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Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA

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Abstract

Purpose

To describe reciprocal changes in cervical alignment after adult spinal deformity (ASD) correction and subsequent development of proximal junctional kyphosis (PJK). This study also investigated these changes using two novel global sagittal angular parameters, cervical–thoracic pelvic angle (CTPA) and the T1 pelvic angle (TPA).

Methods

Multicenter, retrospective consecutive case series of ASD patients undergoing thoracolumbar three-column osteotomy (3CO) with fusion to the pelvis. Radiographs were analyzed at baseline and 1 year post-operatively. Patients were substratified into upper thoracic (UT; UIV T6 and above) and lower thoracic (LT; UIV below T6). PJK was defined by >10° angle between UIV and UIV + 2 and >10° change in the angle from baseline to post-op.

Results

PJK developed in 29 % (78 of 267) of patients. CTPA was linearly correlated with cervical plumbline (CPL) as a measure of cervical sagittal alignment (R = 0.826, p < 0.001). PJK patients had significantly greater post-operative CTPA and SVA than patients without PJK (NPJK) (p = 0.042; p = 0.021). For UT (n = 141) but not LT (n = 136), PJK patients at 1 year had larger CTPA (4.9° vs. 3.7°, p = 0.015) and CPL (5.1 vs. 3.8 cm, p = 0.022) than NPJK patients, despite similar corrections in PT and PI-LL.

Conclusions

The prevalence of PJK was 29 % at 1 year follow-up. CTPA, which correlates with CPL as a global analog of cervical sagittal balance, and TPA describe relative proportions of cervical and thoracolumbar deformities. Patients who develop PJK in the upper thoracic spine after thoracolumbar 3CO also develop concomitant cervical sagittal deformity, with increases in CPL and CTPA.

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Authors and Affiliations

  1. Department of Orthopedic Surgery, New York University School of Medicine, 306 East 15th St., New York, NY, 10003, USA

    Themistocles Protopsaltis, Alex Soroceanu, Jensen K. Henry, Renaud Lafage & Shay Bess

  2. Hopital Saint-Roch, Nice, France

    Nicolas Bronsard

  3. Department of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA, USA

    Justin Smith & Christopher Shaffrey

  4. Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, USA

    Eric Klineberg

  5. San Diego Center for Spinal Disorders, La Jolla, CA, USA

    Gregory Mundis

  6. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Han Jo Kim

  7. Baylor Scoliosis Center, Plano, TX, USA

    Richard Hostin

  8. Department of Orthopedic Surgery, University of Oregon Health Sciences Center, Portland, OR, USA

    Robert Hart

  9. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, USA

    Christopher Ames

Authors
  1. Themistocles Protopsaltis
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  2. Nicolas Bronsard
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  3. Alex Soroceanu
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  5. Renaud Lafage
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  8. Gregory Mundis
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  9. Han Jo Kim
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  11. Robert Hart
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  12. Christopher Shaffrey
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International Spine Study Group

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Correspondence to Themistocles Protopsaltis.

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Conflict of interest

The ISSG received unrestricted grants from DePuy Spine and individual donors in support of this research. None of the authors have conflicts of interest directly related to the research.

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Protopsaltis, T., Bronsard, N., Soroceanu, A. et al. Cervical sagittal deformity develops after PJK in adult thoracolumbar deformity correction: radiographic analysis utilizing a novel global sagittal angular parameter, the CTPA. Eur Spine J 26, 1111–1120 (2017). https://doi.org/10.1007/s00586-016-4653-7

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  • DOI: https://doi.org/10.1007/s00586-016-4653-7

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