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2. Intraoperative fluid management in adult spinal deformity surgery: variation analysis and association with outcomes

Author

Cetik, Riza M., Gum, Jeffrey L., Lafage, Renaud, Smith, Justin S., Bess, Shay, Mullin, Jeffrey P., Kelly, Michael P., Diebo, Bassel G., Buell, Thomas J., Scheer, Justin K., Line, Breton G., Lafage, Virginie, Klineberg, Eric O., Kim, Han Jo, Passias, Peter G., Kebaish, Khaled M., Eastlack, Robert K., Daniels, Alan H., Soroceanu, Alex, Mundis, Gregory M., Hostin, Richard A., Protopsaltis, Themistocles S., Hamilton, D. Kojo, Hart, Robert A., Gupta, Munish C., Lewis, Stephen J., Schwab, Frank J., Lenke, Lawrence G., Shaffrey, Christopher I., Ames, Christopher P., and Burton, Douglas C.

Published
2024
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3. Expectations of clinical improvement following corrective surgery for adult cervical deformity based on functional disability at presentation

Author

Passias, Peter G., Onafowokan, Oluwatobi O., Joujon-Roche, Rachel, Smith, Justin, Tretiakov, Peter, Buell, Thomas, Diebo, Bassel G., Daniels, Alan H., Gum, Jeffrey L., Hamiltion, D. Kojo, Soroceanu, Alex, Scheer, Justin, Eastlack, Robert K., Fessler, Richard G., Klineberg, Eric O., Kim, Han Jo, Burton, Douglas C., Schwab, Frank J., Bess, Shay, Lafage, Virginie, Shaffrey, Christopher I., and Ames, Christopher

Published
2024
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5. Thoracolumbar fusions for adult lumbar deformity show superior QALY gain and lower costs compared with upper thoracic fusions

Author

Kim, Andrew H., Hostin, Richard A., Yeramaneni, Samrat, Gum, Jeffrey L., Nayak, Pratibha, Line, Breton G., Bess, Shay, Passias, Peter G., Hamilton, D. Kojo, Gupta, Munish C., Smith, Justin S., Lafage, Renaud, Diebo, Bassel G., Lafage, Virginie, Klineberg, Eric O., Daniels, Alan H., Protopsaltis, Themistocles S., Schwab, Frank J., Shaffrey, Christopher I., Ames, Christopher P., Burton, Douglas C., and Kebaish, Khaled M.

Published
2024
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7. Contemporary utilization of three-column osteotomy techniques in a prospective complex spinal deformity multicenter database: implications on full-body alignment and perioperative course

Author

Williamson, Tyler K., Mir, Jamshaid M., Smith, Justin S., Lafage, Virginie, Lafage, Renaud, Line, Breton, Diebo, Bassel G., Daniels, Alan H., Gum, Jeffrey L., Hamilton, D. Kojo, Scheer, Justin K., Eastlack, Robert, Demetriades, Andreas K., Kebaish, Khaled M., Lewis, Stephen, Lenke, Lawrence G., Hostin Jr, Richard A., Gupta, Munish C., Kim, Han Jo, Ames, Christopher P., Burton, Douglas C., Shaffrey, Christopher I., Klineberg, Eric O., Bess, Shay, and Passias, Peter G.

Published
2024
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9. Development of a modified frailty index for adult spinal deformities independent of functional changes following surgical correction: a true baseline risk assessment tool

Author

Passias, Peter G., Pierce, Katherine E., Mir, Jamshaid M., Krol, Oscar, Lafage, Renaud, Lafage, Virginie, Line, Breton, Uribe, Juan S., Hostin, Richard, Daniels, Alan, Hart, Robert, Burton, Douglas, Shaffrey, Christopher, Schwab, Frank, Diebo, Bassel G., Ames, Christopher P., Smith, Justin S., Schoenfeld, Andrew J., Bess, Shay, and Klineberg, Eric O.

Published
2024
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10. Are We Focused on the Wrong Early Postoperative Quality Metrics? Optimal Realignment Outweighs Perioperative Risk in Adult Spinal Deformity Surgery.

Author

Passias, Peter, Williamson, Tyler, Mir, Jamshaid, Smith, Justin, Lafage, Virginie, Lafage, Renaud, Line, Breton, Daniels, Alan, Gum, Jeffrey, Schoenfeld, Andrew, Hamilton, David, Soroceanu, Alex, Scheer, Justin, Eastlack, Robert, Mundis, Gregory, Diebo, Bassel, Kebaish, Khaled, Hostin, Richard, Gupta, Munish, Kim, Han, Klineberg, Eric, Ames, Christopher, Hart, Robert, Burton, Douglas, Schwab, Frank, Shaffrey, Christopher, and Bess, Shay

Subjects
Medicare, adult spinal deformity, clinical improvement, complex realignment, complications, cost-utility
Abstract

BACKGROUND: While reimbursement is centered on 90-day outcomes, many patients may still achieve optimal, long-term outcomes following adult spinal deformity (ASD) surgery despite transient short-term complications. OBJECTIVE: Compare long-term clinical success and cost-utility between patients achieving optimal realignment and suboptimally aligned peers. STUDY DESIGN/SETTING: Retrospective cohort study of a prospectively collected multicenter database. METHODS: ASD patients with two-year (2Y) data included. Groups were propensity score matched (PSM) for age, frailty, body mass index (BMI), Charlson Comorbidity Index (CCI), and baseline deformity. Optimal radiographic criteria are defined as meeting low deformity in all three (Scoliosis Research Society) SRS-Schwab parameters or being proportioned in Global Alignment and Proportionality (GAP). Cost-per-QALY was calculated for each time point. Multivariable logistic regression analysis and ANCOVA (analysis of covariance) adjusting for baseline disability and deformity (pelvic incidence (PI), pelvic incidence minus lumbar lordosis (PI-LL)) were used to determine the significance of surgical details, complications, clinical outcomes, and cost-utility. RESULTS: A total of 930 patients were considered. Following PSM, 253 optimal (O) and 253 not optimal (NO) patients were assessed. The O group underwent more invasive procedures and had more levels fused. Analysis of complications by two years showed that the O group suffered less overall major (38% vs. 52%, p = 0.021) and major mechanical complications (12% vs. 22%, p = 0.002), and less reoperations (23% vs. 33%, p = 0.008). Adjusted analysis revealed O patients more often met MCID (minimal clinically important difference) in SF-36 PCS, SRS-22 Pain, and Appearance. Cost-utility-adjusted analysis determined that the O group generated better cost-utility by one year and maintained lower overall cost and costs per QALY (both p < 0.001) at two years. CONCLUSIONS: Fewer late complications (mechanical and reoperations) are seen in optimally aligned patients, leading to better long-term cost-utility overall. Therefore, the current focus on avoiding short-term complications may be counterproductive, as achieving optimal surgical correction is critical for long-term success.

Published
2023

11. Longitudinal Assessment of Modern Spine Surgery Training: 10-Year Follow-up of a Nationwide Survey of Residency and Spine Fellowship Program Directors.

Author

Daniels, Alan, Alsoof, Daniel, McDonald, Christopher, Zhang, Andrew, Diebo, Bassel, Eberson, Craig, Kuris, Eren, Lavelle, William, Shaffrey, Christopher, Hart, Robert, and Ames, Christopher

Abstract

UNLABELLED: Spine surgeons complete training through residency in orthopaedic surgery (ORTH) or neurosurgery (NSGY). A survey was conducted in 2013 to evaluate spine surgery training. Over the past decade, advances in surgical techniques and the changing dynamics in fellowship training may have affected training and program director (PD) perceptions may have shifted. METHODS: This study is a cross-sectional survey distributed to all PDs of ORTH and NSGY residencies and spine fellowships in the United States. Participants were queried regarding characteristics of their program, ideal characteristics of residency training, and opinions regarding the current training environment. χ2 tests were used to compare answers over the years. RESULTS: In total, 241 PDs completed the survey. From 2013 to 2023, NSGY increased the proportion of residents with >300 spine cases (86%-100%) while ORTH remained with >90% of residents with < 225 cases (p < 0.05). A greater number of NSGY PDs encouraged spine fellowship even for community spine surgery practice (0% in 2013 vs. 14% in 2023, p < 0.05), which continued to be significantly different from ORTH PDs (∼88% agreed, p > 0.05). 100% of NSGY PDs remained confident in their residents performing spine surgery, whereas ORTH confidence significantly decreased from 43% in 2013 to 25% in 2023 (p < 0.05). For spinal deformity, orthopaedic PDs (92%), NSGY PDs (96%), and fellowship directors (95%), all agreed that a spine fellowship should be pursued (p = 0.99). In both 2013 and 2023, approximately 44% were satisfied with the spine training model in the United States. In 2013, 24% of all PDs believed we should have a dedicated spine residency, which increased to 39% in 2023 (fellowship: 57%, ORTH: 38%, NSGY: 21%) (p < 0.05). CONCLUSION: Spine surgery training continues to evolve, yet ORTH and neurological surgery training remains significantly different in case volumes and educational strengths. In both 2013 and 2023, less than 50% of PDs were satisfied with the current spine surgery training model, and a growing minority believe that spine surgery should have its own residency training pathway. LEVEL OF EVIDENCE: IV.

Published
2023

16. Hip Osteoarthritis in Patients Undergoing Surgery for Severe Adult Spinal Deformity: Prevalence and Impact on Spine Surgery Outcomes

Author

Diebo, Bassel G., Alsoof, Daniel, Balmaceno-Criss, Mariah, Daher, Mohammad, Lafage, Renaud, Passias, Peter G., Ames, Christopher P., Shaffrey, Christopher I., Burton, Douglas C., Deviren, Vedat, Line, Breton G., Soroceanu, Alex, Hamilton, D. Kojo, Klineberg, Eric O., Mundis, Gregory M., Kim, Han Jo, Gum, Jeffrey L., Smith, Justin S., Uribe, Juan S., Kebaish, Khaled M., Gupta, Munish C., Nunley, Pierce D., Eastlack, Robert K., Hostin, Richard, Protopsaltis, Themistocles S., Lenke, Lawrence G., Hart, Robert A., Schwab, Frank J., Bess, Shay, Lafage, Virginie, Daniels, Alan H., and International Spine Study Group

Published
2024
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17. Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes.

Author

Passias, Peter Gust, Alas, Haddy, Kummer, Nicholas, Tretiakov, Peter, Diebo, Bassel G, Lafage, Renaud, Ames, Christopher P, Line, Breton, Klineberg, Eric O, Burton, Douglas C, Uribe, Juan S, Kim, Han Jo, Daniels, Alan H, Bess, Shay, Protopsaltis, Themistocles, Mundis, Gregory M, Shaffrey, Christopher I, Schwab, Frank J, Smith, Justin S, Lafage, Virginie, and International Spine Study Group

Subjects
Cervical deformity, cervical lordosis, hyperlordosis, spine surgery, Clinical Research, Patient Safety, Clinical Sciences, Neurosciences
Abstract

BackgroundPatients 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).ObjectiveThe 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 methodsOperative 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 (

Published
2022

21. Restoring L4-S1 Lordosis Shape in Severe Sagittal Deformity: Impact of Correction Techniques on Alignment and Complication Profile

Author

Singh, Manjot, Balmaceno-Criss, Mariah, Daher, Mohammad, Lafage, Renaud, Hamilton, D. Kojo, Smith, Justin S., Eastlack, Robert K., Fessler, Richard G., Gum, Jeffrey L., Gupta, Munish C., Hostin, Richard, Kebaish, Khaled M., Klineberg, Eric O., Lewis, Stephen J., Line, Breton G., Nunley, Pierce D., Mundis, Gregory M., Passias, Peter G., Protopsaltis, Themistocles S., Buell, Thomas, Ames, Christopher P., Mullin, Jeffrey P., Soroceanu, Alex, Scheer, Justin K., Lenke, Lawrence G., Bess, Shay, Shaffrey, Christopher I., Schwab, Frank J., Lafage, Virginie, Burton, Douglas C., Diebo, Bassel G., and Daniels, Alan H.

Published
2024
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27. Impact of Hip and Knee Osteoarthritis on Full Body Sagittal Alignment and Compensation for Sagittal Spinal Deformity

Author

Balmaceno-Criss, Mariah, Lafage, Renaud, Alsoof, Daniel, Daher, Mohammad, Hamilton, David Kojo, Smith, Justin S., Eastlack, Robert K., Fessler, Richard G., Gum, Jeffrey L., Gupta, Munish C., Hostin, Richard, Kebaish, Khaled M., Klineberg, Eric O., Lewis, Stephen J., Line, Breton G., Nunley, Pierce D., Mundis, Gregory M., Passias, Peter G., Protopsaltis, Themistocles S., Buell, Thomas, Scheer, Justin K., Mullin, Jeffrey P., Soroceanu, Alex, Ames, Christopher P., Lenke, Lawrence G., Bess, Shay, Shaffrey, Christopher I., Schwab, Frank J., Lafage, Virginie, Burton, Douglas C., Diebo, Bassel G., and Daniels, Alan H.

Published
2024
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28. The Evolution of Enhanced Recovery After Surgery: Assessing the Clinical Benefits of Developments Within Enhanced Recovery After Surgery Protocols in Adult Cervical Deformity Surgery

Author

Passias, Peter G., Tretiakov, Peter S., Onafowokan, Oluwatobi O., Galetta, Matthew, Lorentz, Nathan, Mir, Jamshaid M., Das, Ankita, Dave, Pooja, Lafage, Renaud, Yee, Timothy, Diebo, Bassel, Vira, Shaleen, Jankowski, Pawel P., Hockley, Aaron, Daniels, Alan, Schoenfeld, Andrew J., Mummaneni, Praveen, Paulino, Carl B., and Lafage, Virginie

Published
2024
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30. Predictive Analytics for Determining Extended Operative Time in Corrective Adult Spinal Deformity Surgery.

Author

Passias, Peter G, Poorman, Gregory W, Vasquez-Montes, Dennis, Kummer, Nicholas, Mundis, Gregory, Anand, Neel, Horn, Samantha R, Segreto, Frank A, Passfall, Lara, Krol, Oscar, Diebo, Bassel, Burton, Doug, Buckland, Aaron, Gerling, Michael, Soroceanu, Alex, Eastlack, Robert, Kojo Hamilton, D, Hart, Robert, Schwab, Frank, Lafage, Virginie, Shaffrey, Christopher, Sciubba, Daniel, Bess, Shay, Ames, Christopher, and Klineberg, Eric

Subjects
Biomedical and Clinical Sciences, Clinical Sciences, Patient Safety, Clinical Research, Bioengineering, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, adult spinal deformity, operative time, decision trees, predictive analytics, International Spine Study Group, Neurosciences, Clinical sciences
Abstract

BackgroundMore sophisticated surgical techniques for correcting adult spinal deformity (ASD) have increased operative times, adding to physiologic stress on patients and increased complication incidence. This study aims to determine factors associated with operative time using a statistical learning algorithm.MethodsRetrospective review of a prospective multicenter database containing 837 patients undergoing long spinal fusions for ASD. Conditional inference decision trees identified factors associated with skin-to-skin operative time and cutoff points at which factors have a global effect. A conditional variable-importance table was constructed based on a nonreplacement sampling set of 2000 conditional inference trees. Means comparison for the top 15 variables at their respective significant cutoffs indicated effect sizes.ResultsIncluded: 544 surgical ASD patients (mean age: 58.0 years; fusion length 11.3 levels; operative time: 378 minutes). The strongest predictor for operative time was institution/surgeon. Center/surgeons, grouped by decision tree hierarchy, a and b were, on average, 2 hours faster than center/surgeons c-f, who were 43 minutes faster than centers g-j, all P < 0.001. The next most important predictors were, in order, approach (combined vs posterior increases time by 139 minutes, P < 0.001), levels fused (

Published
2022

34. Machine learning clustering of adult spinal deformity patients identifies four prognostic phenotypes: a multicenter prospective cohort analysis with single surgeon external validation

Author

Mohanty, Sarthak, Hassan, Fthimnir M., Lenke, Lawrence G., Lewerenz, Erik, Passias, Peter G., Klineberg, Eric O., Lafage, Virginie, Smith, Justin S., Hamilton, D. Kojo, Gum, Jeffrey L., Lafage, Renaud, Mullin, Jeffrey, Diebo, Bassel, Buell, Thomas J., Kim, Han Jo, Kebaish, Khalid, Eastlack, Robert, Daniels, Alan H., Mundis, Gregory, Hostin, Richard, Protopsaltis, Themistocles S., Hart, Robert A., Gupta, Munish, Schwab, Frank J., Shaffrey, Christopher I., Ames, Christopher P., Burton, Douglas, and Bess, Shay

Published
2024
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41. Risk of spinal surgery among individuals who have been re-vascularized for coronary artery disease

Author

Passias, Peter G., Ahmad, Waleed, Kapadia, Bhaveen H., Krol, Oscar, Bell, Joshua, Kamalapathy, Pramod, Imbo, Bailey, Tretiakov, Peter, Williamson, Tyler, Onafowokan, Oluwatobi O., Das, Ankita, Joujon-Roche, Rachel, Moattari, Kevin, Passfall, Lara, Kummer, Nicholas, Vira, Shaleen, Lafage, Virginie, Diebo, Bassel, Schoenfeld, Andrew J., and Hassanzadeh, Hamid

Published
2024
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43. The impact of postoperative neurologic complications on recovery kinetics in cervical deformity surgery.

Author

Passias, Peter Gust, Brown, Avery E, Alas, Haddy, Pierce, Katherine E, Bortz, Cole A, Diebo, Bassel, Lafage, Renaud, Lafage, Virginie, Burton, Douglas C, Hart, Robert, Kim, Han Jo, Bess, Shay, Moattari, Kevin, Joujon-Roche, Rachel, Krol, Oscar, Williamson, Tyler, Tretiakov, Peter, Imbo, Bailey, Protopsaltis, Themistocles S, Shaffrey, Christopher, Schwab, Frank, Eastlack, Robert, Line, Breton, Klineberg, Eric, Smith, Justin, Ames, Christopher, and International Spine Study Group

Subjects
International Spine Study Group, Cervical deformity surgery, health-related quality of life, neurologic complications, outcomes, recovery kinetics, Clinical Research, Neurosciences, Patient Safety, Neurodegenerative, Physical Injury - Accidents and Adverse Effects, Rehabilitation, 6.4 Surgery, Evaluation of treatments and therapeutic interventions, Clinical Sciences
Abstract

ObjectiveThe objective of the study is to investigate which neurologic complications affect clinical outcomes the most following cervical deformity (CD) surgery.MethodsCD patients (C2-C7 Cobb >10°, CL >10°, cSVA >4 cm or chin-brow vertical angle >25°) >18 years with follow-up surgical and health-related quality of life (HRQL) data were included. Descriptive analyses assessed demographics. Neurologic complications assessed were C5 motor deficit, central neurodeficit, nerve root motor deficits, nerve sensory deficits, radiculopathy, and spinal cord deficits. Neurologic complications were classified as major or minor, then: intraoperative, before discharge, before 30 days, before 90 days, and after 90 days. HRQL outcomes were assessed at 3 months, 6 months, and 1 year. Integrated health state (IHS) for the neck disability index (NDI), EQ5D, and modified Japanese Orthopaedic Association (mJOA) were assessed using all follow-up time points. A subanalysis assessed IHS outcomes for patients with 2Y follow-up.Results153 operative CD patients were included. Baseline characteristics: 61 years old, 63% female, body mass index 29.7, operative time 531.6 ± 275.5, estimated blood loss 924.2 ± 729.5, 49% posterior approach, 18% anterior approach, 33% combined. 18% of patients experienced a total of 28 neurologic complications in the postoperative period (15 major). There were 7 radiculopathy, 6 motor deficits, 6 sensory deficits, 5 C5 motor deficits, 2 central neurodeficits, and 2 spinal cord deficits. 11.2% of patients experienced neurologic complications before 30 days (7 major) and 15% before 90 days (12 major). 12% of neurocomplication patients went on to have revision surgery within 6 months and 18% within 2 years. Neurologic complication patients had worse mJOA IHS scores at 1Y but no significant differences between NDI and EQ5D (0.003 vs. 0.873, 0.458). When assessing individual complications, central neurologic deficits and spinal cord deficit patients had the worst outcomes at 1Y (2.6 and 1.8 times worse NDI scores, P = 0.04, no improvement in EQ5D, 8% decrease in EQ5D). Patients with sensory deficits had the best NDI and EQ5D outcomes at 1Y (31% decrease in NDI, 8% increase in EQ5D). In a subanalysis, neurologic patients trended toward worse NDI and mJOA IHS outcomes (P = 0.263, 0.163).Conclusions18% of patients undergoing CD surgery experienced a neurologic complication, with 15% within 3 months. Patients who experienced any neurologic complication had worse mJOA recovery kinetics by 1 year and trended toward worse recovery at 2 years. Of the neurologic complications, central neurologic deficits and spinal cord deficits were the most detrimental.

Published
2021

44. The Impact of Lumbopelvic Realignment Versus Prevention Strategies at the Upper-instrumented Vertebra on the Rates of Junctional Failure Following Adult Spinal Deformity Surgery

Author

Passias, Peter G., Williamson, Tyler K., Joujon-Roche, Rachel, Krol, Oscar, Tretiakov, Peter, Imbo, Bailey, Schoenfeld, Andrew J., Owusu-Sarpong, Stephane, Lebovic, Jordan, Mir, Jamshaid, Dave, Pooja, McFarland, Kimberly, Vira, Shaleen, Diebo, Bassel G., Park, Paul, Chou, Dean, Smith, Justin S., Lafage, Renaud, and Lafage, Virginie

Published
2024
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47. The Importance of Incorporating Proportional Alignment in Adult Cervical Deformity Corrections Relative to Regional and Global Alignment: Steps Toward Development of a Cervical-Specific Score

Author

Passias, Peter G., Williamson, Tyler K., Pierce, Katherine E., Schoenfeld, Andrew J., Krol, Oscar, Imbo, Bailey, Joujon-Roche, Rachel, Tretiakov, Peter, Ahmad, Salman, Bennett-Caso, Claudia, Mir, Jamshaid, Dave, Pooja, McFarland, Kimberly, Owusu-Sarpong, Stephane, Lebovic, Jordan A., Janjua, Muhammad Burhan, de la Garza-Ramos, Rafael, Vira, Shaleen, Diebo, Bassel, Koller, Heiko, Protopsaltis, Themistocles S., Lafage, Renaud, and Lafage, Virginie

Published
2024
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48. Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis

Author

Passias, Peter G., Passfall, Lara, Moattari, Kevin, Krol, Oscar, Kummer, Nicholas A., Tretiakov, Peter, Williamson, Tyler, Joujon-Roche, Rachel, Imbo, Bailey, Burhan Janjua, Muhammad, Jankowski, Pawel, Paulino, Carl, Schwab, Frank J., Owusu-Sarpong, Stephane, Singh, Vivek, Ahmad, Salman, Onafowokan, Tobi, Lebovic, Jordan, Tariq, Muhammad, Saleh, Hesham, Vira, Shaleen, Smith, Justin S., Diebo, Bassel, and Schoenfeld, Andrew J.

Published
2024
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49. Efficacy of Varying Surgical Approaches on Achieving Optimal Alignment in Adult Spinal Deformity Surgery

Author

Passias, Peter G., Ahmad, Waleed, Williamson, Tyler K., Lebovic, Jordan, Kebaish, Khaled, Lafage, Renaud, Lafage, Virginie, Line, Breton, Schoenfeld, Andrew J., Diebo, Bassel G., Klineberg, Eric O., Kim, Han Jo, Ames, Christopher P., Daniels, Alan H., Smith, Justin S., Shaffrey, Christopher I., Burton, Douglas C., Hart, Robert A., Bess, Shay, Schwab, Frank J., and Gupta, Munish C.

Published
2024
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50. Cervical deformity patients with baseline hyperlordosis or hyperkyphosis differ in surgical treatment and radiographic outcomes.

Author

Alas, Haddy, Passias, Peter Gust, Diebo, Bassel G, Brown, Avery E, Pierce, Katherine E, Bortz, Cole, Lafage, Renaud, Ames, Christopher P, Line, Breton, Klineberg, Eric O, Burton, Douglas C, Uribe, Juan S, Kim, Han Jo, Daniels, Alan H, Bess, Shay, Protopsaltis, Themistocles, Mundis, Gregory M, Shaffrey, Christopher I, Schwab, Frank J, Smith, Justin S, and Lafage, Virginie

Subjects
Cervical deformity, cervical lordosis, hyperlordosis, spine surgery, Clinical Research, Clinical Sciences, Neurosciences
Abstract

IntroductionPatients 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 methodsOperative 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.ResultsOne 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.ConclusionsHyperlodotic patients trended higher revision rates with greater radiographic malalignment at 1Y postoperative, perhaps due to undercorrection compared to kyphotic etiologies.

Published
2021

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