A comparative analysis of the prevalence and characteristics of cervical malalignment in adults presenting with thoracolumbar spine deformity based on variations in treatment approach over 2 years

Jalai, Cyrus M.; Passias, Peter G.; Lafage, Virginie; Smith, Justin S.; Lafage, Renaud; Poorman, Gregory W.; Diebo, Bassel G.; Liabaud, Barthélemy; Neuman, Brian J.; Shaffrey, Christopher I.; Bess, Shay; Schwab, Frank; Ames, Christopher P.

doi:10.1007/s00586-016-4564-7

Cited by 26 publications

(12 citation statements)

References 21 publications

(28 reference statements)

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“…Incidence of prolonged neck pain after spinal surgery has been well described in previous studies, in which it was evident from the lower scores of patient-reported health-related quality of life (HRQOL) parameters [13, 39]. This makes it important to undertake further investigations to develop an understanding of the patho-mechanism of this post-operative cervical pain, with the goal of devising therapeutic or preventative strategies.…”

Section: Discussionmentioning

confidence: 97%

“…The known global pathologic effects of scoliosis include a deforming coronal deviation of the spine with a concomitant rotation of vertebrae and a flattening of the sagittal profile [11, 12]. In recent studies of adult patients, it has been shown that sagittal alignment has a strong correlation with health-related quality of life scores [13]. Consequently, surgical planning for AIS patients has adopted a focus on sagittal alignment as an important parameter from adult spinal deformity research.…”

Section: Introductionmentioning

confidence: 99%

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Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

et al. 2019

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BackgroundSeveral studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS).MethodsBaseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment.ResultsStratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA.ConclusionsIn surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment.

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Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

et al. 2019

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“…Lee et al reported that TK had a negative correlation with C0–C7 kyphosis and no relationship with C2–C7 kyphosis [29]. In addition, the negative relationship between CK and TK was observed in patients with AIS in several previous publications [2, 18, 24, 25]. Further studies should deeply investigate the effect of TK on CK in asymptomatic populations.…”

Section: Discussionmentioning

confidence: 98%

“…AIS was a three-dimensional deformity of the spine that includes a coronal curve, vertebral rotation, and flattening of the sagittal profile [20–23]. Many studies have demonstrated that some abnormal parameters, such as TK and SVA increased the onset of CK in patients with AIS [5, 18, 24, 25]. Therefore, we hypothesized that these parameters could be related to CK in asymptomatic populations.…”

Section: Discussionmentioning

confidence: 99%

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Liu

Wang

et al. 2019

J Orthop Surg Res

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Background Cervical kyphosis has been pointed out in asymptomatic populations. The purposes of this study were (1) to investigate the incidence of cervical kyphosis in asymptomatic populations, (2) to identify risk factors related to cervical kyphosis, and (3) to assess the relationship between cervical kyphosis and health-related quality of life (HRQOL). Methods A cohort of 235 asymptomatic volunteers’ records was retrospectively analyzed. Radiographic parameters of the coronal and sagittal planes were measured in the full-length spine x-ray. All patients were classified into two groups based on the cervical lordosis angle: cervical lordosis (CL) and cervical kyphosis (CK). HRQOL was evaluated by EQ-5D and SF-36 (PCS and MCS) questionnaires. Results CK was observed in 90 of 235 (38.3%) participants. There was a significant difference with regard to age between volunteers with CK and CL (32.23 ± 8.12 vs. 42.12 ± 6.14, p < 0.05). Several parameters had a significant relationship with CK, including TK, T1 slope, TIA, SVA, and CT. Logistic regression analysis identified age, TK, T1 slope, and SVA as independent risk factors of CK. In addition, there was a negative correlation between CK and the parameters of HRQOL (EQ-5D, − 0.63; PCS, − 0.68; MCS, − 0.59). Conclusions The incidence of CK in normal populations is 38.3%. Some spinal parameters are related to CK. CK is associated with the HRQOL.

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“…25 After correction of the TLD, patients tend to be more misaligned 2 years from surgery with worse TK, T1 slope-cervical lordosis, cervical lordosis, cSVA, C2-T3 SVA, and global SVA compared with patients with TLD who were not operated on. 28 These patients additionally have worse Oswestry Disability Index and Scoliosis Research Society activity at 1 and 2 years. Even after controlling for magnitude of TLD, cervical alignment has a direct effect on health measures.…”

Section: Cervical-thoracic-lumbar Relationshipmentioning

confidence: 96%

Cervical Spine Deformity: Indications, Considerations, and Surgical Outcomes

Cho

Safir

Lombardi

et al. 2019

J Am Acad Orthop Surg

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Cervical spinal deformity (CSD) in adult patients is a relatively uncommon yet debilitating condition with diverse etiologies and clinical manifestations. Similar to thoracolumbar deformity, CSD can be broadly divided into scoliosis and kyphosis. Severe forms of CSD can lead to pain; neurologic deterioration, including myelopathy; and cervical spine-specific symptoms such as difficulty with horizontal gaze, dysphagia, and dyspnea. Recently, an increased interest is shown in systematically studying CSD with introduction of classification schemes and treatment algorithms. Both major and minor complications after surgical intervention have been analyzed and juxtaposed to patient-reported outcomes. An ongoing effort exists to better understand the relationship between cervical and thoracolumbar spinal alignment, most importantly in the sagittal plane. Traumatic CSD can result from instability secondary to trauma. Upper CS injuries

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A comparative analysis of the prevalence and characteristics of cervical malalignment in adults presenting with thoracolumbar spine deformity based on variations in treatment approach over 2 years

Cited by 26 publications

References 21 publications

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Cervical Spine Deformity: Indications, Considerations, and Surgical Outcomes

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