TY - JOUR
T1 - Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients
AU - Bortz, Cole
AU - Passias, Peter G.
AU - Pierce, Katherine Elizabeth
AU - Alas, Haddy
AU - Brown, Avery
AU - Naessig, Sara
AU - Ahmad, Waleed
AU - Lafage, Renaud
AU - Ames, Christopher P.
AU - Diebo, Bassel G.
AU - Line, Breton G.
AU - Klineberg, Eric O.
AU - Burton, Douglas C.
AU - Eastlack, Robert K.
AU - Kim, Han Jo
AU - Sciubba, Daniel M.
AU - Soroceanu, Alex
AU - Bess, Shay
AU - Shaffrey, Christopher I.
AU - Schwab, Frank J.
AU - Smith, Justin S.
AU - Lafage, Virginie
N1 - Publisher Copyright:
© 2020 Journal of Craniovertebral Junction and Spine | Published by Wolters Kluwer - Medknow.
PY - 2020/4/1
Y1 - 2020/4/1
N2 - 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.
AB - 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.
KW - Cervical deformity
KW - Cervicothoracic junction
KW - Inflection
KW - Outcomes
KW - Surgery
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U2 - 10.4103/jcvjs.JCVJS_57_20
DO - 10.4103/jcvjs.JCVJS_57_20
M3 - Article
C2 - 32905029
AN - SCOPUS:85088612734
SN - 0974-8237
VL - 11
SP - 131
EP - 138
JO - Journal of Craniovertebral Junction and Spine
JF - Journal of Craniovertebral Junction and Spine
IS - 2
ER -