PMID- 34729000
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20220428
IS  - 0974-8237 (Print)
IS  - 0976-9285 (Electronic)
IS  - 0974-8237 (Linking)
VI  - 12
IP  - 3
DP  - 2021 Jul-Sep
TI  - Prioritization of realignment associated with superior clinical outcomes for 
      surgical cervical deformity patients.
PG  - 311-317
LID - 10.4103/jcvjs.jcvjs_26_21 [doi]
AB  - BACKGROUND: To optimize quality of life in patients with cervical deformity (CD), 
      there may be alignment targets to be prioritized. OBJECTIVE: To prioritize the 
      cervical parameter targets for alignment. METHODS: Included: CD patients (C2-C7 
      Cobb >10( degrees ) degrees , C2-C7 lordosis [CL] >10( degrees ) degrees , cSVA > 4 cm, or chin-brow vertical 
      angle >25( degrees ) degrees ) with full baseline (BL) and 1-year (1Y) radiographic parameters 
      and Neck Disability Index (NDI) scores; patients with cervical (C) or 
      cervicothoracic (CT) Primary Driver Ames type. Patients with BL Ames classified 
      as low CD for both parameters of cSVA (<4 cm) and T1 slope minus CL (TS-CL) 
      (<15( degrees ) degrees ) were excluded. Patients assessed: Meeting Minimal Clinically Important 
      Difference (MCID) for NDI (<-15 DeltaNDI). Ratios of correction were found for 
      regional parameters categorized by Primary Ames Driver (C or CT). Decision tree 
      analysis assessed cut-offs for differences associated with meeting NDI MCID at 
      1Y. RESULTS: Seventy-seven CD patients (62.1 years, 64%F, 28.8 kg/m(2)). 41.6% 
      met MCID for NDI. A backward linear regression model including radiographic 
      differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an 
      R (2)= 0.820 (P = 0.032) included TS-CL, cSVA, MGS, C2SS, C2-T3 angle, C2-T3 
      sagittal vertical axis (SVA), CL. By primary Ames driver, 67.5% of patients were 
      C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and 
      CT were not significant between the two groups (P > 0.050). Decision tree 
      analysis determined cut-offs for radiographic change, prioritizing in the 
      following order: >/=42.5( degrees ) C2-T3 angle, >35.4( degrees ) CL, <-31.76( degrees ) C2 slope, <-11.57 
      mm cSVA, <-2.16( degrees ) MGS, >-30.8 mm C2-T3 SVA, and </=-33.6( degrees ) TS-CL. CONCLUSIONS: 
      Certain ratios of correction of cervical parameters contribute to improving neck 
      disability. Prioritizing these radiographic alignment parameters may help 
      optimize patient-reported outcomes for patients undergoing CD surgery.
CI  - Copyright: (c) 2021 Journal of Craniovertebral Junction and Spine.
FAU - Pierce, Katherine E
AU  - Pierce KE
AD  - Department of Orthopaedic, New York Spine Institute, NYU Langone Orthopedic 
      Hospital, New York, NY, USA.
AD  - Departments of Neurologic Surgery, New York Spine Institute, NYU Langone 
      Orthopedic Hospital, New York, NY, USA.
FAU - Passias, Peter Gust
AU  - Passias PG
AD  - Department of Orthopaedic, New York Spine Institute, NYU Langone Orthopedic 
      Hospital, New York, NY, USA.
AD  - Departments of Neurologic Surgery, New York Spine Institute, NYU Langone 
      Orthopedic Hospital, New York, NY, USA.
FAU - Brown, Avery E
AU  - Brown AE
AD  - Department of Orthopaedic, New York Spine Institute, NYU Langone Orthopedic 
      Hospital, New York, NY, USA.
AD  - Departments of Neurologic Surgery, New York Spine Institute, NYU Langone 
      Orthopedic Hospital, New York, NY, USA.
FAU - Bortz, Cole A
AU  - Bortz CA
AD  - Department of Orthopaedic, New York Spine Institute, NYU Langone Orthopedic 
      Hospital, New York, NY, USA.
AD  - Departments of Neurologic Surgery, New York Spine Institute, NYU Langone 
      Orthopedic Hospital, New York, NY, USA.
FAU - Alas, Haddy
AU  - Alas H
AD  - Department of Orthopaedic, New York Spine Institute, NYU Langone Orthopedic 
      Hospital, New York, NY, USA.
AD  - Departments of Neurologic Surgery, New York Spine Institute, NYU Langone 
      Orthopedic Hospital, New York, NY, USA.
FAU - Lafage, Renaud
AU  - Lafage R
AD  - Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA.
FAU - Krol, Oscar
AU  - Krol O
AD  - Department of Orthopaedic, New York Spine Institute, NYU Langone Orthopedic 
      Hospital, New York, NY, USA.
AD  - Departments of Neurologic Surgery, New York Spine Institute, NYU Langone 
      Orthopedic Hospital, New York, NY, USA.
FAU - Chou, Dean
AU  - Chou D
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      USA.
FAU - Burton, Douglas C
AU  - Burton DC
AD  - Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas 
      City, KS, USA.
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, USA.
FAU - Klineberg, Eric
AU  - Klineberg E
AD  - Department of Orthopaedic Surgery, University of California, Davis, CA, USA.
FAU - Hart, Robert
AU  - Hart R
AD  - Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, 
      USA.
FAU - Gum, Jeffrey
AU  - Gum J
AD  - Norton Leatherman Spine Center, Louisville, KY, USA.
FAU - Daniels, Alan
AU  - Daniels A
AD  - Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown 
      University, Providence, RI, USA.
FAU - Hamilton, Kojo
AU  - Hamilton K
AD  - Department of Neurological Surgery, School of Medicine, University of Pittsburgh, 
      Pittsburgh, PA, USA.
FAU - Bess, Shay
AU  - Bess S
AD  - Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. 
      Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA.
FAU - Protopsaltis, Themistocles
AU  - Protopsaltis T
AD  - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA.
FAU - Shaffrey, Christopher
AU  - Shaffrey C
AD  - Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA.
AD  - Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, 
      USA.
FAU - Schwab, Frank A
AU  - Schwab FA
AD  - Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA.
FAU - Smith, Justin S
AU  - Smith JS
AD  - Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA.
FAU - Lafage, Virginie
AU  - Lafage V
AD  - Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA.
FAU - Ames, Christopher
AU  - Ames C
AD  - Department of Neurological Surgery, University of California, San Francisco, CA, 
      USA.
CN  - International Spine Study Group
LA  - eng
PT  - Journal Article
DEP - 20210908
PL  - India
TA  - J Craniovertebr Junction Spine
JT  - Journal of craniovertebral junction & spine
JID - 101536746
PMC - PMC8501814
OTO - NOTNLM
OT  - Cervical deformity
OT  - prioritization
OT  - realignment
COIS- There are no conflicts of interest.
EDAT- 2021/11/04 06:00
MHDA- 2021/11/04 06:01
PMCR- 2021/07/01
CRDT- 2021/11/03 06:54
PHST- 2021/02/25 00:00 [received]
PHST- 2021/06/22 00:00 [accepted]
PHST- 2021/11/03 06:54 [entrez]
PHST- 2021/11/04 06:00 [pubmed]
PHST- 2021/11/04 06:01 [medline]
PHST- 2021/07/01 00:00 [pmc-release]
AID - JCVJS-12-311 [pii]
AID - 10.4103/jcvjs.jcvjs_26_21 [doi]
PST - ppublish
SO  - J Craniovertebr Junction Spine. 2021 Jul-Sep;12(3):311-317. doi: 
      10.4103/jcvjs.jcvjs_26_21. Epub 2021 Sep 8.