Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients
Abstract Background Several studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification o...
| Main Authors: | , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2019-01-01
|
| Series: | BMC Surgery |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12893-019-0471-2 |
| _version_ | 1830357834246651904 |
|---|---|
| author | W. Pepke H. Almansour R. Lafage B. G. Diebo B. Wiedenhöfer F. Schwab V. Lafage M. Akbar |
| author_facet | W. Pepke H. Almansour R. Lafage B. G. Diebo B. Wiedenhöfer F. Schwab V. Lafage M. Akbar |
| author_sort | W. Pepke |
| collection | DOAJ |
| description | Abstract Background Several studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS). Methods Baseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment. Results Stratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA. Conclusions In surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment. |
| first_indexed | 2024-12-20T02:29:20Z |
| format | Article |
| id | doaj.art-baf99f96bd6a40b38cc068c5ccd12c0b |
| institution | Directory Open Access Journal |
| issn | 1471-2482 |
| language | English |
| last_indexed | 2024-12-20T02:29:20Z |
| publishDate | 2019-01-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Surgery |
| spelling | doaj.art-baf99f96bd6a40b38cc068c5ccd12c0b2022-12-21T19:56:36ZengBMCBMC Surgery1471-24822019-01-0119111210.1186/s12893-019-0471-2Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patientsW. Pepke0H. Almansour1R. Lafage2B. G. Diebo3B. Wiedenhöfer4F. Schwab5V. Lafage6M. Akbar7Clinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University HospitalClinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University HospitalHospital for Special SurgeryDepartment of Orthopaedic Surgery, State University of New York, Downstate Medical CenterSpine Surgery, ATOS Clinic HeidelbergHospital for Special SurgeryHospital for Special SurgeryClinic for Orthopaedics and Trauma Surgery, Center for Orthopaedics, Trauma Surgery and Spinal Cord Injury, Heidelberg University HospitalAbstract Background Several studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS). Methods Baseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment. Results Stratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA. Conclusions In surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment.http://link.springer.com/article/10.1186/s12893-019-0471-2Cervical alignmentCervical spineAdolescent scoliosisAISDeformity |
| spellingShingle | W. Pepke H. Almansour R. Lafage B. G. Diebo B. Wiedenhöfer F. Schwab V. Lafage M. Akbar Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients BMC Surgery Cervical alignment Cervical spine Adolescent scoliosis AIS Deformity |
| title | Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients |
| title_full | Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients |
| title_fullStr | Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients |
| title_full_unstemmed | Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients |
| title_short | Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients |
| title_sort | cervical spine alignment following surgery for adolescent idiopathic scoliosis ais a pre to post analysis of 81 patients |
| topic | Cervical alignment Cervical spine Adolescent scoliosis AIS Deformity |
| url | http://link.springer.com/article/10.1186/s12893-019-0471-2 |
| work_keys_str_mv | AT wpepke cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT halmansour cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT rlafage cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT bgdiebo cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT bwiedenhofer cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT fschwab cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT vlafage cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients AT makbar cervicalspinealignmentfollowingsurgeryforadolescentidiopathicscoliosisaisapretopostanalysisof81patients |