Radiographic benefit of incorporating the inflection between the cervical and thoracic curves in fusion constructs for surgical cervical deformity patients

Autor: Cole Bortz, Peter G Passias, Katherine Elizabeth Pierce, Haddy Alas, Avery Brown, Sara Naessig, Waleed Ahmad, Renaud Lafage, Christopher P Ames, Bassel G Diebo, Breton G Line, Eric O Klineberg, Douglas C Burton, Robert K Eastlack, Han Jo Kim, Daniel M Sciubba, Alex Soroceanu, Shay Bess, Christopher I Shaffrey, Frank J Schwab, Justin S Smith, Virginie Lafage
Jazyk: angličtina
Rok vydání: 2020
Předmět:
Zdroj: Journal of Craniovertebral Junction and Spine, Vol 11, Iss 2, Pp 131-138 (2020)
Druh dokumentu: article
ISSN: 0974-8237
DOI: 10.4103/jcvjs.JCVJS_57_20
Popis: Purpose: The aim is to assess the relationship between cervicothoracic inflection point and baseline disability, as well as the relationship between clinical outcomes and pre- to postoperative changes in inflection point. Methods: Cervical deformity (CD) patients with baseline and 3-month (3M) postoperative radiographic, clinical, and inflection data were grouped by region of inflection point: C6 or above, C6-C7 to C7-T1, T1, or below. Inflection was defined as: Distal-most level where cervical lordosis (CL) changes to thoracic kyphosis (TK). Differences in alignment and patient factors across pre- and postoperative inflection point groups were assessed, as were outcomes by the inclusion of inflection in the CD-corrective fusion construct. Results: A total of 108 patients were included. Preoperative inflection breakdown: C6 or above (42%), C6-C7 to C7-T1 (44%), T1 or below (15%). Surgery was associated with a caudal migration of inflection by 3M: C6 or above (8%), C6-C7 to C7-T1 (58%), T1 or below (33%). For patients with preoperative inflection T1 or below, the inclusion of inflection in the fusion construct was associated with improvements in horizontal gaze (McGregor's Slope included: −11.3° vs. not included: 1.6°, P = 0.038). The inclusion of preoperative inflection in fusion was associated with the superior cervical sagittal vertical axis (cSVA) changes for C6-C7 to C7-T1 patients (−5.2 mm vs. 3.2 mm, P = 0.018). The location of postoperative inflection was associated with variation in 3M alignment: Inflection C6 or above was associated with less Pelvic Tilt (PT), PT and a trend of larger cSVA. Location of inflection or inclusion in fusion was not associated with reoperation or distal junctional kyphosis. Conclusions: Incorporating the inflection point between CL and TK in the fusion construct was associated with superior restoration of cervical alignment and horizontal gaze for surgical CD patients.
Databáze: Directory of Open Access Journals
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