Neurosurgery, University of Pittsburgh, Pittsburgh, Pennsylvania, USA.
13
Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon, USA.
14
Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA.
15
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.

Abstract

OBJECTIVE:

Although previous reports suggest that surgery can improve the pain and disability of cervical spinal deformity (CSD), techniques are not standardized. Our objective was to assess for consensus on recommended surgical plans for CSD treatment.

METHODS:

Eighteen CSD cases were assembled, including a clinical vignette, cervical imaging (radiography, computed tomography/magnetic resonance imaging), and full-length standing radiography. Fourteen deformity surgeons (10 orthopedic, 4 neurosurgery) were queried regarding recommended surgical plans.

RESULTS:

There was marked variation in treatment plans across all deformity types. Even for the least complex deformities (moderate midcervical apex kyphosis), there was lack of agreement on approach (50% combined anterior-posterior, 25% anterior only, 25% posterior only), number of anterior (range, 2-6) and posterior (range, 4-16) fusion levels, and types of osteotomies. As the kyphosis apex moved caudally (cervical-thoracic junction/upper thoracic spine) and for cases with chin-on-chest kyphosis, >80% of surgeons agreed on a posterior-only approach and >70% recommended a pedicle subtraction osteotomy or vertebral column resection, but the range in number of anterior (4-8) and posterior (4-27) fusion levels was exceptionally broad. Cases of cervical/cervical-thoracic scoliosis had the least agreement for approach (48% posterior only, 33% combined anterior-posterior, 17% anterior-posterior-anterior or posterior-anterior-posterior, 2% anterior only) and had broad variation in the number of anterior (2-5) and posterior (6-19) fusion levels, and recommended osteotomies (41% pedicle subtraction osteotomy/vertebral column resection).

CONCLUSIONS:

Among a panel of deformity surgeons, there was marked lack of consensus on recommended surgical approach, osteotomies, and fusion levels for CSD. Further study is warranted to assess whether specific surgical treatment approaches are associated with better outcomes.

KEYWORDS:

Cervical; Deformity; Fusion; Kyphosis; Osteotomy; Spine; Surgery

PMID:
27086260
DOI:
10.1016/j.wneu.2016.04.020
[Indexed for MEDLINE]

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