Spinopelvic sagittal compensation in adult cervical deformity.

Autor:	Ye J; 1Department of Orthopaedic Surgery, Sun Yat-sen Memorial Hospital, Sun Yat-sen University, Guangzhou, Guangdong Province, China., Rider SM; 13Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri; and., Lafage R; 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York., Gupta S; 14Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Farooqi AS; 14Department of Orthopaedic Surgery, University of Pennsylvania, Philadelphia, Pennsylvania., Protopsaltis TS; 3Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York., Passias PG; 3Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, New York., Smith JS; 4Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia., Lafage V; 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York., Kim HJ; 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York., Klineberg EO; 5Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California., Kebaish KM; 6Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, Maryland., Scheer JK; 7Department of Neurological Surgery, University of California, San Francisco, California., Mundis GM; 8Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California., Soroceanu A; 9University of Calgary Spine Program, University of Calgary, Alberta, Canada., Bess S; 10Rocky Mountain Hospital for Children, Presbyterian/St. Luke's Medical Center, Denver, Colorado., Ames CP; 7Department of Neurological Surgery, University of California, San Francisco, California., Shaffrey CI; Departments of11Neurological Surgery and.; 12Orthopedic Surgery, Duke University, Durham, North Carolina., Gupta MC; 13Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri; and.
Jazyk:	angličtina
Zdroj:	Journal of neurosurgery. Spine [J Neurosurg Spine] 2023 Mar 24; Vol. 39 (1), pp. 1-10. Date of Electronic Publication: 2023 Mar 24 (Print Publication: 2023).
DOI:	10.3171/2023.2.SPINE221295
Abstrakt:	Objective: The objective of this study was to evaluate spinopelvic sagittal alignment and spinal compensatory changes in adult cervical kyphotic deformity. Methods: A database composed of 13 US spine centers was retrospectively reviewed for adult patients who underwent cervical reconstruction with radiographic evidence of cervical kyphotic deformity: C2-7 sagittal vertical axis > 4 cm, chin-brow vertical angle > 25°, or cervical kyphosis (T1 slope [T1S] cervical lordosis [CL] > 15°) (n = 129). Sagittal parameters were evaluated preoperatively and in the early postoperative window (6 weeks to 6 months postoperatively) and compared with asymptomatic control patients. Adult cervical deformity patients were further stratified by degree of cervical kyphosis (severe kyphosis, C2-T3 Cobb angle ≤ -30°; moderate kyphosis, ≤ 0°; and minimal kyphosis, > 0°) and severity of sagittal malalignment (severe malalignment, sagittal vertical axis T3-S1 ≤ -60 mm; moderate malalignment, ≤ 20 mm; and minimal malalignment > 20 mm). Results: Compared with asymptomatic control patients, cervical deformity was associated with increased C0-2 lordosis (32.9° vs 23.6°), T1S (33.5° vs 28.0°), thoracolumbar junction kyphosis (T10-L2 Cobb angle -7.0° vs -1.7°), and pelvic tilt (PT) (19.7° vs 15.9°) (p < 0.01). Cervicothoracic kyphosis was correlated with C0-2 lordosis (R = -0.57, p < 0.01) and lumbar lordosis (LL) (R = -0.20, p = 0.03). Cervical reconstruction resulted in decreased C0-2 lordosis, increased T1S, and increased thoracic and thoracolumbar junction kyphosis (p < 0.01). Patients with severe cervical kyphosis (n = 34) had greater C0-2 lordosis (p < 0.01) and postoperative reduction of C0-2 lordosis (p = 0.02) but no difference in PT. Severe cervical kyphosis was also associated with a greater increase in thoracic and thoracolumbar junction kyphosis postoperatively (p = 0.01). Patients with severe sagittal malalignment (n = 52) had decreased PT (p = 0.01) and increased LL (p < 0.01), as well as a greater postoperative reduction in LL (p < 0.01). Conclusions: Adult cervical deformity is associated with upper cervical hyperlordotic compensation and thoracic hypokyphosis. In the setting of increased kyphotic deformity and sagittal malalignment, thoracolumbar junction kyphosis and lumbar hyperlordosis develop to restore normal center of gravity. There was no consistent compensatory pelvic retroversion or anteversion among the adult cervical deformity patients in this cohort.
Databáze:	MEDLINE
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