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Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes
Haddy Alas1, Peter Gust Passias1, Bassel G Diebo2, Avery E Brown1, Katherine E Pierce1, Cole Bortz1, Renaud Lafage3, Christopher P Ames4, Breton Line5, Eric O Klineberg6, Douglas C Burton7, Juan S Uribe8, Han Jo Kim3, Alan H Daniels9, Shay Bess5, Themistocles Protopsaltis1, Gregory M Mundis10, Christopher I Shaffrey11, Frank J Schwab3, Justin S Smith11, Virginie Lafage3
1 Department of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Orthopaedic Hospital, NY Spine Institute, New York City, USA
2 Department of Orthopaedic Surgery, Downstate Medical Center, State University of New York, Brooklyn, NY, USA
3 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, USA
4 Department of Neurological Surgery, University of California San Francisco, San Francisco, USA
5 Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
6 Department of Orthopaedic Surgery, University of California, Davis, USA
7 Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
8 Department of Neurosurgery, University of South Florida, Tampa, FL, USA
9 Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
10 Division of Orthopaedic Surgery, Scripps Clinic, San Diego Center for Spinal Disorders, La Jolla, CA, USA
11 Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
Correspondence Address:
Peter Gust Passias
NYU Langone Medical Center, New York Spine Institute, Hospital for Joint Diseases, 301 East 17th Street, New York 10003, NY
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcvjs.jcvjs_29_21
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Introduction: Patients with symptomatic cervical deformity (CD) requiring surgical correction often present with hyperkyphosis (HK), though patients with hyperlordotic curves may require surgery as well. Few studies have investigated differences in CD-corrective surgery with regards to HK and hyperlordosis (HL).
Materials and Methods: Operative CD patients (C2-C7 Cobb >10°, cervical lordosis [CL] >10°, cervical sagittal vertical axis [cSVA] >4 cm, chin-brow vertical angle >25°) with baseline (BL) and 1Y radiographic data. Patients were stratified based on BL C2-7 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 1 SD were considered the control group.
Results: One hundred and two surgical CD pts (61 years, 65%F, 30 kg/m2) with BL and 1Y radiographic data were included. Twenty pts met definitions for HK and 21 pts 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 the posterior approach. Op-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-sagittal vertical axis (SVA) (10.8 vs. 7.0 vs. −47.8 mm, P = 0.001). HL pts had less discectomies, less corpectomies, and similar osteotomy rates to HK. HL had × 3 revisions of HK and controls (28.6 vs. 10.0 vs. 9.2%, respectively, P = 0.046). At 1Y, HL pts had higher cSVA, and trended higher SVA and SS than HK. In terms of BL-upper cervical alignment, HK pts had higher McGregor's-slope (16.1° vs. −3.3°, P = 0.001) and C0-C2 Cobb (43.3° vs. 26.9°, P < 0.001), however postoperative differences in McGregor's slope and C0-C2 were not significant. HK drivers of deformity were primarily C (90%), whereas HL had primary computed tomography (38.1%), upper thoracic (23.8%), and C (14.3%) drivers.
Conclusions: Hyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1Y postoperative, perhaps due to undercorrection compared to kyphotic etiologies.
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