Analysis of Successful Versus Failed Radiographic Outcomes After Cervical Deformity Surgery

International Spine Study Group (ISSG)

Research output: Contribution to journalArticle

Abstract

Study Design. Prospective multicenter cohort study with consecutive enrollment. Objective. To evaluate preoperative alignment and surgical factors associated with suboptimal early postoperative radiographic outcomes after surgery for cervical deformity. Summary of Background Data. Recent studies have demonstrated correlation between cervical sagittal alignment and patient-reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful versus failed cervical alignment corrections remain unclear. Methods. Patients with adult cervical deformity (ACD) included with either cervical kyphosis more than 10°, C2-C7 sagittal vertical axis (cSVA) of more than 4 cm, or chin-brow vertical angle of more than 25°. Patients were categorized into failed outcomes group if cSVA of more than 4 cm or T1 slope and cervical lordosis (TS-CL) of more than 20°at 6 months postoperatively. Results. A total of 71 patients with ACD (mean age 62 yr, 56% women, 41% revisions) were included. Fourty-five had primary cervical deformities and 26 at the cervico-thoracic junction. Thirty-three (46.4%) had failed radiographic outcomes by cSVA and 46 (64.7%) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4°vs. 47.8°, P = 0.01), worse postoperative C2 slope (35.0°vs. 23.8°, P = 0.004), TS-CL (35.2°vs. 24.9°, P = 0.01), CPT (47.9°vs. 28.2°, P < 0.001), "+" Schwab modifiers (P = 0.007), revision surgery (P = 0.05), and failure to address the secondary, thoracolumbar driver of the deformity (P = 0.02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4°vs. -2.1°, P = 0.03), CPT (52.6°vs. 39.1°, P = 0.04), worse postoperative C2 slope (30.2°vs. 13.3°, P < 0.001), cervical lordosis (-3.6°vs. -15.1°, P = 0.01), and CPT (37.7°vs. 24.0°, P < 0.001). Multivariate analysis revealed postoperative distal junctional kyphosis associated with suboptimal outcomes by cSVA (odds ratio 0.06, confidence interval 0.01-0.4, P = 0.004) and TS-CL (odds ratio 0.15, confidence interval 0.02-0.97, P = 0.05). Conclusion. Factors associated with failure to correct the cSVA included revision surgery, worse preoperative CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early postoperative distal junctional kyphosis significantly affects postoperative radiographic outcomes.

Original languageEnglish (US)
Pages (from-to)E733-E781
JournalSpine
Volume43
Issue number13
DOIs
StatePublished - Jul 1 2018

Fingerprint

Lordosis
Kyphosis
Reoperation
Odds Ratio
Confidence Intervals
Chin
Multicenter Studies
Cohort Studies
Thorax
Multivariate Analysis

Keywords

  • alignment targets
  • cervical deformity
  • cervicothoracic junction
  • deformity correction
  • deformity driver
  • distal junctional kyphosis
  • failed outcomes
  • radiographic outcomes
  • sagittal malalignment
  • surgical planning

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Analysis of Successful Versus Failed Radiographic Outcomes After Cervical Deformity Surgery. / International Spine Study Group (ISSG).

In: Spine, Vol. 43, No. 13, 01.07.2018, p. E733-E781.

Research output: Contribution to journalArticle

International Spine Study Group (ISSG). / Analysis of Successful Versus Failed Radiographic Outcomes After Cervical Deformity Surgery. In: Spine. 2018 ; Vol. 43, No. 13. pp. E733-E781.
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abstract = "Study Design. Prospective multicenter cohort study with consecutive enrollment. Objective. To evaluate preoperative alignment and surgical factors associated with suboptimal early postoperative radiographic outcomes after surgery for cervical deformity. Summary of Background Data. Recent studies have demonstrated correlation between cervical sagittal alignment and patient-reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful versus failed cervical alignment corrections remain unclear. Methods. Patients with adult cervical deformity (ACD) included with either cervical kyphosis more than 10°, C2-C7 sagittal vertical axis (cSVA) of more than 4 cm, or chin-brow vertical angle of more than 25°. Patients were categorized into failed outcomes group if cSVA of more than 4 cm or T1 slope and cervical lordosis (TS-CL) of more than 20°at 6 months postoperatively. Results. A total of 71 patients with ACD (mean age 62 yr, 56{\%} women, 41{\%} revisions) were included. Fourty-five had primary cervical deformities and 26 at the cervico-thoracic junction. Thirty-three (46.4{\%}) had failed radiographic outcomes by cSVA and 46 (64.7{\%}) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4°vs. 47.8°, P = 0.01), worse postoperative C2 slope (35.0°vs. 23.8°, P = 0.004), TS-CL (35.2°vs. 24.9°, P = 0.01), CPT (47.9°vs. 28.2°, P < 0.001), {"}+{"} Schwab modifiers (P = 0.007), revision surgery (P = 0.05), and failure to address the secondary, thoracolumbar driver of the deformity (P = 0.02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4°vs. -2.1°, P = 0.03), CPT (52.6°vs. 39.1°, P = 0.04), worse postoperative C2 slope (30.2°vs. 13.3°, P < 0.001), cervical lordosis (-3.6°vs. -15.1°, P = 0.01), and CPT (37.7°vs. 24.0°, P < 0.001). Multivariate analysis revealed postoperative distal junctional kyphosis associated with suboptimal outcomes by cSVA (odds ratio 0.06, confidence interval 0.01-0.4, P = 0.004) and TS-CL (odds ratio 0.15, confidence interval 0.02-0.97, P = 0.05). Conclusion. Factors associated with failure to correct the cSVA included revision surgery, worse preoperative CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early postoperative distal junctional kyphosis significantly affects postoperative radiographic outcomes.",
keywords = "alignment targets, cervical deformity, cervicothoracic junction, deformity correction, deformity driver, distal junctional kyphosis, failed outcomes, radiographic outcomes, sagittal malalignment, surgical planning",
author = "{International Spine Study Group (ISSG)} and Protopsaltis, {Themistocles S.} and Subaraman Ramchandran and Hamilton, {D. Kojo} and Daniel Sciubba and Passias, {Peter G.} and Virginie Lafage and Renaud Lafage and Smith, {Justin S.} and Hart, {Robert A.} and Munish Gupta and Douglas Burton and Shay Bess and Christopher Shaffrey and Ames, {Christopher P.}",
year = "2018",
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doi = "10.1097/BRS.0000000000002524",
language = "English (US)",
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pages = "E733--E781",
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TY - JOUR

T1 - Analysis of Successful Versus Failed Radiographic Outcomes After Cervical Deformity Surgery

AU - International Spine Study Group (ISSG)

AU - Protopsaltis, Themistocles S.

AU - Ramchandran, Subaraman

AU - Hamilton, D. Kojo

AU - Sciubba, Daniel

AU - Passias, Peter G.

AU - Lafage, Virginie

AU - Lafage, Renaud

AU - Smith, Justin S.

AU - Hart, Robert A.

AU - Gupta, Munish

AU - Burton, Douglas

AU - Bess, Shay

AU - Shaffrey, Christopher

AU - Ames, Christopher P.

PY - 2018/7/1

Y1 - 2018/7/1

N2 - Study Design. Prospective multicenter cohort study with consecutive enrollment. Objective. To evaluate preoperative alignment and surgical factors associated with suboptimal early postoperative radiographic outcomes after surgery for cervical deformity. Summary of Background Data. Recent studies have demonstrated correlation between cervical sagittal alignment and patient-reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful versus failed cervical alignment corrections remain unclear. Methods. Patients with adult cervical deformity (ACD) included with either cervical kyphosis more than 10°, C2-C7 sagittal vertical axis (cSVA) of more than 4 cm, or chin-brow vertical angle of more than 25°. Patients were categorized into failed outcomes group if cSVA of more than 4 cm or T1 slope and cervical lordosis (TS-CL) of more than 20°at 6 months postoperatively. Results. A total of 71 patients with ACD (mean age 62 yr, 56% women, 41% revisions) were included. Fourty-five had primary cervical deformities and 26 at the cervico-thoracic junction. Thirty-three (46.4%) had failed radiographic outcomes by cSVA and 46 (64.7%) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4°vs. 47.8°, P = 0.01), worse postoperative C2 slope (35.0°vs. 23.8°, P = 0.004), TS-CL (35.2°vs. 24.9°, P = 0.01), CPT (47.9°vs. 28.2°, P < 0.001), "+" Schwab modifiers (P = 0.007), revision surgery (P = 0.05), and failure to address the secondary, thoracolumbar driver of the deformity (P = 0.02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4°vs. -2.1°, P = 0.03), CPT (52.6°vs. 39.1°, P = 0.04), worse postoperative C2 slope (30.2°vs. 13.3°, P < 0.001), cervical lordosis (-3.6°vs. -15.1°, P = 0.01), and CPT (37.7°vs. 24.0°, P < 0.001). Multivariate analysis revealed postoperative distal junctional kyphosis associated with suboptimal outcomes by cSVA (odds ratio 0.06, confidence interval 0.01-0.4, P = 0.004) and TS-CL (odds ratio 0.15, confidence interval 0.02-0.97, P = 0.05). Conclusion. Factors associated with failure to correct the cSVA included revision surgery, worse preoperative CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early postoperative distal junctional kyphosis significantly affects postoperative radiographic outcomes.

AB - Study Design. Prospective multicenter cohort study with consecutive enrollment. Objective. To evaluate preoperative alignment and surgical factors associated with suboptimal early postoperative radiographic outcomes after surgery for cervical deformity. Summary of Background Data. Recent studies have demonstrated correlation between cervical sagittal alignment and patient-reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful versus failed cervical alignment corrections remain unclear. Methods. Patients with adult cervical deformity (ACD) included with either cervical kyphosis more than 10°, C2-C7 sagittal vertical axis (cSVA) of more than 4 cm, or chin-brow vertical angle of more than 25°. Patients were categorized into failed outcomes group if cSVA of more than 4 cm or T1 slope and cervical lordosis (TS-CL) of more than 20°at 6 months postoperatively. Results. A total of 71 patients with ACD (mean age 62 yr, 56% women, 41% revisions) were included. Fourty-five had primary cervical deformities and 26 at the cervico-thoracic junction. Thirty-three (46.4%) had failed radiographic outcomes by cSVA and 46 (64.7%) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4°vs. 47.8°, P = 0.01), worse postoperative C2 slope (35.0°vs. 23.8°, P = 0.004), TS-CL (35.2°vs. 24.9°, P = 0.01), CPT (47.9°vs. 28.2°, P < 0.001), "+" Schwab modifiers (P = 0.007), revision surgery (P = 0.05), and failure to address the secondary, thoracolumbar driver of the deformity (P = 0.02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4°vs. -2.1°, P = 0.03), CPT (52.6°vs. 39.1°, P = 0.04), worse postoperative C2 slope (30.2°vs. 13.3°, P < 0.001), cervical lordosis (-3.6°vs. -15.1°, P = 0.01), and CPT (37.7°vs. 24.0°, P < 0.001). Multivariate analysis revealed postoperative distal junctional kyphosis associated with suboptimal outcomes by cSVA (odds ratio 0.06, confidence interval 0.01-0.4, P = 0.004) and TS-CL (odds ratio 0.15, confidence interval 0.02-0.97, P = 0.05). Conclusion. Factors associated with failure to correct the cSVA included revision surgery, worse preoperative CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early postoperative distal junctional kyphosis significantly affects postoperative radiographic outcomes.

KW - alignment targets

KW - cervical deformity

KW - cervicothoracic junction

KW - deformity correction

KW - deformity driver

KW - distal junctional kyphosis

KW - failed outcomes

KW - radiographic outcomes

KW - sagittal malalignment

KW - surgical planning

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U2 - 10.1097/BRS.0000000000002524

DO - 10.1097/BRS.0000000000002524

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VL - 43

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JF - Spine

SN - 0362-2436

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