Send to

Choose Destination

See 1 citation found by title matching your search:

Neurosurgery. 2018 Oct 1;83(4):651-659. doi: 10.1093/neuros/nyx438.

Primary Drivers of Adult Cervical Deformity: Prevalence, Variations in Presentation, and Effect of Surgical Treatment Strategies on Early Postoperative Alignment.

Author information

Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri.
Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon.
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
Department of Neurological Surgery, University of Calgary, Calgary, Alberta, Canada.
Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.



Primary drivers (PDs) of adult cervical deformity (ACD) have not been described in relation to pre- and early postoperative alignment or degree of correction.


To define the PDs of ACD to understand the impact of driver region on global postoperative compensatory mechanisms.


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.


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).


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.


Supplemental Content

Full text links

Icon for Silverchair Information Systems
Loading ...
Support Center