Evolution of Adult Cervical Deformity Surgery Clinical and Radiographic Outcomes Based on a Multicenter Prospective Study: Are Behaviors and Outcomes Changing With Experience?

Passias, Peter G.; Krol, Oscar; Moattari, Kevin; Williamson, Tyler; Lafage, Virginie; Lafage, Renaud; Kim, Hee Jin; Daniels, Alan H.; Diebo, Bassel G.; Protopsaltis, Themistocles S.; Kebaish, Khaled M.; Sorocéanu, Alexandra; Hamilton, D. Kojo; Klineberg, Eric O.; Schoenfeld, Andrew J.; Vira, Shaleen; Line, Breton; Hart, Robert A.; Burton, Douglas C.; Schwab, Frank; Shaffrey, Christopher I.; Bess, Shay; Smith, Justin S.; Ames, Christopher P.

doi:10.1097/brs.0000000000004419

Spine

2022

DOI: 10.1097/brs.0000000000004419

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Evolution of Adult Cervical Deformity Surgery Clinical and Radiographic Outcomes Based on a Multicenter Prospective Study: Are Behaviors and Outcomes Changing With Experience?

Peter G. Passias

Oscar Krol

Kevin Moattari

et al.

Abstract: and on behalf of the International Spine Study Group m Study Design. Retrospective cohort study.Objective. Assess changes in outcomes and surgical approaches for adult cervical deformity surgery over time.

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2024

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Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

Williamson,

Koslosky,

Lebovic

et al. 2024

Clinical Spine Surgery

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Background: The association of Hounsfield units (HU) and junctional pathologies in adult cervical deformity (ACD) surgery has not been elucidated. Objective: Assess if the bone mineral density of the LIV, as assessed by HUs, is prognostic for the risk of complications after ACD surgery. Study Design/Setting: Retrospective cohort study. Methods: HUs were measured on preoperative CT scans. Means comparison test assessed differences in HUs based on the occurrence of complications, linear regression assessed the correlation of HUs with risk factors, and multivariable logistic regression followed by a conditional inference tree derived a threshold for HUs based on the increased likelihood of developing a complication. Results: In all, 107 ACD patients were included. Thirty-one patients (29.0%) developed a complication (18.7% perioperative), with 20.6% developing DJK and 11.2% developing DJF. There was a significant correlation between lower LIVs and lower HUs (r=0.351, P=0.01), as well as age and HUs at the LIV. Age did not correlate with change in the DJK angle (P>0.2). HUs were lower at the LIV for patients who developed a complication and an LIV threshold of 190 HUs was predictive of complications (OR: 4.2, [1.2–7.6]; P=0.009). Conclusions: Low bone mineral density at the lowest instrumented vertebra, as assessed by a threshold lower than 190 Hounsfield units, may be a crucial risk factor for the development of complications after cervical deformity surgery. Preoperative CT scans should be routinely considered in at-risk patients to mitigate this modifiable risk factor during surgical planning. Level of Evidence: Level—III

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Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

Williamson,

Koslosky,

Lebovic

et al. 2024

Clinical Spine Surgery

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Evolution of Adult Cervical Deformity Surgery Clinical and Radiographic Outcomes Based on a Multicenter Prospective Study: Are Behaviors and Outcomes Changing With Experience?

Abstract: and on behalf of the International Spine Study Group m Study Design. Retrospective cohort study.Objective. Assess changes in outcomes and surgical approaches for adult cervical deformity surgery over time.

Cited by 1 publication

References 39 publications

Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

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