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Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patients
Katherine E Pierce1, Peter Gust Passias1, Avery E Brown1, Cole A Bortz1, Haddy Alas1, Renaud Lafage2, Oscar Krol1, Dean Chou3, Douglas C Burton4, Breton Line5, Eric Klineberg6, Robert Hart7, Jeffrey Gum8, Alan Daniels9, Kojo Hamilton10, Shay Bess11, Themistocles Protopsaltis12, Christopher Shaffrey13, Frank A Schwab2, Justin S Smith14, Virginie Lafage2, Christopher Ames3, International Spine Study Group5
1 Department of Orthopaedic; Departments of Neurologic Surgery, New York Spine Institute, NYU Langone Orthopedic Hospital, New York, NY, USA
2 Department of Orthopedics, Hospital for Special Surgery, New York, NY, USA
3 Department of Neurological Surgery, University of California, San Francisco, CA, USA
4 Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA
5 Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, CO
6 Department of Orthopaedic Surgery, University of California, Davis, CA, USA
7 Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
8 Norton Leatherman Spine Center, Louisville, KY, USA
9 Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI, USA
10 Department of Neurological Surgery, School of Medicine, University of Pittsburgh, Pittsburgh, PA, USA
11 Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. Luke's/Rocky Mountain Hospital for Children, Denver, Colorado, USA
12 Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA
13 Department of Neurosurgery; Department of Orthopaedic Surgery, Duke University Medical Center, Durham, NC, USA
14 Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA
Correspondence Address:
Peter Gust Passias
Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NYU School of Medicine, NY Spine Institute, Orthopaedic Hospital, 301, East 17th St., New York, 10003, NY
USA
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/jcvjs.jcvjs_26_21
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Background: To optimize quality of life in patients with cervical deformity (CD), there may be alignment targets to be prioritized.
Objective: To prioritize the cervical parameter targets for alignment.
Methods: Included: CD patients (C2–C7 Cobb >10°°, C2–C7 lordosis [CL] >10°°, cSVA > 4 cm, or chin-brow vertical angle >25°°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical (C) or cervicothoracic (CT) Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA (<4 cm) and T1 slope minus CL (TS-CL) (<15°°) were excluded. Patients assessed: Meeting Minimal Clinically Important Difference (MCID) for NDI (<−15 ΔNDI). Ratios of correction were found for regional parameters categorized by Primary Ames Driver (C or CT). Decision tree analysis assessed cut-offs for differences associated with meeting NDI MCID at 1Y.
Results: Seventy-seven CD patients (62.1 years, 64%F, 28.8 kg/m2). 41.6% met MCID for NDI. A backward linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 = 0.820 (P = 0.032) included TS-CL, cSVA, MGS, C2SS, C2-T3 angle, C2-T3 sagittal vertical axis (SVA), CL. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the two groups (P > 0.050). Decision tree analysis determined cut-offs for radiographic change, prioritizing in the following order: ≥42.5° C2-T3 angle, >35.4° CL, <−31.76° C2 slope, <−11.57 mm cSVA, <−2.16° MGS, >−30.8 mm C2-T3 SVA, and ≤−33.6° TS-CL.
Conclusions: Certain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient-reported outcomes for patients undergoing CD surgery.
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