Journal
SPINE
Volume 39, Issue 17, Pages E1001-E1009Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/BRS.0000000000000432
Keywords
adult; cervical; deformity; lordosis; prevalence; sagittal imbalance; spine
Categories
Funding
- DePuy Spine
Ask authors/readers for more resources
Study Design. Multicenter, prospective, consecutive case series. Objective. To assess prevalence and type of cervical deformity among adults with thoracolumbar (TL) deformity and to assess for associations between cervical deformities and different types of TL deformities. Summary of Background Data. Cervical deformity can present concomitantly with TL deformity and have implications for the management of TL deformity. Methods. Multicenter, prospective, consecutive series of adult (age > 18 yr) patients with TL deformity. Parameters included pelvic tilt (PT), pelvic incidence (PI), lumbar lordosis (LL), C2-C7 sagittal vertical axis (C2-C7SVA), C7-S1SVA, and C2-C7 lordosis. Cervical deformity was defined as cervical lordosis more than 0 degrees (cervical kyphosis [CK]) or C2-C7SVA more than 4 cm (cervical positive sagittal malalignment [CPSM]). Patients were stratified by the Scoliosis Research Society-Schwab classification of adult TL deformity, including curve type (N = sagittal deformity, T = thoracic scoliosis, L = lumbar scoliosis, and D = T + L scoliosis) and modifier grades: PT (0: <20 degrees, + : 20 degrees 30 degrees, ++: >30 degrees), C7 S1SVA (0: <4 cm, + : 4-9.5 cm, ++ : >9.5 cm), and PI-LL mismatch (0: <10 degrees, +: 10-20 degrees, ++ : >20 degrees). Results. A total of 470 patients met criteria (mean age = 52 yr). Mean cervical lordosis and C2-C7SVA were -8 degrees and 3.2 cm, respectively. CK and CPSM prevalence were 31% and 29%, respectively, and prevalence of CK and/or CPSM was 53%. CK prevalence differed by curve type (N = 15%, L = 27%, D = 37%, T = 49%; P < 0.001); CPSM prevalence did not differ by curve type (P = 0.19). Higher PT grades had lower CK prevalence (0 = 40%, + = 27%, ++ = 15%; P < 0.001) but greater CPSM prevalence (0 = 23%, + = 28%, ++ = 45%; P = 0.001). Similarly, higher SVA grades had lower CK prevalence (0 = 40%, + = 23%, ++ = 11%; P < 0.001) but greater CPSM prevalence (0 = 24%, + = 24%, + + = 48%; P < 0.001). Higher PI-LL grades had lower CK prevalence (0 = 35%, + = 31%, ++ = 22%; P = 0.034) but no CPSM association (P = 0.46). Conclusion. Cervical deformity is highly prevalent (53%) in adult TL deformity. C7-S1SVA, PT, and PI-LL modifiers are associated with cervical deformity prevalence. These findings suggest that TL deformity evaluation should include assessment for concomitant cervical deformity and that further study is warranted to define their potential clinical impact.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available