PMID- 34559752 OWN - NLM STAT- MEDLINE DCOM- 20210928 LR - 20230831 IS - 1528-1159 (Electronic) IS - 0362-2436 (Linking) VI - 46 IP - 20 DP - 2021 Oct 15 TI - At What Point Should the Thoracolumbar Region Be Addressed in Patients Undergoing Corrective Cervical Deformity Surgery? PG - E1113-E1118 LID - 10.1097/BRS.0000000000004045 [doi] AB - STUDY DESIGN: Retrospective cohort study. OBJECTIVE: The aim of this study was to investigate the impact of cervical to thoracolumbar ratios on poor outcomes in cervical deformity (CD) corrective surgery. SUMMARY OF BACKGROUND DATA: Consideration of distal regional and global alignment is a critical determinant of outcomes in CD surgery. For operative CD patients, it is unknown whether certain thoracolumbar parameters play a significant role in poor outcomes and whether addressing such parameters is warranted. METHODS: Included: surgical CD patients (C2-C7 Cobb >10 degrees , cervical lordosis [CL] >10 degrees , C2-C7 sagittal vertical axis (cSVA) >4 cm, or chin-brow vertical angle >25 degrees ) with baseline and 1-year data. Patients were assessed for ratios of preop cervical and global parameters including: C2 Slope/T1 slope, T1 slope minus C2-C7 lordosis (TS-CL)/mismatch between pelvic incidence and lumbar lordosis (PI-LL), cSVA/sagittal vertical axis (SVA). Deformity classification ratios of cervical (Ames-ISSG) to spinopelvic (SRS-Schwab) were investigated: cSVA modifier/SVA modifier, TS-CL modifier/PI-LL modifier. Cervical to thoracic ratios included C2-C7 lordosis/T4-T12 kyphosis. Correlations assessed the relationship between ratios and poor outcomes (major complication, reoperation, distal junctional kyphosis (DJK), or failure to meet minimal clinically important difference [MCID]). Decision tree analysis through multiple iterations of multivariate regressions assessed cut-offs for ratios for acquiring suboptimal outcomes. RESULTS: A total of 110 CD patients were included (61.5 years, 66% F, 28.8 kg/m2). Mean preoperative radiographic ratios calculated: C2 slope/T1 slope of 1.56, TS-CL/PI-LL of 11.1, cSVA/SVA of 5.4, CL/thoracic kyphosis (TK) of 0.26. Ames-ISSG and SRS-Schwab modifier ratios: cSVA/SVA of 0.1 and TS-CL/PI-LL of 0.35. Pearson correlations demonstrated a relationship between major complications and baseline TS-CL/PI-LL, Ames TS-CL/Schwab PI-LL modifiers, and the CL/TK ratios (P < 0.050). Reoperation had significant correlation with TS-CL/PI-LL and cSVA/SVA ratios. Postoperative DJK correlated with C2 slope/T1 slope and CL/TK ratios. Not meeting MCID for Neck Disability Index (NDI) correlated with CL/TK ratio and not meeting MCID for EQ5D correlated with Ames TS-CL/Schwab PI-LL. CONCLUSION: Consideration of cervical to global alignment is a critical determinant of outcomes in CD corrective surgery. Key ratios of cervical to global alignment correlate with suboptimal clinical outcomes. A larger cervical lordosis to TK predicted postoperative complication, DJK, and not meeting MCID for NDI.Level of Evidence: 4. CI - Copyright (c) 2021 Wolters Kluwer Health, Inc. All rights reserved. FAU - Passias, Peter G AU - Passias PG AD - Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY. FAU - Pierce, Katherine E AU - Pierce KE AD - Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY. FAU - Naessig, Sara AU - Naessig S AD - Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY. FAU - Ahmad, Waleed AU - Ahmad W AD - Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY. FAU - Passfall, Lara AU - Passfall L AD - Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY. FAU - Lafage, Renaud AU - Lafage R AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY. FAU - Kim, Han Jo AU - Kim HJ AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY. FAU - Daniels, Alan AU - Daniels A AD - Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI. FAU - Eastlack, Robert AU - Eastlack R AD - Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, CA. FAU - Klineberg, Eric AU - Klineberg E AD - Department of Orthopaedic Surgery, University of California, Davis, Davis, CA. FAU - Line, Breton AU - Line B AD - Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO. FAU - Mummaneni, Praveen AU - Mummaneni P AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA. FAU - Hart, Robert AU - Hart R AD - Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA. FAU - Burton, Douglas AU - Burton D AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS. FAU - Bess, Shay AU - Bess S AD - Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO. FAU - Schwab, Frank AU - Schwab F AD - Department of Orthopedics, Hospital for Special Surgery, New York, NY. FAU - Shaffrey, Christopher AU - Shaffrey C AD - Departments of Neurosurgery and Orthopaedic Surgery, Duke University Medical Center, Durham, NC. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia, Charlottesville, VA. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA. CN - International Spine Study Group LA - eng PT - Journal Article PL - United States TA - Spine (Phila Pa 1976) JT - Spine JID - 7610646 SB - IM MH - Cervical Vertebrae/diagnostic imaging/surgery MH - Humans MH - *Kyphosis/diagnostic imaging/surgery MH - *Lordosis/diagnostic imaging/surgery MH - Postoperative Period MH - Retrospective Studies EDAT- 2021/09/25 06:00 MHDA- 2021/09/29 06:00 CRDT- 2021/09/24 17:15 PHST- 2021/09/24 17:15 [entrez] PHST- 2021/09/25 06:00 [pubmed] PHST- 2021/09/29 06:00 [medline] AID - 00007632-202110150-00014 [pii] AID - 10.1097/BRS.0000000000004045 [doi] PST - ppublish SO - Spine (Phila Pa 1976). 2021 Oct 15;46(20):E1113-E1118. doi: 10.1097/BRS.0000000000004045.