Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine?
Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers. Design: This was a retrospective review. Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity. Methods: Patients >18 years with adul...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2019-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2019;volume=10;issue=3;spage=152;epage=159;aulast=Passias |
| _version_ | 1818541246104207360 |
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| author | Peter G Passias Haddy Alas Renaud Lafage Bassel G Diebo Irene Chern Christopher P Ames Paul Park Khoi D Than Alan H Daniels D Kojo Hamilton Douglas C Burton Robert A Hart Shay Bess Breton G Line Eric O Klineberg Christopher I Shaffrey Justin S Smith Frank J Schwab Virginie Lafage |
| author_facet | Peter G Passias Haddy Alas Renaud Lafage Bassel G Diebo Irene Chern Christopher P Ames Paul Park Khoi D Than Alan H Daniels D Kojo Hamilton Douglas C Burton Robert A Hart Shay Bess Breton G Line Eric O Klineberg Christopher I Shaffrey Justin S Smith Frank J Schwab Virginie Lafage |
| author_sort | Peter G Passias |
| collection | DOAJ |
| description | Hypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers.
Design: This was a retrospective review.
Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity.
Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] <45° and lumbar lordosis [LL] apex below L4; Type 2: PI <45° and LL apex above L4; Type 3:45°<PI <65°; and Type 4: PI >65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups.
Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2–4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = −0.131, P = 0.015), CBVA (r = −0.473, P < 0.001), and C0S (r = −0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948–0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12–1.38], P < 0.001).
Conclusions: Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes. |
| first_indexed | 2024-12-11T22:06:07Z |
| format | Article |
| id | doaj.art-a03d1e0a3fc242888d10fb58a743c549 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-11T22:06:07Z |
| publishDate | 2019-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-a03d1e0a3fc242888d10fb58a743c5492022-12-22T00:48:57ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372019-01-0110315215910.4103/jcvjs.JCVJS_71_19Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine?Peter G PassiasHaddy AlasRenaud LafageBassel G DieboIrene ChernChristopher P AmesPaul ParkKhoi D ThanAlan H DanielsD Kojo HamiltonDouglas C BurtonRobert A HartShay BessBreton G LineEric O KlinebergChristopher I ShaffreyJustin S SmithFrank J SchwabVirginie LafageHypothesis: Reciprocal changes in the upper cervical spine correlate with adult TL deformity modifiers. Design: This was a retrospective review. Introduction: The upper cervical spine has remarkable adaptability to wide ranges of thoracolumbar (TL) deformity. Methods: Patients >18 years with adult spinal deformity (ASD) and complete radiographic data at baseline (BL) and 1 year were identified. Patients were grouped into component types of the Roussouly classification system (Type 1: Pelvic incidence [PI] <45° and lumbar lordosis [LL] apex below L4; Type 2: PI <45° and LL apex above L4; Type 3:45°<PI <65°; and Type 4: PI >65°). Patients were categorized by increasing severity of Schwab modifiers at BL (0, +, and ++) and further grouped by regional malalignment moving cranially (P: pelvic only; LP: lumbopelvic; TL: thoracic and LP; C: subaxial and TL). Analysis of variance and Pearson's r assessed changes in BL upper cervical parameters (C0-2, C0 slope, McGregor's Slope [MGS], and CBVA) across groups. Results: A total of 343 ASD patients were analyzed. When grouped by BL Schwab and Roussouly, Group P had the lowest BL disability compared to other Groups, while Roussouley Type 1 correlated with higher BL disability compared to Type 2. Moving cranially up the spine, Group P, Group LP, and Group TL did not differ in C0-2 angle, C0 slope, MGS, or CBVA. Group C had a significantly smaller C0-C2, and more negative MGS, C0 slope, and CBVA than noncervical groups. Type 1 trended slightly higher CBVA and MGS than types 2–4, but no differences in cervical lordosis, C0-C2, or C0S were found. MGS (r = −0.131, P = 0.015), CBVA (r = −0.473, P < 0.001), and C0S (r = −0.099, P = 0.042) correlated most strongly with sagittal vertical axis (SVA) compared to other Schwab modifiers. We found SVA > 34 mm predicted a 1 unit (°°) decrease in MGS (odds ratio [OR]: 0.970 [0.948–0.993], P = 0.010), while cervical SVA >51 mm predicted a 1 unit increase in MGS (OR: 1.25 [1.12–1.38], P < 0.001). Conclusions: Our study suggests that upper cervical alignment remains relatively stable through most broad variations of adult TL deformity. Changes in SVA correlated most with upper cervical changes.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2019;volume=10;issue=3;spage=152;epage=159;aulast=Passiascervical spineglobal spinal deformityroussouly classificationschwab classification |
| spellingShingle | Peter G Passias Haddy Alas Renaud Lafage Bassel G Diebo Irene Chern Christopher P Ames Paul Park Khoi D Than Alan H Daniels D Kojo Hamilton Douglas C Burton Robert A Hart Shay Bess Breton G Line Eric O Klineberg Christopher I Shaffrey Justin S Smith Frank J Schwab Virginie Lafage Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? Journal of Craniovertebral Junction and Spine cervical spine global spinal deformity roussouly classification schwab classification |
| title | Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? |
| title_full | Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? |
| title_fullStr | Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? |
| title_full_unstemmed | Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? |
| title_short | Global spinal deformity from the upper cervical perspective. What is “Abnormal” in the upper cervical spine? |
| title_sort | global spinal deformity from the upper cervical perspective what is abnormal in the upper cervical spine |
| topic | cervical spine global spinal deformity roussouly classification schwab classification |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2019;volume=10;issue=3;spage=152;epage=159;aulast=Passias |
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