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


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
Publication statusAccepted/In press - Apr 13 2016



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

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

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