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

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

Research output: Contribution to journalArticle

Abstract

Purpose: Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years. Methods: Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2–C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2–C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year). Results: Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients’ CD rates at 1 and 2 years were 78.9, and 63.0 %, respectively. Non-Op CD rates were 21.1 and 37.0 % at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p <0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2–T3 SVA, and global SVA compared to Non-Ops (p <0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p <0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019). Conclusions: In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.

Original languageEnglish (US)
Pages (from-to)1-10
Number of pages10
JournalEuropean Spine Journal
DOIs
StateAccepted/In press - Apr 13 2016

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Lordosis
Spine
Kyphosis
Quality of Life
Therapeutics
Scoliosis
Decision Making
Thorax
Demography
Databases
Research

Keywords

  • Adult spinal deformity
  • Cervical deformity
  • Cervical spine malalignment
  • Health-related quality of life
  • Thoracolumbar deformity

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

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. / Jalai, Cyrus M.; Passias, Peter G.; Lafage, Virginie; Smith, Justin S.; Lafage, Renaud; Poorman, Gregory W.; Diebo, Bassel; Liabaud, Barthélemy; Neuman, Brian J; Scheer, Justin K.; Shaffrey, Christopher I.; Bess, Shay; Schwab, Frank; Ames, Christopher P.; International Spine Study Group (Issg), Spine Study Group (Issg).

In: European Spine Journal, 13.04.2016, p. 1-10.

Research output: Contribution to journalArticle

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 & International Spine Study Group (Issg), SSGI 2016, '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, pp. 1-10. https://doi.org/10.1007/s00586-016-4564-7
Jalai, Cyrus M. ; Passias, Peter G. ; Lafage, Virginie ; Smith, Justin S. ; Lafage, Renaud ; Poorman, Gregory W. ; Diebo, Bassel ; Liabaud, Barthélemy ; Neuman, Brian J ; Scheer, Justin K. ; Shaffrey, Christopher I. ; Bess, Shay ; Schwab, Frank ; Ames, Christopher P. ; International Spine Study Group (Issg), Spine Study Group (Issg). / 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. In: European Spine Journal. 2016 ; pp. 1-10.
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abstract = "Purpose: Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years. Methods: Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2–C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2–C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year). Results: Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients’ CD rates at 1 and 2 years were 78.9, and 63.0 {\%}, respectively. Non-Op CD rates were 21.1 and 37.0 {\%} at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p <0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2–T3 SVA, and global SVA compared to Non-Ops (p <0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p <0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019). Conclusions: In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.",
keywords = "Adult spinal deformity, Cervical deformity, Cervical spine malalignment, Health-related quality of life, Thoracolumbar deformity",
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T1 - 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

AU - Jalai, Cyrus M.

AU - Passias, Peter G.

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Lafage, Renaud

AU - Poorman, Gregory W.

AU - Diebo, Bassel

AU - Liabaud, Barthélemy

AU - Neuman, Brian J

AU - Scheer, Justin K.

AU - Shaffrey, Christopher I.

AU - Bess, Shay

AU - Schwab, Frank

AU - Ames, Christopher P.

AU - International Spine Study Group (Issg), Spine Study Group (Issg)

PY - 2016/4/13

Y1 - 2016/4/13

N2 - Purpose: Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years. Methods: Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2–C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2–C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year). Results: Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients’ CD rates at 1 and 2 years were 78.9, and 63.0 %, respectively. Non-Op CD rates were 21.1 and 37.0 % at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p <0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2–T3 SVA, and global SVA compared to Non-Ops (p <0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p <0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019). Conclusions: In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.

AB - Purpose: Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years. Methods: Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2–C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2–C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year). Results: Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients’ CD rates at 1 and 2 years were 78.9, and 63.0 %, respectively. Non-Op CD rates were 21.1 and 37.0 % at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p <0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2–T3 SVA, and global SVA compared to Non-Ops (p <0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p <0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019). Conclusions: In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.

KW - Adult spinal deformity

KW - Cervical deformity

KW - Cervical spine malalignment

KW - Health-related quality of life

KW - Thoracolumbar deformity

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