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


July 2016, Volume 25, Issue 8, pp 2423 - 2432 Original Article Read Full Article 10.1007/s00586-016-4564-7

First Online: 13 April 2016

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.


Read Full Article