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Chen H, Wu T, Pan S, Zhang L, Zhao Y, Chen X, Sun Y, Lu WW, Zhou F. Finite element analysis of a new preoperative traction for cervical kyphosis: suspensory traction. Med Biol Eng Comput 2024; 62:2867-2877. [PMID: 38709337 PMCID: PMC11330378 DOI: 10.1007/s11517-024-03113-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2023] [Accepted: 04/26/2024] [Indexed: 05/07/2024]
Abstract
A finite element model of cervical kyphosis was established to analyze the stress of cervical spine under suspensory traction and to explore the mechanism and effect of it. A patient with typical cervical kyphosis (C2-C5) underwent CT scan imaging, and 3D slicer was used to reconstruct the C2 to T2 vertebral bodies. The reconstructed data was imported into Hypermesh 2020 and Abaqus 2017 for meshing and finite element analysis. The changes of the kyphotic angle and the von Mises stress on the annulus fibrosus of each intervertebral disc and ligaments were analyzed under suspensory traction conditions. With the increase of suspensory traction weight, the overall kyphosis of cervical spine showed a decreasing trend. The correction of kyphosis was mainly contributed by the change of kyphotic segments. The kyphotic angle of C2-C5 was corrected from 45° to 13° finally. In cervical intervertebral discs, the stress was concentrated to anterior and posterior part, except for C4-5. The stress of the anterior longitudinal ligament (ALL) decreased from the rostral to the caudal, and the high level von Mises stress of the kyphotic segments appeared at C2-C3, C3-C4, and C4-C5. The roles of the other ligaments were not obvious. The kyphotic angle was significantly reduced by the suspensory traction. Shear effect due to the high von Mises stress in the anterior and posterior parts of annulus fibrosus and the tension on the anterior longitudinal ligament play a role in the correction of cervical kyphosis.
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Affiliation(s)
- Hongyu Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Tianchi Wu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China
| | - Shengfa Pan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Li Zhang
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Yanbin Zhao
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Xin Chen
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Yu Sun
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - William W Lu
- Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong, Hong Kong SAR, China.
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Science, Shenzhen, China.
| | - Feifei Zhou
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China.
- Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China.
- Beijing Key Laboratory of Spinal Disease Research, Beijing, China.
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2
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Jackson-Fowl B, Hockley A, Naessig S, Ahmad W, Pierce K, Smith JS, Ames C, Shaffrey C, Bennett-Caso C, Williamson TK, McFarland K, Passias PG. Adult cervical spine deformity: a state-of-the-art review. Spine Deform 2024; 12:3-23. [PMID: 37776420 DOI: 10.1007/s43390-023-00735-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/27/2020] [Accepted: 07/01/2023] [Indexed: 10/02/2023]
Abstract
Adult cervical deformity is a structural malalignment of the cervical spine that may present with variety of significant symptomatology for patients. There are clear and substantial negative impacts of cervical spine deformity, including the increased burden of pain, limited mobility and functionality, and interference with patients' ability to work and perform everyday tasks. Primary cervical deformities develop as the result of a multitude of different etiologies, changing the normal mechanics and structure of the cervical region. In particular, degeneration of the cervical spine, inflammatory arthritides and neuromuscular changes are significant players in the development of disease. Additionally, cervical deformities, sometimes iatrogenically, may present secondary to malalignment or correction of the thoracic, lumbar or sacropelvic spine. Previously, classification systems were developed to help quantify disease burden and influence management of thoracic and lumbar spine deformities. Following up on these works and based on the relationship between the cervical and distal spine, Ames-ISSG developed a framework for a standardized tool for characterizing and quantifying cervical spine deformities. When surgical intervention is required to correct a cervical deformity, there are advantages and disadvantages to both anterior and posterior approaches. A stepwise approach may minimize the drawbacks of either an anterior or posterior approach alone, and patients should have a surgical plan tailored specifically to their cervical deformity based upon symptomatic and radiographic indications. This state-of-the-art review is based upon a comprehensive overview of literature seeking to highlight the normal cervical spine, etiologies of cervical deformity, current classification systems, and key surgical techniques.
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Affiliation(s)
- Brendan Jackson-Fowl
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Aaron Hockley
- Department of Neurosurgery, University of Alberta, Edmonton, AB, USA
| | - Sara Naessig
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Waleed Ahmad
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Katherine Pierce
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Christopher Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Claudia Bennett-Caso
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Tyler K Williamson
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Kimberly McFarland
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA
| | - Peter G Passias
- Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Medical Center, NY Spine Institute, 301 East 17th St, New York, NY, 10003, USA.
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3
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Merrill RK, Clohisy JC, Albert TJ, Qureshi SA. Concepts and Techniques to Prevent Cervical Spine Deformity After Spine Surgery: A Narrative Review. Neurospine 2023; 20:221-230. [PMID: 37016868 PMCID: PMC10080418 DOI: 10.14245/ns.2244780.390] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 12/22/2022] [Indexed: 04/03/2023] Open
Abstract
Adult cervical spine deformity is associated with decreased health-related quality of life, disability, and myelopathy. A number of radiographic parameters help to characterize cervical deformity and aid in the diagnosis and treatment. There are several etiologies for cervical spine deformity, the most common being iatrogenic. Additionally, spine surgery can accelerate adjacent segment degeneration which may lead to deformity. It is therefore important for all spine surgeons to be aware of the potential to cause iatrogenic cervical deformity. The aim of this review is to highlight concepts and techniques to prevent cervical deformity after spine surgery.
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Affiliation(s)
- Robert K. Merrill
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - John C. Clohisy
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Todd J. Albert
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Sheeraz A. Qureshi
- Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, USA
- Corresponding Author Sheeraz A. Qureshi Department of Orthopedic Surgery, Minimally Invasive Spine Surgery, Hospital for Special Surgery, 535 East 70th Street, 4th Floor, New York, NY 10021, USA
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Shengfa P, Hongyu C, Yu S, Fengshan Z, Li Z, Xin C, Yinze D, Yanbin Z, Feifei Z. Effect of cervical suspensory traction in the treatment of severe cervical kyphotic deformity. Front Surg 2023; 9:1090199. [PMID: 36684247 PMCID: PMC9852755 DOI: 10.3389/fsurg.2022.1090199] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2022] [Accepted: 11/28/2022] [Indexed: 01/08/2023] Open
Abstract
Objective This study aimed to investigate a new noninvasive traction method on the treatment of severe cervical kyphotic deformity. Methods The clinical data of patients with severe cervical kyphosis (Cobb > 40°) treated in Peking University Third Hospital from March 2004 to March 2020 were retrospectively summarized. 46 cases were enrolled, comprising 27 males and 19 females. Fifteen patients underwent skull traction, and 31 patients underwent suspensory traction. Among them, seven used combined traction after one week of suspensory traction. Bedside lateral radiographs were taken every two or three days during traction. The cervical kyphosis angle was measured on lateral radiographs in and extended position at each point in time. The correction rate and evaluated Japanese Orthopedic Association (JOA) scoring for the function of the spinal cord were also measured. The data before and after the operation were compared with paired sample t-test or Wilcoxon signed-rank test. Results No neurological deterioration occurred during the skull traction and the cervical suspensory traction. There were 12 patients with normal neurological function, and the JOA score of the other 34 patients improved from 11.5 ± 2.8 to 15.4 ± 1.8 at the end of follow up (P < 0.05). The average kyphotic Cobb angle was 66.1° ± 25.2, 28.7° ± 20.1 and 17.4° ± 25.7 pre-traction, pre-operative, and at the final follow-up, respectively (P < 0.05). The average correction rate of skull traction and suspensory traction was 34.2% and 60.6% respectively. Among these, the correction rate of patients with simple suspensory traction was 69.3%. For patients with a correction rate of less than 40% by suspensory traction, combined traction was continued, and the correction rates after suspensory traction and combined traction were 30.7% and 67.1% respectively. Conclusions Pre-correction by cervical suspensory traction can achieve good results for severe cervical kyphotic deformity, with no wound and an easy process. Combined traction is effective for supplemental traction after suspensory traction.
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Affiliation(s)
- Pan Shengfa
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Chen Hongyu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Sun Yu
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhang Fengshan
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhang Li
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Chen Xin
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Diao Yinze
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhao Yanbin
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China
| | - Zhou Feifei
- Department of Orthopaedics, Peking University Third Hospital, Beijing, China,Engineering Research Center of Bone and Joint Precision Medicine, Beijing, China,Beijing Key Laboratory of Spinal Disease Research, Beijing, China,Correspondence: Zhou Feifei
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5
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Elias E, Bess S, Line BG, Lafage V, Lafage R, Klineberg E, Kim HJ, Passias P, Nasser Z, Gum JL, Kebaish K, Eastlack R, Daniels AH, Mundis G, Hostin R, Protopsaltis TS, Soroceanu A, Hamilton DK, Kelly MP, Gupta M, Hart R, Schwab FJ, Burton D, Ames CP, Shaffrey CI, Smith JS. Operative treatment outcomes for adult cervical deformity: a prospective multicenter assessment with mean 3-year follow-up. J Neurosurg Spine 2022; 37:855-864. [PMID: 35901674 DOI: 10.3171/2022.6.spine22422] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2022] [Accepted: 06/01/2022] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Adult cervical deformity (ACD) has high complication rates due to surgical complexity and patient frailty. Very few studies have focused on longer-term outcomes of operative ACD treatment. The objective of this study was to assess minimum 2-year outcomes and complications of ACD surgery. METHODS A multicenter, prospective observational study was performed at 13 centers across the United States to evaluate surgical outcomes for ACD. Demographics, complications, radiographic parameters, and patient-reported outcome measures (PROMs; Neck Disability Index, modified Japanese Orthopaedic Association, EuroQol-5D [EQ-5D], and numeric rating scale [NRS] for neck and back pain) were evaluated, and analyses focused on patients with ≥ 2-year follow-up. RESULTS Of 169 patients with ACD who were eligible for the study, 102 (60.4%) had a minimum 2-year follow-up (mean 3.4 years, range 2-8.1 years). The mean age at surgery was 62 years (SD 11 years). Surgical approaches included anterior-only (22.8%), posterior-only (39.6%), and combined (37.6%). PROMs significantly improved from baseline to last follow-up, including Neck Disability Index (from 47.3 to 33.0) and modified Japanese Orthopaedic Association score (from 12.0 to 12.8; for patients with baseline score ≤ 14), neck pain NRS (from 6.8 to 3.8), back pain NRS (from 5.5 to 4.8), EQ-5D score (from 0.74 to 0.78), and EQ-5D visual analog scale score (from 59.5 to 66.6) (all p ≤ 0.04). More than half of the patients (n = 58, 56.9%) had at least one complication, with the most common complications including dysphagia, distal junctional kyphosis, instrumentation failure, and cardiopulmonary events. The patients who did not achieve 2-year follow-up (n = 67) were similar to study patients based on baseline demographics, comorbidities, and PROMs. Over the course of follow-up, 23 of the total 169 enrolled patients were reported to have died. Notably, these represent all-cause mortalities during the course of follow-up. CONCLUSIONS This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of health-related quality of life at a mean 3.4-year follow-up, despite high complication rates and a high rate of all-cause mortality that is reflective of the overall frailty of this patient population. To the authors' knowledge, this study represents the largest and most comprehensive prospective effort to date designed to assess the intermediate-term outcomes and complications of operative treatment for ACD.
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Affiliation(s)
- Elias Elias
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Shay Bess
- 2Presbyterian St. Luke's Medical Center, Denver, Colorado
| | - Breton G Line
- 2Presbyterian St. Luke's Medical Center, Denver, Colorado
| | - Virginie Lafage
- 3Department of Orthopedic Surgery, Lennox Hill Hospital, New York, New York
| | - Renaud Lafage
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric Klineberg
- 5Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Han Jo Kim
- 4Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Peter Passias
- 6Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Zeina Nasser
- 7Neuroscience Research Center, Faculty of Medical Sciences, Lebanese University, Hadath, Lebanon
| | | | - Khaled Kebaish
- 9Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | | | - Alan H Daniels
- 11Department of Orthopedic Surgery, Brown University, Providence, Rhode Island
| | | | - Richard Hostin
- 12Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | | | - Alex Soroceanu
- 13Department of Orthopedic Surgery, University of Calgary, Alberta, Canada
| | - D Kojo Hamilton
- 14Department of Neurosurgery, University of Pittsburgh, Pennsylvania
| | - Michael P Kelly
- 15Department of Orthopedic Surgery, Rady Children's Hospital, San Diego, California
| | - Munish Gupta
- 16Department of Orthopedic Surgery, Washington University, St. Louis, Missouri
| | - Robert Hart
- 17Department of Orthopaedic Surgery, Swedish Medical Center, Seattle, Washington
| | - Frank J Schwab
- 3Department of Orthopedic Surgery, Lennox Hill Hospital, New York, New York
| | - Douglas Burton
- 18Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Christopher P Ames
- 19Department of Neurological Surgery, University of California, San Francisco, California; and
| | - Christopher I Shaffrey
- 20Departments of Neurosurgery and Orthopedic Surgery, Duke University, Durham, North Carolina
| | - Justin S Smith
- 1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
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Kim HC, Oh SH, Oh JK, Ha Y. Surgical Strategies and Perioperative Considerations for Cervical Deformity With Cerebral Palsy: A Comprehensive Review of the Literature. Neurospine 2022; 19:868-875. [PMID: 36597622 PMCID: PMC9816591 DOI: 10.14245/ns.2244956.478] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2022] [Accepted: 12/13/2022] [Indexed: 12/27/2022] Open
Abstract
The complex nature of the cervical spine makes surgical intervention challenging when treating cervical deformity in patients with cerebral palsy (CDCP). However, few studies have investigated the unique characteristics of cerebral palsy that create the need for surgery, the most effective surgical strategies, and the possible perioperative complications. The intended benefit and the potential risk of postoperative complications must be considered when deciding to operate for CDCP. Because the approach and correction strategy depend on the type of cervical deformity, as well as the patient's comorbidities and functional status, a customized strategy is needed. Perioperatively, botulinum toxin injections and muscle division techniques can help control excessive involuntary movements and improve the spinal fusion success rate. Surgical intervention for CDCP requires a multidisciplinary approach, and the information presented in this article is intended to help in the perioperative management and surgical treatment of CDCP.
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Affiliation(s)
- Hyung Cheol Kim
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Sung Han Oh
- Department of Neurosurgery, Bundang Jesaeng General Hospital, Seongnam, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yoon Ha
- Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea,Corresponding Author Yoon Ha Department of Neurosurgery, Spine and Spinal Cord Institute, Severance Hospital, Yonsei University College of Medicine, 50-1 Yonsei-ro, Seodaemun-gu, Seoul 03722, Korea
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7
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Kim HJ, Virk S, Elysee J, Ames C, Passias P, Shaffrey C, Mundis G, Protopsaltis T, Gupta M, Klineberg E, Hart R, Smith JS, Bess S, Schwab F, Lafage R, Lafage V. Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity. J Clin Med 2021; 10:jcm10214826. [PMID: 34768346 PMCID: PMC8584313 DOI: 10.3390/jcm10214826] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2021] [Revised: 10/11/2021] [Accepted: 10/11/2021] [Indexed: 11/18/2022] Open
Abstract
Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based on different morphologies of cervical deformity. Methods: Adult patients enrolled in a prospective cervical deformity database were classified into four deformity types (Flatneck (FN), Focal kyphosis (FK), Cervicothoracic kyphosis (CTK) and Coronal (C)), as previously described. We analyzed group differences in demographics, preoperative symptoms, health-related quality of life scores (HRQOLs), and surgical strategies were evaluated, and postop radiographic and HROQLs at 1+ year follow up were compared. Results: 90/109 eligible patients (mean age 63.3 ± 9.2, 64% female, CCI 1.01 ± 1.36) were evaluated. Group distributions included FN = 33%, FK = 29%, CTK = 29%, and C = 9%. Significant differences were noted in the surgical approaches for the four types of deformities, with FN and FK having a high number of anterior/posterior (APSF) approaches, while CTK and C had more posterior only (PSF) approaches. For FN and FK, PSF was utilized more in cases with prior anterior surgery (70% vs. 25%). For FN group, PSF resulted in inferior neck disability index compared to those receiving APSF suggesting APSF is superior for FN types. CTK types had more three-column osteotomies (3CO) (p < 0.01) and longer fusions with the LIV below T7 (p < 0.01). There were no differences in the UIV between all deformity types (p = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (p < 0.05) with their respective surgical strategies. Conclusions: The four types of cervical deformities had different surgical strategies to achieve improvements in HRQOLs. FN and FK types were more often treated with APSF surgery, while types CTK and C were more likely to undergo PSF. CTK deformities had the highest number of 3COs. This information may provide guidelines for the successful management of cervical deformities.
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Affiliation(s)
- Han Jo Kim
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
- Correspondence:
| | - Sohrab Virk
- Department of Orthopedics, Northwell Health, Great Neck, New York, NY 11021, USA;
| | - Jonathan Elysee
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
| | - Christopher Ames
- Department of Neurosurgery, University of San Francisco School of Medicine, San Francisco, CA 94143, USA;
| | - Peter Passias
- Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY 10016, USA; (P.P.); (T.P.)
| | - Christopher Shaffrey
- Department of Neurosurgery, Duke University Medical Center, Durham, NC 27708, USA;
| | - Gregory Mundis
- Division of Orthopaedic Surgery, Scripps Clinic Medical Group, La Jolla, CA 92037, USA;
| | | | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO 63010, USA;
| | - Eric Klineberg
- Department of Orthopedic Surgery, University of California Davis, Davis, CA 95616, USA;
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, OR 97239, USA;
| | - Justin S. Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 22904, USA;
| | - Shay Bess
- Denver International Spine Center, Rocky Mountain Hospital for Children at Presbyterian St. Luke’s, Denver, CO 80218, USA;
| | - Frank Schwab
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
| | - Renaud Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
| | - Virginie Lafage
- Department of Orthopedics, Hospital for Special Surgery, New York, NY 10021, USA; (J.E.); (F.S.); (R.L.); (V.L.)
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8
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Kim CW, Hyun SJ, Kim KJ. Systematic Review of Reciprocal Changes after Spinal Reconstruction Surgery : Do Not Miss the Forest for the Trees. J Korean Neurosurg Soc 2021; 64:843-852. [PMID: 34619822 PMCID: PMC8590906 DOI: 10.3340/jkns.2020.0234] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2020] [Accepted: 01/27/2021] [Indexed: 12/04/2022] Open
Abstract
The purpose of this review was to synthesize the research on global spinal alignment and reciprocal changes following cervical or thoracolumbar reconstruction surgery. We carried out a search of PubMed, EMBASE, and Cochrane Library for studies through May 2020, and ultimately included 11 articles. The optimal goal of a truly balanced spine is to maintain the head over the femoral heads. When spinal imbalance occurs, the human body reacts through various compensatory mechanisms to maintain the head over the pelvis and to retain a horizontal gaze. Historically, deformity correction has focused on correcting scoliosis and preventing scoliotic curve progression. Following substantial correction of a spinal deformity, reciprocal changes take place in the flexible segments proximal and distal to the area of correction. Restoration of lumbar lordosis following surgery to correct a thoracolumbar deformity induces reciprocal changes in T1 slope, cervical lordosis, pelvic shift, and lower extremity parameters. Patients with cervical kyphosis exhibit different patterns of reciprocal changes depending on whether they have head-balanced or trunk-balanced kyphosis. These reciprocal changes should be considered to in order to prevent secondary spine disorders. We emphasize the importance of evaluating the global spinal alignment to assess postoperative changes.
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Affiliation(s)
- Chang-Wook Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ki-Jeong Kim
- Department of Neurosurgery, Spine Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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9
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Abstract
The treatment of adult cervical deformity continues to be complex with high complication rates. However there are many new advancements and overall patients do well following surgical correction. To date there are now many types of cervical deformity that have been classified and there exists a variety of surgical options. These recent advances have been developed in the last few years and the field continues to grow at a rapid rate. Thus, the goal of this article is to provide an updated review of cervical sagittal balance including; cervical alignment parameters, deformity classification, clinical evaluation, with both conservative and surgical treatment options.
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Affiliation(s)
- Justin K Scheer
- Department of Neurological Surgery, 8785University of California, San Francisco, San Francisco, CA, USA
| | - Darryl Lau
- Department of Neurosurgery, 12296School of Medicine, New York University, New York, NY, USA
| | - Christopher P Ames
- Department of Neurological Surgery, 8785University of California, San Francisco, San Francisco, CA, USA
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10
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Scheer JK, Lau D, Smith JS, Lee SH, Safaee MM, Fury M, Ames CP. Alignment, Classification, Clinical Evaluation, and Surgical Treatment for Adult Cervical Deformity: A Complete Guide. Neurosurgery 2021; 88:864-883. [PMID: 33548924 DOI: 10.1093/neuros/nyaa582] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 08/30/2020] [Indexed: 11/12/2022] Open
Abstract
Adult cervical deformity management is complex and is a growing field with many recent advancements. The cervical spine functions to maintain the position of the head and plays a pivotal role in influencing subjacent global spinal alignment and pelvic tilt as compensatory changes occur to maintain horizontal gaze. There are various types of cervical deformity and a variety of surgical options available. The major advancements in the management of cervical deformity have only been around for a few years and continue to evolve. Therefore, the goal of this article is to provide a comprehensive review of cervical alignment parameters, deformity classification, clinical evaluation, and surgical treatment of adult cervical deformity. The information presented here may be used as a guide for proper preoperative evaluation and surgical treatment in the adult cervical deformity patient.
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Affiliation(s)
- Justin K Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Darryl Lau
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Sang-Hun Lee
- Department of Orthopedic Surgery, Johns Hopkins Hospital, Baltimore, Maryland
| | - Michael M Safaee
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Marissa Fury
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Congenital Osseous Torticollis that Mimics Congenital Muscular Torticollis: A Retrospective Observational Study. CHILDREN-BASEL 2020; 7:children7110227. [PMID: 33202872 PMCID: PMC7696718 DOI: 10.3390/children7110227] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/20/2020] [Revised: 11/10/2020] [Accepted: 11/11/2020] [Indexed: 12/02/2022]
Abstract
It may be difficult to diagnose congenital osseous torticollis based on physical examinations or plain X-rays, especially when children have no other accompanying congenital defects. This study reports the children with torticollis caused by the vertebral anomaly with the symptom of abnormal head and neck posture only. We retrospectively reviewed the records of 1015 patients diagnosed with congenital torticollis in a single tertiary hospital (Incheon St. Mary’s Hospital, Korea) who were referred from a primary local clinic. We included those with deficits in passive range of motion (PROM) of neck. Ultrasonography of the sternocleidomastoid (SCM) muscles, ophthalmologic and neurologic examinations, and cervical X-rays were performed for all patients. If bony malalignment was suspected from X-ray, three-dimensional volume-rendered computed tomography (3D-CT) was performed. Ten patients were diagnosed with osseous torticollis with no defect other than bony anomalies. Although X-ray images were acquired for all patients, vertebral anomalies were definitely confirmed in three cases (30.0%) only, and the others (70.0%) were confirmed by CT. The most common type of vertebral anomaly was single-level fusion. Identifying congenital vertebral anomalies is challenging especially when the degree of invasion is only one level. Although abnormal findings on X-rays may be subtle, a careful examination must be performed to avoid misdiagnosis.
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12
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Xu C, Zhang Y, Dong M, Wu H, Yu W, Tian Y, Cao P, Chen H, Wang X, Shen X, Liu Y, Yuan W. The relationship between preoperative cervical sagittal balance and clinical outcome of laminoplasty treated cervical ossification of the posterior longitudinal ligament patients. Spine J 2020; 20:1422-1429. [PMID: 32474225 DOI: 10.1016/j.spinee.2020.05.542] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/06/2019] [Revised: 05/10/2020] [Accepted: 05/20/2020] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT Laminoplasty is a common surgical method used to treat patients with cervical ossification of the posterior longitudinal ligament (OPLL). Although laminoplasty is preferred over traditional laminectomy, the factors affecting the complications and outcomes are unclear. Recently, sagittal balance indexes have been revealed to be predictors of clinical outcomes in patients with cervical degenerative diseases, but their relationships with laminoplasty-treated OPLL outcomes remains unknown. PURPOSE The purpose of this study is to evaluate the relationship of preoperative cervical sagittal balance indexes and clinical outcome in laminoplasty treated OPLL patients. STUDY DESIGN This is a retrospective case study. PATIENT POPULATION Between January 2015 and January 2017, 181 consecutively included patients who underwent cervical laminoplasty for OPLL were enrolled (male:female ratio=126:75; mean age=60.2 years). Cervical spine lateral radiographs in neutral, flexion, and extension positions were taken before and 2 years after the surgery. OUTCOME MEASURES The C2-C7 Cobb angle, T1 slope, C1-C7 sagittal vertical axis (SVA), C2-C7 SVA, CGH (center of gravity of the head)-C7 SVA, cervical JOA (Japanese Orthopedic Association) score, and neck VAS (visual analogue scale) score were measured preoperatively and postoperatively at the 2-year follow-up. METHODS The patients were divided into two groups according to changes in the lordotic angle or the recovery rate of the JOA score. The relationships between the postoperative lordosis loss or the clinical outcome and the preoperative variables, including the patient's age, JOA score, C2-C7 Cobb angle, T1 slope, C1-C7 SVA, C2-C7 SVA, and CGH-C7 SVA, were investigated. RESULTS The patients were divided into two groups according to the postoperative change in the C2-C7 Cobb angle. There were no differences in the age, preoperative C2-C7 Cobb angle, C1-C7 SVA, or C2-C7 SVA; there was only a difference in the preoperative CGH-C7 SVA and T1 slope level (p=.038, p=.042). The postoperative JOA and JOA recovery rate were related to the postoperative lordosis loss in cervical alignment (p=.048, p=.031). We again divided the patients into two groups according to the JOA recovery rate and found that only the preoperative CGH-C7 SVA and C1-C7 SVA were related to the neurological outcome (p=.011, p=.047). According to the multivariate logistic regression analysis, higher preoperative CGH-C7 SVA levels were significantly associated with decreases in the lordosis angle postoperatively and the clinical outcome (p=.018, OR=1.225; p=.034, OR=1.654). The ROC (receiver operating characteristic) analysis revealed that the proper cutoff value of preoperative CGH-C7 SVA for predicting the postoperative loss of lordosis and clinical outcomes is 3.8 cm. CONCLUSION Preoperative cervical sagittal balance indexes are related to the outcomes of OPLL patients after laminoplasty. Patients with high preoperative CGH-C7 SVA levels have a high probability of developing sagittal imbalances and neurological symptoms of the cervical spine, and this measurement can be used as a predictor of outcomes in laminoplasty-treated cervical OPLL patients.
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Affiliation(s)
- Chen Xu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Yizhi Zhang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Minjie Dong
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Huiqiao Wu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Wenchao Yu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Ye Tian
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Peng Cao
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Huajiang Chen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Xinwei Wang
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Xiaolong Shen
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China
| | - Yang Liu
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China.
| | - Wen Yuan
- Spine Center, Department of Orthopedics, Changzheng Hospital, Second Military Medical University, 415th Feng Yang Road, Shanghai 200003, PR China.
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13
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Bohl MA, McBryan S, Kakarla UK, Leveque JC, Sethi R. Utility of a Novel Biomimetic Spine Model in Surgical Education: Case Series of Three Cervicothoracic Kyphotic Deformities. Global Spine J 2020; 10:583-591. [PMID: 32677566 PMCID: PMC7359677 DOI: 10.1177/2192568219865182] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
STUDY DESIGN Evaluation of new technology. OBJECTIVES To evaluate the utility of a novel biomimetic spine model as a surgical planning and education resource in the treatment of cervical spine deformities (CSD). METHODS Three patients with CSD were identified and synthetic spine models were manufactured to match the anatomical and biomechanical properties of each patient. Each model underwent 3 phases of surgical correction: maximum correction with no osteotomies performed, with posterior column osteotomies (PCOs) only, and with PCOs and a 3-column osteotomy (3CO). Lateral fluoroscopic films were obtained after each phase of correction for measurement of cervical lordosis. Surgeons were surveyed to obtain subjective feedback on the perceived model utility. RESULTS Each model began with a kyphotic deformity that was mobile, rigid, or fixed. The mobile model achieved successive lordotic correction with each phase of correction. The rigid and fixed models achieved much less correction with no osteotomies and PCOs only, and the majority of correction with 3COs. Each model predicted with varying, but overall high, accuracy the amount of correction achieved in each patient. The surgeons felt the model had very high utility as a surgical education platform. CONCLUSIONS The models appeared to accurately replicate the gross anatomy and biomechanical performance of the patients' spines. This high fidelity to the individual patient's anatomy, bone quality, and segmental mobility resulted in a custom model that provides an invaluable learning platform for surgical education. These results suggest the models may have utility in surgical planning, but further studies are needed.
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Affiliation(s)
- Michael A. Bohl
- St Joseph’s Hospital and Medical Center, Phoenix, AZ, USA,Virginia Mason Medical Center, Seattle, WA, USA,Michael A. Bohl, Department of Neurosurgery, Barrow Neurological Institute, St Joseph’s Hospital and Medical Center, Phoenix, AZ 85013-4409, USA.
| | - Sarah McBryan
- St Joseph’s Hospital and Medical Center, Phoenix, AZ, USA
| | | | | | - Rajiv Sethi
- Virginia Mason Medical Center, Seattle, WA, USA,University of Washington, Seattle, WA, USA
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14
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Defining an Algorithm of Treatment for Severe Cervical Deformity Using Surgeon Survey and Treatment Patterns. World Neurosurg 2020; 139:e541-e547. [DOI: 10.1016/j.wneu.2020.04.057] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2020] [Accepted: 04/08/2020] [Indexed: 11/21/2022]
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15
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Pathological Features and Surgical Strategies of Cervical Deformity. BIOMED RESEARCH INTERNATIONAL 2020; 2020:4290597. [PMID: 32461987 PMCID: PMC7243010 DOI: 10.1155/2020/4290597] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/03/2019] [Accepted: 04/28/2020] [Indexed: 01/15/2023]
Abstract
Cervical deformity (CD) is a kind of disorder influencing cervical alignment. Although the incidence of CD is not high, this deformity can cause not only pain but also difficulties in daily activities such as swallowing and maintaining upright position. Even though the common cause of cervical deformity is still controversial, previous studies divided CD into congenital deformity and secondary deformity; secondary deformity includes iatrogenic and noniatrogenic deformity according to pathogenic factors. Due to the lack of relevant studies, a standardized evaluation for CD is absent. Even though the assessment of preoperative condition and surgical planning mainly rely on personal experience, the evaluation methods could still be summarized from previous studies. The objective in this article is to summarize studies on cervical scoliosis, identify clinical problems, and provide directions for researchers interested in delving deep into this specific topic. In this review, we found that the lack of standard classification system could lead to an absence of clinical guidance; in addition, the osseous landmarks and vascular distributions could be variable in CD patients, which might cause the risk of vascular or neurological complications; furthermore, multiple deformities were usually presented in CD patients, which might cause chain reaction after the correction of CD; this would prevent surgeons from choosing realignment surgery that is effective but risky.
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16
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Horn SR, Passias PG, Oh C, Lafage V, Lafage R, Smith JS, Line B, Anand N, Segreto FA, Bortz CA, Scheer JK, Eastlack RK, Deviren V, Mummaneni PV, Daniels AH, Park P, Nunley PD, Kim HJ, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery. J Neurosurg Spine 2020; 32:182-190. [PMID: 31675700 DOI: 10.3171/2019.7.spine18651] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2018] [Accepted: 07/09/2019] [Indexed: 11/06/2022]
Abstract
OBJECTIVE Cervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery. METHODS The authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2-7 Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2-7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25°. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope-cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC). RESULTS In total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients' conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0-11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2-12 kyphosis, TS-CL, C2-T3 SVA, C2-T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9-39), worse baseline neurological status (OR 11.4, 95% CI 1.8-70.8), baseline pelvic tilt > 20° (OR 0.92, 95% CI 0.85-0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1-4.1), preoperative C2-T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9-1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09-10.3). CONCLUSIONS Of all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct.
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Affiliation(s)
- Samantha R Horn
- 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Peter G Passias
- 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Cheongeun Oh
- 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Virginie Lafage
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Breton Line
- 4Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Neel Anand
- 5Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California
| | - Frank A Segreto
- 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Cole A Bortz
- 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Justin K Scheer
- 6Department of Neurosurgery, University of Illinois at Chicago, Illinois
| | - Robert K Eastlack
- 7Department of Orthopaedic Surgery, Scripps Health, La Jolla, California
| | - Vedat Deviren
- 8Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Praveen V Mummaneni
- 8Department of Orthopaedic Surgery, University of California, San Francisco, California
| | - Alan H Daniels
- 9Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island
| | - Paul Park
- 10Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan
| | - Pierce D Nunley
- 11Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana
| | - Han Jo Kim
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric O Klineberg
- 12Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Douglas C Burton
- 13Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- 14Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington; and
| | - Frank J Schwab
- 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- 4Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Christopher I Shaffrey
- 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia
| | - Christopher P Ames
- 15Department of Neurological Surgery, University of California, San Francisco, California
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Abstract
STUDY DESIGN Retrospective review. OBJECTIVE The aim of this study was to develop a novel surgical invasiveness index for cervical deformity (CD) surgery that incorporates CD-specific parameters. SUMMARY OF BACKGROUND DATA There has been a surgical invasiveness index for general spine surgery and adult spinal deformity, but a CD index has not been developed. METHODS CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin brow vertical angle >25°. Consensus from experienced spine and neurosurgeons selected weightings for each variable that went into the invasiveness index. Binary logistic regression predicted high operative time (>338 minutes), estimated blood loss (EBL) (>600 mL), or length of stay (LOS) >5 days) based on the median values of operative time, EBL, and LOS. Multivariable regression modeling was utilized to construct a final model incorporating the strongest combination of factors to predict operative time, LOS, and EBL. RESULTS Eighty-five CD patients were included (61 years, 66% females). The variables in the newly developed CD invasiveness index with their corresponding weightings were: history of previous cervical surgery (3), anterior cervical discectomy and fusion (2/level), corpectomy (4/level), levels fused (1/level), implants (1/level), posterior decompression (2/level), Smith-Peterson osteotomy (2/level), three-column osteotomy (8/level), fusion to upper cervical spine (2), absolute change in T1 slope minus cervical lordosis, cSVA, T4-T12 thoracic kyphosis (TK), and sagittal vertical axis (SVA) from baseline to 1-year. The newly developed CD-specific invasiveness index strongly predicted long LOS (R = 0.310, P < 0.001), high EBL (R = 0.170, P = 0.011), and extended operative time (R = 0.207, P = 0.031). A second analysis used multivariable regression modeling to determine which combination of factors in the newly developed index were the strongest determinants of operative time, LOS, and EBL. The final predictive model included: number of corpectomies, levels fused, decompression, combined approach, and absolute changes in SVA, cSVA, and TK. This model predicted EBL (R = 0.26), operative time (R = 0.12), and LOS (R = 0.13). CONCLUSION Extended LOS, operative time, and high blood loss were strongly predicted by the newly developed CD invasiveness index, incorporating surgical factors and radiographic parameters clinically relevant for patients undergoing CD corrective surgery. LEVEL OF EVIDENCE 4.
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18
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Passias PG, Horn SR, Oh C, Lafage R, Lafage V, Smith JS, Line B, Protopsaltis TS, Yagi M, Bortz CA, Segreto FA, Alas H, Diebo BG, Sciubba DM, Kelly MP, Daniels AH, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP. Predicting the Occurrence of Postoperative Distal Junctional Kyphosis in Cervical Deformity Patients. Neurosurgery 2019; 86:E38-E46. [DOI: 10.1093/neuros/nyz347] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2018] [Accepted: 04/18/2019] [Indexed: 11/14/2022] Open
Abstract
ABSTRACT
BACKGROUND
Distal junctional kyphosis (DJK) development after cervical deformity (CD)-corrective surgery is a growing concern for surgeons and patients. Few studies have investigated risk factors that predict the occurrence of DJK.
OBJECTIVE
To predict DJK development after CD surgery using predictive modeling.
METHODS
CD criteria was at least one of the following: C2-C7 Coronal/Cobb > 10°, C2-7 sagittal vertical axis (cSVA) > 4 cm, chin-brow vertical angle > 25°. DJK was defined as the development of an angle <−10° from the end of fusion construct to the second distal vertebra, and change in this angle by <−10° from baseline to postoperative. Baseline demographic, clinical, and surgical information were used to predict the occurrence of DJK using generalized linear modeling both as one overall model and as submodels using baseline demographic and clinical predictors or surgical predictors.
RESULTS
One hundred seventeen CD patients were included. At any postoperative visit up to 1 yr, 23.1% of CD patients developed DJK. DJK was predicted with high accuracy using a combination of baseline demographic, clinical, and surgical factors by the following factors: preoperative neurological deficit, use of transition rod, C2-C7 lordosis (CL)<−12°, T1 slope minus CL > 31°, and cSVA > 54 mm. In the model using only baseline demographic/clinical predictors of DJK, presence of comorbidities, presence of baseline neurological deficit, and high preoperative C2-T3 angle were included in the final model (area under the curve = 87%). The final model using only surgical predictors for DJK included combined approach, posterior upper instrumented vertebrae below C4, use of transition rod, lack of anterior corpectomy, more than 3 posterior osteotomies, and performance of a 3-column osteotomy.
CONCLUSION
Preoperative assessment and consideration should be given to these factors that are predictive of DJK to mitigate poor outcomes.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Cheongeun Oh
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton Line
- Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | | | - Mitsuru Yagi
- Department of Orthopedic Surgery, Keio University, Tokyo, Japan
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Haddy Alas
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, New York
| | - Daniel M Sciubba
- Department of Neurosurgery, Johns Hopkins Medical Center, Baltimore, Maryland
| | - Michael P Kelly
- Department of Orthopaedic Surgery, Washington University in St. Louis, St. Louis, Missouri
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island
| | - Eric O Klineberg
- Department of Orthopedic Surgery, University of California Davis, Sacramento, California
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Shay Bess
- Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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19
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Passias PG, Segreto FA, Lafage R, Lafage V, Smith JS, Line BG, Scheer JK, Mundis GM, Hamilton DK, Kim HJ, Horn SR, Bortz CA, Diebo BG, Vira S, Gupta MC, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Shaffrey CI, Ames CP, Bess S. Recovery kinetics following spinal deformity correction: a comparison of isolated cervical, thoracolumbar, and combined deformity morphometries. Spine J 2019; 19:1422-1433. [PMID: 30930292 DOI: 10.1016/j.spinee.2019.03.006] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Revised: 03/19/2019] [Accepted: 03/21/2019] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The postoperative recovery patterns of cervical deformity patients, thoracolumbar deformity patients, and patients with combined cervical and thoracolumbar deformities, all relative to one another, is not well understood. Clear objective benchmarks are needed to quantitatively define a "good" versus a "bad" postoperative recovery across multiple follow-up visits, varying deformity types, and guide expectations. PURPOSE To objectively define and compare the complete 2-year postoperative recovery process among operative cervical only, thoracolumbar only, and combined deformity patients using area-under-the-curve (AUC) methodology. STUDY DESIGN/SETTING Retrospective review of 2 prospective, multicenter adult cervical and spinal deformity databases. PATIENT SAMPLE One hundred seventy spinal deformity patients. OUTCOME MEASURES Common health-related quality of life (HRQOL) assessments across both databases included the EuroQol 5-Dimension Questionnaire and Numeric Rating Scale (NRS) back pain assessment. In order to compare disability improvements, the Neck Disability Index (NDI) and the Oswestry Disability Index (ODI) were merged into one outcome variable, the ODI-NDI. Both assessments are gauged on the same scale, with minimal question deviation. Sagittal Radiographic Alignment was also assessed at pre- and all postoperative time points. METHODS Operative deformity patients >18 years old with baseline (BL) to 2-year HRQOLs were included. Patients were stratified by cervical only (C), thoracolumbar only (T), and combined deformities (CT). HRQOL and radiographic outcomes were compared within and between deformity groups. AUC normalization generated normalized HRQOL scores at BL and all follow-up intervals (6 weeks, 3 months, 1 year, and 2 year). Normalized scores were plotted against follow-up time interval. AUC was calculated for each follow-up interval, and total area was divided by cumulative follow-up length, determining overall, time-adjusted HRQOL recovery (Integrated Health State, IHS). Multiple linear regression models determined significant predictors of HRQOL discrepancies among deformity groups. RESULTS One hundred seventy patients were included (27 C, 27 T, and 116 CT). Age, BMI, sex, smoking status, osteoporosis, depression, and BL HRQOL scores were similar among groups (p >. 05). T and CT patients had higher comorbidity severities (CCI: C 0.696, T 1.815, CT 1.699, p = .020). Posterior surgical approaches were most common (62.9%) followed by combined (28.8%) and anterior (6.5%). Standard HRQOL analysis found no significant differences among groups until 1-year follow-up, where C patients exhibited comparatively greater NRS back pain (4.88 vs. 3.65 vs. 3.28, p = .028). NRS Back pain differences between groups subsided by 2-years (p>.05). Despite C patients exhibiting significantly faster ODI-NDI minimal clinically important difference (MCID) achievement (33.3% vs. 0% vs. 23.0%, p < .001), all deformity groups exhibited similar ODI-NDI MCID achievement by 2-years (51.9% vs. 59.3% vs. 62.9%, p = 0.563). After HRQOL normalization, similar results were observed relative to the standard analysis (1-year NRS Back: C 1.17 vs. T 0.50 vs. CT 0.51, p < .001; 2-year NRS Back: 1.20 vs. 0.51 vs. 0.69, p = .060). C patients exhibited a worse NRS back normalized IHS (C 1.18 vs. T 0.58 vs. CT 0.63, p = .004), indicating C patients were in a greater state of postoperative back pain for a longer amount of time. Linear regression models determined postoperative distal junctional kyphosis (adjusted beta: 0.207, p = .039) and osteoporosis (adjusted beta: 0.269, p = .007) as the strongest predictors of a poor NRS back IHS (model summary: R2 = 0.177, p = .039). CONCLUSIONS Despite C patients exhibiting a quicker rate of MCID disability (ODI-NDI) improvement, they exhibited a poorer overall recovery of back pain with worse NRS back scores compared with BL status and other deformity groups. Postoperative distal junctional kyphosis and osteoporosis were identified as primary drivers of a poor postoperative NRS back IHS. Utilization of the IHS, a single number adjusting for all postoperative HRQOL visits, in conjunction with predictive modelling may pose as an improved method of gauging the effect of surgical details and complications on a patient's entire recovery process.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA.
| | - Frank A Segreto
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton G Line
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA
| | - Gregory M Mundis
- Department of Orthopaedics, San Diego Center for Spinal Disorders, La Jolla, CA, USA
| | - D Kojo Hamilton
- Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Samantha R Horn
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Cole A Bortz
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA
| | - Shaleen Vira
- Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Munish C Gupta
- Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
| | - Robert A Hart
- Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA
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Clinical comparison between simple laminectomy and laminectomy plus posterior instrumentation in surgical treatment of cervical myelopathy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:975-982. [PMID: 30737557 DOI: 10.1007/s00590-019-02395-6] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/01/2018] [Accepted: 02/04/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Posterior stabilization in patients treated with laminectomy for spondylotic cervical myelopathy is still a debate. Despite both being reported in literature by several authors, some controversies still exist. The aim of this study is to compare clinical and radiological outcomes in patients treated with laminectomy or laminectomy with posterior stabilization. MATERIAL AND METHODS We retrospectively evaluated 42 patients affected by cervical myelopathy (mean age 70.43 ± 5.03 years), 19 treated with laminectomy (group A) and 23 with laminectomy and posterior instrumentation (group B). Neurological status was assessed with Nurick scale, pain with VAS and radiological parameters with C2-C7 SVA, T1 slope and C2-C7 lordosis, clinical function with modified Japanese Orthopaedic Association score (JOA). Also, surgery time and blood loss were recorded. Student's t test was used for continuous variables, while Kruskal-Wallis test was used for categorical values. RESULTS No differences were found in postoperative Nurick scale (p = 0.587), VAS (p = 0.62), mJOA (p = 0.197) and T1 slope (p = 0.559), while laminectomy with fusion showed better postoperative cervical lordosis (p = 0.007) and C2-C7 SVA (p < 0.00001), but higher blood loss (p < 0.00001) and surgical time (p < 0.00001). Both groups showed better Nurick scale (p = 0.00017 for group A and p = 0.00081 for group B), VAS (p = 0.02 for group A and p = 0.046 for group B) and mJOA (p < 0.00001 for both groups) than preoperative values. CONCLUSIONS Both treatments are a valuable choice, offering some benefits and disadvantages against each other. Each procedure must be carefully evaluated on the basis of patients' general status, preoperative pain, signs of instability and potential benefits from cervical alignment correction.
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Passias PG, Jalai CM, Worley N, Vira S, Scheer JK, Smith JS, Ramachandran S, Soroceanu A, Horn SR, Poorman GW, Protopsaltis TS, Klineberg EO, Sciubba DM, Kim HJ, Hamilton DK, Lafage R, Lafage V, Ames CP. Development of New-Onset Cervical Deformity in Nonoperative Adult Spinal Deformity Patients With 2-Year Follow-Up. Int J Spine Surg 2018; 12:725-734. [PMID: 30619677 DOI: 10.14444/5091] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Purpose Evaluate the presence of new-onset cervical deformity (CD) in nonoperative adult spinal deformity (ASD) patients with extended follow-up, with consideration for predictors, prevalence, and impact on patient-reported outcomes. Methods Retrospective review of a prospective nonoperative ASD cohort. New onset CD patients at 1- (CD-1Y) and 2-year (CD-2Y) follow-up were defined as displaying baseline cervical alignment. Univariate analyses determined differences in radiographic parameters and outcome scores of CD and maintained-cervical-alignment patients. Multivariate binary logistic regression models determined new-onset CD predictors. Results A total of 143 patients were included (mean age 54 years, mean body mass index 25.6 kg/m2, 86% female). Cervical deformity rate was 38.5% at baseline. New-onset CD incidence at 1- and 2-year follow-up was 30.0% and 41.7%, respectively. Global sagittal profile comparison of CD-1Y/CD-2Y versus maintained cervical alignment cases revealed no differences (P > .05) at any interval. Baseline C2-C7 sagittal vertical axis (SVA) was associated with increased new-onset CD risk at 1 (odds ratio [OR] 1.14, P = .025) and 2 years (OR 1.04, P = .032); prior spine surgical history was associated with CD risk at 1-year follow-up (OR 6.75, P = .047); baseline C2 slope was associated with increased CD risk at 2-year follow-up (OR 1.12, P = .041). CD development did not significantly impact health-related quality of life (P > .05). Conclusions Cervical deformity can manifest in nonoperative ASD patients: 30.0% at 1-year follow-up, and 41.7% at 2-year follow-up. Progressive CD manifested independently of thoracolumbar profile changes. Increased baseline C2-C7 SVA, C2 slope, and prior surgical history increased new-onset CD odds at 1 and 2 years.
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Affiliation(s)
- Peter G Passias
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Cyrus M Jalai
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Nancy Worley
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Shaleen Vira
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Justin K Scheer
- School of Medicine, University of California, San Diego, La Jolla, California
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Subaraman Ramachandran
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | | | - Samantha R Horn
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | - Gregory W Poorman
- Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York
| | | | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Daniel M Sciubba
- Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - D Kojo Hamilton
- Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Segreto FA, Lafage V, Lafage R, Smith JS, Line BG, Eastlack RK, Scheer JK, Chou D, Frangella NJ, Horn SR, Bortz CA, Diebo BG, Neuman BJ, Protopsaltis TS, Kim HJ, Klineberg EO, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Ames CP, Passias PG. Recovery Kinetics: Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology. Neurosurgery 2018; 85:E40-E51. [DOI: 10.1093/neuros/nyy435] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/04/2018] [Accepted: 08/16/2018] [Indexed: 11/13/2022] Open
Affiliation(s)
- Frank A Segreto
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Breton G Line
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Robert K Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Dean Chou
- Department of Orthopaedics, University of California, San Francisco, California
| | - Nicholas J Frangella
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, New York
| | - Samantha R Horn
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, New York
| | - Cole A Bortz
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, New York
| | - Bassel G Diebo
- Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York
| | - Brian J Neuman
- Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland
| | | | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Eric O Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Douglas C Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, Kansas
| | - Robert A Hart
- Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, Washington
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Orthopaedics, University of California, San Francisco, California
| | - Peter G Passias
- Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, New York
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Shin JH, Yanamadala V, Cha TD. Computer-Assisted Navigation for Real Time Planning of Pedicle Subtraction Osteotomy in Cervico-Thoracic Deformity Correction. Oper Neurosurg (Hagerstown) 2018; 16:445-450. [DOI: 10.1093/ons/opy162] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2017] [Accepted: 05/25/2018] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Pedicle subtraction osteotomy (PSO) at the cervicothoracic junction (CTJ) is a powerful technique to correct severe kyphosis and sagittal malalignment. Reported techniques have demonstrated the safety and efficacy of the PSO, however limited visualization of surrounding tissues increases the potential for complications with this advanced technique.
OBJECTIVE
To describe the application of computed tomographic (CT)-based image guidance to the planning and execution of PSO at the CTJ.
METHODS
Intraoperative registration and verification of anatomic landmarks are performed with the intraoperative O-arm CT across the CTJ. With the navigation probe, the targeted pedicle is identified and the intended trajectories are rehearsed and saved on the navigational computer. As the PSO is performed, the navigation probe is used to check the depth, accuracy, and trajectory through each side. The extent of soft tissue dissection around the lateral aspect of the vertebral body through which the PSO is performed is also verified in real time. This technique was performed in 12 consecutive patients from 2013-2016. An IRB approved, retrospective analysis was performed from a prospective spinal deformity outcomes database. Patient consent is not required for publication as this report does not describe a specific case but rather a surgical technique used in practice.
RESULTS
There were no vascular, esophageal, or soft tissue injuries in 12 consecutive patients. There were no cases of paralysis. Two patients developed hand weakness days after surgery. Intraoperative O-arm CT performed after closure of the osteotomy confirmed the accuracy of the osteotomy planning with no breach of the anterior cortical wall of the osteotomized vertebral body.
CONCLUSION
CT-guided navigation allows for 3-dimensional visualization of the CTJ and minimizes complications associated with inadequate surgical visualization of vascular and deep organ structures.
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Affiliation(s)
- John H Shin
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Vijay Yanamadala
- Department of Neurosurgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
| | - Thomas D Cha
- Department of Orthopedic Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts
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Ailon T, Smith JS, Shaffrey CI, Kim HJ, Mundis G, Gupta M, Klineberg E, Schwab F, Lafage V, Lafage R, Passias P, Protopsaltis T, Neuman B, Daniels A, Scheer JK, Soroceanu A, Hart R, Hostin R, Burton D, Deviren V, Albert TJ, Riew KD, Bess S, Ames CP. Outcomes of Operative Treatment for Adult Cervical Deformity: A Prospective Multicenter Assessment With 1-Year Follow-up. Neurosurgery 2017; 83:1031-1039. [DOI: 10.1093/neuros/nyx574] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2017] [Accepted: 10/31/2017] [Indexed: 11/13/2022] Open
Affiliation(s)
- Tamir Ailon
- Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Gregory Mundis
- Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California
| | - Munish Gupta
- Department of Orthopaedic Surgery, Washington University, St Louis, Missouri
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Peter Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | | | - Brian Neuman
- Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland
| | - Alan Daniels
- Department of Orthopaedic Surgery, Brown University Alpert Medical School, Providence, Rhode Island
| | - Justin K Scheer
- Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois
| | - Alex Soroceanu
- Department of Orthopaedics, University of Calgary, Calgary, Alberta, Canada
| | - Robert Hart
- Swedish Neuroscience Institute, Seattle, Washington
| | - Rick Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Douglas Burton
- Department of Orthopaedics, University of Kansas Medical Center, Kansas City, Kansas
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California
| | - Todd J Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - K Daniel Riew
- Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York
| | - Shay Bess
- Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Goel A, Kaswa A, Shah A, Dhar A. Multilevel Spinal Segmental Fixation for Kyphotic Cervical Spinal Deformity in Pediatric Age Group-Report of Management in 2 Cases. World Neurosurg 2017; 106:661-665. [PMID: 28735126 DOI: 10.1016/j.wneu.2017.07.055] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Revised: 07/08/2017] [Accepted: 07/11/2017] [Indexed: 11/29/2022]
Abstract
OBJECTIVE We discuss the role of instability of multiple spinal segments including the atlantoaxial joint in the pathogenesis of cervical kyphotic deformity. MATERIAL AND METHODS Two male patients (5 and 17 years old) had severe cervical kyphosis and presented with symptoms related to myelopathy. The patients underwent multisegmental spinal distraction and fixation that included atlantoaxial joint. No bone decompression was done. RESULTS At a follow-up of >30 months, both patients had significant neurologic recovery. Investigations at follow-up showed successful arthrodesis of treated spinal segments. Although incomplete, there was recovery in kyphosis. CONCLUSIONS Multisegmental spinal distraction and fixation can lead to reduction in kyphosis and relief from symptoms related to myelopathy. Role of spinal instability in general and atlantoaxial joint instability in particular in pathogenesis of cervical kyphosis need to be assessed on the basis of studies with a larger number of patients.
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Affiliation(s)
- Atul Goel
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India; Department of Neurosurgery, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India.
| | - Amol Kaswa
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Abhidha Shah
- Department of Neurosurgery, K.E.M. Hospital and Seth G.S. Medical College, Parel, Mumbai, India
| | - Arjun Dhar
- Department of Neurosurgery, Lilavati Hospital and Research Centre, Bandra (E), Mumbai, India
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Passias PG, Jalai CM, Smith JS, Lafage V, Diebo BG, Protopsaltis T, Poorman G, Ramchandran S, Bess S, Shaffrey CI, Ames CP, Schwab F. Characterizing Adult Cervical Deformity and Disability Based on Existing Cervical and Adult Deformity Classification Schemes at Presentation and Following Correction. Neurosurgery 2017; 82:192-201. [DOI: 10.1093/neuros/nyx175] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2016] [Accepted: 03/14/2017] [Indexed: 11/13/2022] Open
Abstract
Abstract
BACKGROUND
Adult cervical deformity (ACD) classifications have not been implemented in a prospective ACD population and in conjunction with adult spinal deformity (ASD) classifications.
OBJECTIVE
To characterize cervical deformity type and malalignment with 2 classifications (Ames-ACD and Schwab-ASD).
METHODS
Retrospective review of a prospective multicenter ACD database. Inclusion: patients ≥18 yr with pre- and postoperative radiographs. Patients were classified with Ames-ACD and Schwab-ASD schemes. Ames-ACD descriptors (C = cervical, CT = cervicothoracic, T = thoracic, S = coronal, CVJ = craniovertebral) and alignment modifiers (cervical sagittal vertical axis [cSVA], T1 slope minus cervical lordosis [TS-CL], modified Japanese Ortphopaedic Association [mJOA] score, horizontal gaze) were assigned. Schwab-ASD curve type stratification and modifier grades were also designated. Deformity and alignment group distributions were compared with Pearson χ2/ANOVA.
RESULTS
Ames-ACD descriptors in 84 patients: C = 49 (58.3%), CT = 20 (23.8%), T = 9 (10.7%), S = 6 (7.1%). cSVA modifier grades differed in C, CT, and T deformities (P < .019). In C, TS-CL grade prevalence differed (P = .031). Among Ames-ACD modifiers, high (1+2) cSVA grades differed across deformities (C = 47.7%, CT = 89.5%, T = 77.8%, S = 50.0%, P = .013). Schwab-ASD curve type and presence (n = 74, T = 2, L = 6, D = 2) differed significantly in S deformities (P < .001). Higher Schwab-ASD pelvic incidence minus lumbar lordosis grades were less likely in Ames-ACD CT deformities (P = .027). Higher pelvic tilt grades were greater in high (1+2) cSVA (71.4% vs 36.0%, P = .015) and high (2+3) mJOA (24.0% vs 38.1%, P = .021) scores. Postoperatively, C and CT deformities had a trend toward lower cSVA grades, but only C deformities differed in TS-CL grade prevalence (0 = 31.3%, 1 = 12.2%, 2 = 56.1%, P = .007).
CONCLUSION
Cervical deformities displayed higher TS-CL grades and different cSVA grade distributions. Preoperative associations with global alignment modifiers and Ames-ACD descriptors were observed, though only cervical modifiers showed postoperative differences.
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Affiliation(s)
- Peter G Passias
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Cyrus M Jalai
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Bassel G Diebo
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
| | - Themistocles Protopsaltis
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Gregory Poorman
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Subaraman Ramchandran
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Shay Bess
- Division of Spine Surgery, Hospital for Joint Diseases, NYU Langone Medical Center, New York, New York
| | - Christopher I Shaffrey
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
| | - Frank Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York
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Smith JS, Line B, Bess S, Shaffrey CI, Kim HJ, Mundis G, Scheer JK, Klineberg E, O’Brien M, Hostin R, Gupta M, Daniels A, Kelly M, Gum JL, Schwab FJ, Lafage V, Lafage R, Ailon T, Passias P, Protopsaltis T, Albert TJ, Riew KD, Hart R, Burton D, Deviren V, Ames CP, Group ISS. The Health Impact of Adult Cervical Deformity in Patients Presenting for Surgical Treatment: Comparison to United States Population Norms and Chronic Disease States Based on the EuroQuol-5 Dimensions Questionnaire. Neurosurgery 2017; 80:716-725. [DOI: 10.1093/neuros/nyx028] [Citation(s) in RCA: 56] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/17/2016] [Accepted: 01/13/2017] [Indexed: 11/13/2022] Open
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Asymmetric C7 pedicle subtraction osteotomy for correction of rigid cervical coronal imbalance secondary to post-traumatic heterotopic ossification: a case report, description of a novel surgical technique, and literature review. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:141-145. [PMID: 28032224 DOI: 10.1007/s00586-016-4931-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/13/2016] [Revised: 12/07/2016] [Accepted: 12/19/2016] [Indexed: 10/20/2022]
Abstract
PURPOSE Deformities of the cervical spine are uncommon in the coronal plane. In this report, a unique case of a 31-year-old male with a fixed, 30° left coronal deformity due to heterotopic ossification 3 years status post poly-trauma was treated with an asymmetric C7 pedicle subtraction osteotomy (PSO). METHODS Case report. RESULTS Pre-operatively, the patient had a fixed 45-degree left tilt of his neck and radiographs demonstrated a rigid 30° scoliosis, 7 cm coronal imbalance, and 4 cm negative sagittal balance, diffuse bridging bone between the spinous processes and the facet joints of C5 to T1 bilaterally. An asymmetric C7 PSO with C2-T3 posterior spinal fusion was completed without complication. There was residual 9° coronal deformity, 2.9 cm left coronal imbalance, and 2.3 cm sagittal imbalance. He had a marked improvement in his function, as assessed by the SF-36 physical component score (pre-op 31.1; post-op 44.7) and mental component score (pre-op 46.0; post-op 66.8). Post-operatively, neck disability index scores also improved (pre-op 38; post-op 16). Although the patient passed away from a drug overdose 14 months post-operatively, he did not report neck pain, he had not sought evaluation from another physician for his neck, and he had not undergone a subsequent neck operation before his passing. CONCLUSION In this one patient, an asymmetric C7 PSO was performed safely. While it was effective in addressing a fixed cervical coronal imbalance, its efficacy and safety profile should be confirmed in larger cohorts.
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Smith JS, Klineberg E, Shaffrey CI, Lafage V, Schwab FJ, Protopsaltis T, Scheer JK, Ailon T, Ramachandran S, Daniels A, Mundis G, Gupta M, Hostin R, Deviren V, Eastlack R, Passias P, Hamilton DK, Hart R, Burton DC, Bess S, Ames CP. Assessment of Surgical Treatment Strategies for Moderate to Severe Cervical Spinal Deformity Reveals Marked Variation in Approaches, Osteotomies, and Fusion Levels. World Neurosurg 2016; 91:228-37. [DOI: 10.1016/j.wneu.2016.04.020] [Citation(s) in RCA: 58] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/21/2015] [Revised: 04/05/2016] [Accepted: 04/05/2016] [Indexed: 11/29/2022]
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Jalai CM, Passias PG, Lafage V, Smith JS, Lafage R, Poorman GW, Diebo B, Liabaud B, Neuman BJ, Scheer JK, Shaffrey CI, Bess S, Schwab F, Ames CP. 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. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 25:2423-32. [DOI: 10.1007/s00586-016-4564-7] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/05/2016] [Revised: 04/05/2016] [Accepted: 04/06/2016] [Indexed: 12/31/2022]
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Smith JS, Ramchandran S, Lafage V, Shaffrey CI, Ailon T, Klineberg E, Protopsaltis T, Schwab FJ, O'Brien M, Hostin R, Gupta M, Mundis G, Hart R, Kim HJ, Passias PG, Scheer JK, Deviren V, Burton D, Eastlack R, Bess S, Albert TJ, Riew DK, Ames CP. Prospective Multicenter Assessment of Early Complication Rates Associated With Adult Cervical Deformity Surgery in 78 Patients. Neurosurgery 2015; 79:378-88. [DOI: 10.1227/neu.0000000000001129] [Citation(s) in RCA: 72] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
Abstract
BACKGROUND
Acute kidney injury (AKI) is a serious postoperative complication.
OBJECTIVE
To determine whether AKI in patients after craniotomy is associated with heightened 30-day mortality.
METHODS
We performed a 2-center, retrospective cohort study of 1656 craniotomy patients who received critical care between 1998 and 2011. The exposure of interest was AKI defined as meeting RIFLE (Risk, Injury, Failure, Loss of Kidney Function, and End-stage Kidney Disease) class risk, injury, and failure criteria, and the primary outcome was 30-day mortality. Adjusted odds ratios were estimated by multivariable logistic regression models with inclusion of covariate terms thought to plausibly interact with both AKI and mortality. Additionally, mortality in craniotomy patients with AKI was analyzed with a risk-adjusted Cox proportional hazards regression model and propensity score matching as a sensitivity analysis.
RESULTS
The incidences of RIFLE class risk, injury, and failure were 5.7%, 2.9%, and 1.3%, respectively. The odds of 30-day mortality in patients with RIFLE class risk, injury, or failure fully adjusted were 2.79 (95% confidence interval “CI”, 1.76-4.42), 7.65 (95% CI, 4.16-14.07), and 14.41 (95% CI, 5.51-37.64), respectively. Patients with AKI experienced a significantly higher risk of death during follow-up; hazard ratio, 1.82 (95% CI, 1.34-2.46), 3.37 (95% CI, 2.36-4.81), and 5.06 (95% CI, 2.99-8.58), respectively, fully adjusted. In a cohort of propensity score-matched patients, RIFLE class remained a significant predictor of 30-day mortality.
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Affiliation(s)
- Justin S. Smith
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | | | - Virginie Lafage
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | | | - Tamir Ailon
- Department of Neurosurgery, University of Virginia, Charlottesville, Virginia
| | - Eric Klineberg
- Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California
| | | | - Frank J. Schwab
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Michael O'Brien
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Richard Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas
| | - Munish Gupta
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Gregory Mundis
- San Diego Center for Spinal Disorders, La Jolla, California
| | - Robert Hart
- Department of Orthopaedic Surgery, Oregon Health & Science University, Portland, Oregon
| | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Peter G. Passias
- Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York
| | - Justin K. Scheer
- University of California San Diego, School of Medicine, San Diego, California
| | - Vedat Deviren
- Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California
| | - Douglas.C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas
| | | | - Shay Bess
- Rocky Mountain Hospital for Children, Denver, Colorado
| | - Todd J. Albert
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York
| | - Daniel K. Riew
- Department of Orthopedic Surgery, Columbia University, New York
| | - Christopher P. Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, California
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Postoperative cervical deformity in 215 thoracolumbar patients with adult spinal deformity: prevalence, risk factors, and impact on patient-reported outcome and satisfaction at 2-year follow-up. Spine (Phila Pa 1976) 2015; 40:283-91. [PMID: 25901975 DOI: 10.1097/brs.0000000000000746] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective review of prospective multicenter database. OBJECTIVE Quantify the incidence of new onset cervical deformity (CD) after adult spinal deformity surgery of the thoracolumbar spine, identify predictors of development, and determine the impact on outcomes. SUMMARY OF BACKGROUND DATA High prevalence of residual CD has been identified after surgical treatment of adult spinal deformity. Development of new onset CD is less understood and its clinical impact unclear. METHODS A total of 215 patients with complete 2-year follow-up and full-length radiographs met inclusion criteria. CD was defined by T1 slope minus Cervical Lordosis (CL) more than 20°, C2-C7 sagittal vertical axis more than 40 mm, or C2-C7 kyphosis more than 10°. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new onset CD. The impact of CD on health-related quality of life and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. RESULTS The overall rate of CD at 2 years after surgery was 63%. Univariate analysis revealed that patients who developed new onset CD postoperatively had higher incidence of diabetes (7.35% vs. 1.28%, P = 0.05), increased preoperative C2-C7 sagittal vertical axis (P = 0.04) and C2 slope (P = 0.038), and smaller diameter rods used at surgery (P = 0.032). Independent predictors of new onset CD at 2 years included: diabetes (odds ratio, 10.49; P = 0.046) and increased preoperative T1 slope minus cervical lordosis (odds ratio, 1.08/º; P = 0.022). Ending instrumentation below T4 was a negative predictor (odds ratio, 0.31; P = 0.019). Patients with and without CD experienced improvements in 2-year 36-Item Short Form Health Survey (P = 0.0001), Oswestry Disability Index (P = 0.0001), and Scoliosis Research Society (P = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction (P = 0.28). CONCLUSION A total of 47.7% of patients without preoperative CD developed new onset postoperative CD after thoracolumbar surgery. Independent predictors of new onset CD at 2 years included diabetes, higher preoperative T1 slope minus cervical lordosis, and ending instrumentation above T4. Significant improvements in health-related quality of life scores occurred despite the development of postoperative CD. LEVEL OF EVIDENCE 2.
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