Journal of Craniovertebral Junction and Spine (Jan 2021)

Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patients

  • Katherine E Pierce,
  • Peter Gust Passias,
  • Avery E Brown,
  • Cole A Bortz,
  • Haddy Alas,
  • Renaud Lafage,
  • Oscar Krol,
  • Dean Chou,
  • Douglas C Burton,
  • Breton Line,
  • Eric Klineberg,
  • Robert Hart,
  • Jeffrey Gum,
  • Alan Daniels,
  • Kojo Hamilton,
  • Shay Bess,
  • Themistocles Protopsaltis,
  • Christopher Shaffrey,
  • Frank A Schwab,
  • Justin S Smith,
  • Virginie Lafage,
  • Christopher Ames,
  • International Spine Study Group

DOI
https://doi.org/10.4103/jcvjs.jcvjs_26_21
Journal volume & issue
Vol. 12, no. 3
pp. 311 – 317

Abstract

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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°°, C2–C7 lordosis [CL] >10°°, cSVA > 4 cm, or chin-brow vertical angle >25°°) 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 ( 0.050). Decision tree analysis determined cut-offs for radiographic change, prioritizing in the following order: ≥42.5° C2-T3 angle, >35.4° CL, −30.8 mm C2-T3 SVA, and ≤−33.6° 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.

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