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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

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Abstract

Purpose

Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years.

Methods

Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2–C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2–C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year).

Results

Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients’ CD rates at 1 and 2 years were 78.9, and 63.0 %, respectively. Non-Op CD rates were 21.1 and 37.0 % at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p < 0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2–T3 SVA, and global SVA compared to Non-Ops (p < 0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p < 0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019).

Conclusions

In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, New York Spine Institute, New York University Medical Center—Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA

    Cyrus M. Jalai, Peter G. Passias, Gregory W. Poorman & Shay Bess

  2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA

    Virginie Lafage, Renaud Lafage, Bassel Diebo, Barthélemy Liabaud & Frank Schwab

  3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA

    Justin S. Smith & Christopher I. Shaffrey

  4. Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA

    Brian J. Neuman

  5. Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA

    Justin K. Scheer

  6. Department of Neurological Surgery, University of California, San Francisco, CA, USA

    Christopher P. Ames

Authors
  1. Cyrus M. Jalai
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  2. Peter G. Passias
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  3. Virginie Lafage
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  4. Justin S. Smith
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  5. Renaud Lafage
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  6. Gregory W. Poorman
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  7. Bassel Diebo
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  8. Barthélemy Liabaud
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  9. Brian J. Neuman
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  10. Justin K. Scheer
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  11. Christopher I. Shaffrey
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  12. Shay Bess
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  13. Frank Schwab
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  14. Christopher P. Ames
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Consortia

International Spine Study Group (ISSG)

Corresponding author

Correspondence to Peter G. Passias.

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Financial information

Funding for the International Spine Study Group Foundation, through which this study was conducted, is from research grants from DePuy Spine and individual donations.

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Jalai, C.M., Passias, P.G., Lafage, V. et al. 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. Eur Spine J 25, 2423–2432 (2016). https://doi.org/10.1007/s00586-016-4564-7

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  • DOI: https://doi.org/10.1007/s00586-016-4564-7

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