학술논문
Prioritization of Realignment Associated With Superior Clinical Outcomes for Cervical Deformity Patients.
Document Type
article
Author
Pierce, Katherine E; Passias, Peter G; Brown, Avery E; Bortz, Cole A; Alas, Haddy; Passfall, Lara; Krol, Oscar; Kummer, Nicholas; Lafage, Renaud; Chou, Dean; Burton, Douglas C; Line, Breton; Klineberg, Eric; Hart, Robert; Gum, Jeffrey; Daniels, Alan; Hamilton, Kojo; Bess, Shay; Protopsaltis, Themistocles; Shaffrey, Christopher; Schwab, Frank A; Smith, Justin S; Lafage, Virginie; Ames, Christopher; International Spine Study Group (ISSG)
Source
Neurospine. 18(3)
Subject
Language
Abstract
ObjectiveTo prioritize the cervical parameter targets for alignment.MethodsIncluded: cervical deformity (CD) patients (C2-7 Cobb angle > 10°, cervical lordosis > 10°, cervical sagittal vertical axis [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 cervical lordosis (TS-CL) ( < 15°) were excluded. Patients assessed: meeting minimum clinically important differences (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 cutoffs for differences associated with meeting NDI MCID at 1Y.ResultsSeventy-seven CD patients (mean age, 62.1 years; 64% female; body mass index, 28.8 kg/m2). Forty-one point six percent of patients met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 of 0.820 (p = 0.032) included TS-CL, cSVA, McGregor's slope (MGS), C2 sacral slope, C2-T3 angle, C2-T3 SVA, cervical lordosis. 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 2 groups (p > 0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: ≥ 42.5° C2-T3 angle, > 35.4° cervical lordosis, < -31.76° C2 slope, < -11.57-mm cSVA, < -2.16° MGS, > -30.8-mm C2-T3 SVA, and ≤ -33.6° TS-CL.ConclusionCertain 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.