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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

1
Department of Orthopaedic Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York.
2
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York.
3
Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri.
4
Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon.
5
Department of Orthopaedic Surgery, University of California, San Francisco, San Francisco, California.
6
Department of Neurological Surgery, University of Calgary, Calgary, Alberta, Canada.
7
Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia.
8
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.

Abstract

BACKGROUND:

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

OBJECTIVE:

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

METHODS:

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.

RESULTS:

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).

CONCLUSION:

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.

PMID:
28950349
DOI:
10.1093/neuros/nyx438

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