Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes
Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlo...
| Main Authors: | , , , , , , , , , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2022-01-01
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| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=271;epage=277;aulast=Passias |
| _version_ | 1811240617951363072 |
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| author | Peter Gust Passias Haddy Alas Nicholas Kummer Peter Tretiakov Bassel G Diebo Renaud Lafage Christopher P Ames Breton Line Eric O Klineberg Douglas C Burton Juan S Uribe Han Jo Kim Alan H Daniels Shay Bess Themistocles Protopsaltis Gregory M Mundis Christopher I Shaffrey Frank J Schwab Justin S Smith Virginie Lafage International Spine Study Group |
| author_facet | Peter Gust Passias Haddy Alas Nicholas Kummer Peter Tretiakov Bassel G Diebo Renaud Lafage Christopher P Ames Breton Line Eric O Klineberg Douglas C Burton Juan S Uribe Han Jo Kim Alan H Daniels Shay Bess Themistocles Protopsaltis Gregory M Mundis Christopher I Shaffrey Frank J Schwab Justin S Smith Virginie Lafage International Spine Study Group |
| author_sort | Peter Gust Passias |
| collection | DOAJ |
| description | Background: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL).
Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes.
Materials and Methods: Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2–C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (−6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (<−28.43°) depending on directionality. Patients within 1SD were considered control group.
Results: 102 surgical CD patients (61 years, 65% F, 30 kg/m2) with BL and 1Y radiographic data were included. 20 patients met definitions for HK and 21 patients met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with posterior approach. Operative time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-SVA (10.8 vs. 7.0 vs. −47.8 mm, P = 0.001). HL patients had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had 3x revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL patients had higher cSVA and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK patients had higher McGregor's slope (MGS) (16.1° vs. 3.3°, P = 0.002) and C0–C2 Cobb (43.3° vs. 26.9°, P < 0.001), however, postoperative differences in MGS and C0–C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary CT (38.1%), UT (23.8%), and C (14.3%) drivers.
Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1-year postoperative, perhaps due to undercorrection compared to kyphotic etiologies. |
| first_indexed | 2024-04-12T13:23:23Z |
| format | Article |
| id | doaj.art-e0998950d7774b039fc95af1fb11c023 |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-04-12T13:23:23Z |
| publishDate | 2022-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-e0998950d7774b039fc95af1fb11c0232022-12-22T03:31:25ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372022-01-0113327127710.4103/jcvjs.jcvjs_66_21Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomesPeter Gust PassiasHaddy AlasNicholas KummerPeter TretiakovBassel G DieboRenaud LafageChristopher P AmesBreton LineEric O KlinebergDouglas C BurtonJuan S UribeHan Jo KimAlan H DanielsShay BessThemistocles ProtopsaltisGregory M MundisChristopher I ShaffreyFrank J SchwabJustin S SmithVirginie LafageInternational Spine Study GroupBackground: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), although patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD corrective surgery with regard to HK and hyperlordosis (HL). Objective: The objective of the study is to evaluate patterns in treatment for CD patients with baseline (BL) HK and HL and understand how extreme curvature of the spine may influence surgical outcomes. Materials and Methods: Operative CD patients with BL and 1-year (1Y) radiographic data were included in the study. Patients were stratified based on BL C2–C7 lordosis (CL) angle: those >1 standard deviation (SD) from the mean (−6.96 ± 21.47°) were hyperlordotic (>14.51°) or hyperkyphotic (<−28.43°) depending on directionality. Patients within 1SD were considered control group. Results: 102 surgical CD patients (61 years, 65% F, 30 kg/m2) with BL and 1Y radiographic data were included. 20 patients met definitions for HK and 21 patients met definitions for HL. No differences in demographics or disability were noted. HK had higher estimated blood loss (EBL) with anterior approaches than HL but similar EBL with posterior approach. Operative time did not differ between groups. Control, HL, and HK groups differed in BL TS-CL (36.6° vs. 22.5° vs. 60.7°, P < 0.001) and BL-SVA (10.8 vs. 7.0 vs. −47.8 mm, P = 0.001). HL patients had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had 3x revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL patients had higher cSVA and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK patients had higher McGregor's slope (MGS) (16.1° vs. 3.3°, P = 0.002) and C0–C2 Cobb (43.3° vs. 26.9°, P < 0.001), however, postoperative differences in MGS and C0–C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary CT (38.1%), UT (23.8%), and C (14.3%) drivers. Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1-year postoperative, perhaps due to undercorrection compared to kyphotic etiologies.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=271;epage=277;aulast=Passiascervical deformitycervical lordosishyperlordosisspine surgery |
| spellingShingle | Peter Gust Passias Haddy Alas Nicholas Kummer Peter Tretiakov Bassel G Diebo Renaud Lafage Christopher P Ames Breton Line Eric O Klineberg Douglas C Burton Juan S Uribe Han Jo Kim Alan H Daniels Shay Bess Themistocles Protopsaltis Gregory M Mundis Christopher I Shaffrey Frank J Schwab Justin S Smith Virginie Lafage International Spine Study Group Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes Journal of Craniovertebral Junction and Spine cervical deformity cervical lordosis hyperlordosis spine surgery |
| title | Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes |
| title_full | Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes |
| title_fullStr | Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes |
| title_full_unstemmed | Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes |
| title_short | Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes |
| title_sort | cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes |
| topic | cervical deformity cervical lordosis hyperlordosis spine surgery |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2022;volume=13;issue=3;spage=271;epage=277;aulast=Passias |
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