Changes in Cervical Alignment after Multilevel Schwab Grade II Thoracolumbar Osteotomies for Adult Spinal Deformity

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Abstract

STUDY DESIGN.: Retrospective Cohort OBJECTIVE.: To describe changes in cervical alignment(CA) and deformity (CD) after multilevel Schwab Grade II Osteotomies for adult spinal deformity (ASD). SUMMARY OF BACKGROUND DATA.: Reciprocal cervical and global changes after ASD surgery have not been previous described in the setting of multilevel osteotomy. METHODS.: Patients with long-segment (> 5 levels) fusion and osteotomy for ASD were radiographically evaluated. Pre- and post-operative cervical parameters evaluated included cervical lordosis (CL), C2-C7 sagittal vertical axis (C2-C7 SVA), and the T1 slope (T1S) minus the CL (T1S-CL). CD was defined as C2-C7 SVA >4?cm, CL?<?0°, or T1S-CL≥15°. RESULTS.: 85 patients (mean age 64?±?11.1) were identified. Preoperative lumbar lordosis (LL) was 28.7°?±?13.8°, thoracic kyphosis (TK) was 28.2°?±?17.0°, C7 plumbline (C7 SVA) was 7.54?±?6.7?cm, pelvic tilt (PT) was 30.0°?±?8.96°, lumbopelvic mismatch was 32°?±?17.1°, and the T1 pelvic angle (TPA) was 26.8°?±?12.9°. The C7 SVA and TPA corrected to 3.90?cm (p?<?0.0001) and 17.5°, respectively (p?<?0.0001). CD increased from 41 (48%) to 47 (55%) patients. The mean CL changed from 16.5° to 11.9°(p?<?0.013), C2 SVA from 10.1?cm to 6.37?cm (p?<?0.0001), T1S-CL from 10.2° to 14.3° (p?=?0.021), and TK from 28° to 39° (p?<?0.0001). A correlation was observed between T1S and CL (ρ=.435, p?<?0.0001) and C2-C7 SVA (ρ=.624, p?<?0.0001). T1S was the only independent predictor of both the postoperative C2-C7 SVA and CLIn this study, the presence of any single preoperative CD criterion was noted to be a risk for persistent global deformity on postoperative radiograph (OR?=?2.5) and the development of PJK (OR?=?2.1). The T1-CL?<?15° may indicate an even greater risk for persistent 3global deformity (OR?=?3.5). CONCLUSIONS.: Thoracolumbar fusion with multilevel Schwab Grade II Osteotomies was associated with a decreased CL and reciprocal increases in TK and T1S-CL.Level of Evidence: 3

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - May 19 2017

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

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