Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients

Cole Bortz, Peter G. Passias, Katherine Elizabeth Pierce, Haddy Alas, Avery Brown, Sara Naessig, Waleed Ahmad, Renaud Lafage, Christopher P. Ames, Bassel G. Diebo, Breton G. Line, Eric O. Klineberg, Douglas C. Burton, Robert K. Eastlack, Han Jo Kim, Daniel M. Sciubba, Alex Soroceanu, Shay Bess, Christopher I. Shaffrey, Frank J. SchwabJustin S. Smith, Virginie Lafage

Research output: Contribution to journalArticle

Abstract

Purpose: The aim is to assess the relationship between cervicothoracic inflection point and baseline disability, as well as the relationship between clinical outcomes and pre- to postoperative changes in inflection point. Methods: Cervical deformity (CD) patients with baseline and 3-month (3M) postoperative radiographic, clinical, and inflection data were grouped by region of inflection point: C6 or above, C6-C7 to C7-T1, T1, or below. Inflection was defined as: Distal-most level where cervical lordosis (CL) changes to thoracic kyphosis (TK). Differences in alignment and patient factors across pre- and postoperative inflection point groups were assessed, as were outcomes by the inclusion of inflection in the CD-corrective fusion construct. Results: A total of 108 patients were included. Preoperative inflection breakdown: C6 or above (42%), C6-C7 to C7-T1 (44%), T1 or below (15%). Surgery was associated with a caudal migration of inflection by 3M: C6 or above (8%), C6-C7 to C7-T1 (58%), T1 or below (33%). For patients with preoperative inflection T1 or below, the inclusion of inflection in the fusion construct was associated with improvements in horizontal gaze (McGregor's Slope included: -11.3° vs. not included: 1.6°, P = 0.038). The inclusion of preoperative inflection in fusion was associated with the superior cervical sagittal vertical axis (cSVA) changes for C6-C7 to C7-T1 patients (-5.2 mm vs. 3.2 mm, P = 0.018). The location of postoperative inflection was associated with variation in 3M alignment: Inflection C6 or above was associated with less Pelvic Tilt (PT), PT and a trend of larger cSVA. Location of inflection or inclusion in fusion was not associated with reoperation or distal junctional kyphosis. Conclusions: Incorporating the inflection point between CL and TK in the fusion construct was associated with superior restoration of cervical alignment and horizontal gaze for surgical CD patients.

Original languageEnglish (US)
Pages (from-to)131-138
Number of pages8
JournalJournal of Craniovertebral Junction and Spine
Volume11
Issue number2
DOIs
StatePublished - Apr 1 2020

Keywords

  • Cervical deformity
  • Cervicothoracic junction
  • Inflection
  • Outcomes
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

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    Bortz, C., Passias, P. G., Pierce, K. E., Alas, H., Brown, A., Naessig, S., Ahmad, W., Lafage, R., Ames, C. P., Diebo, B. G., Line, B. G., Klineberg, E. O., Burton, D. C., Eastlack, R. K., Kim, H. J., Sciubba, D. M., Soroceanu, A., Bess, S., Shaffrey, C. I., ... Lafage, V. (2020). Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients. Journal of Craniovertebral Junction and Spine, 11(2), 131-138. https://doi.org/10.4103/jcvjs.JCVJS_57_20