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Changes in Cervical Spinal Alignment After Thoracolumbar Corrective Surgery in Adult Patients With Adolescent Idiopathic Scoliosis.

Abstract：

STUDY DESIGN:Case-control study. OBJECTIVE:To examine factors influencing cervical alignment after corrective surgery for adult patients with adolescent idiopathic scoliosis (AdIS) SUMMARY OF BACKGROUND DATA.: Corrective surgery for spinal deformity influences postoperative cervical spinal alignment, but changes in the cervical alignment in adults with AdIS are scarcely reported. METHODS:We retrospectively examined 85 patients with AdIS who underwent posterior corrective surgery for thoracic or lumbar major curve and were followed up for 2 years. Clinical characteristics, radiographic parameters, and health-related quality of life (HRQOL) were evaluated. Cervical deformity (CD) was defined as one of the following cases: (1) T1 tilt minus C2-C7 angle more than 20°, (2) C2-C7 SVA more than 40 mm, (3) and C2-C7 angle less than -10°. Patients were divided into those with and without CD based on the defined criteria; statistically relevant factors were analyzed. RESULTS:There were 19 patients in the postoperative CD group. The average age at the time of surgery was lower in the CD group (26.5 vs. 31.4). In the CD group, the average preoperative T1 tilt was smaller (1.1° vs. 12.5°), and the C2-C7 angle was kyphotic (-16.1° vs. 3.0°). The average kyphotic angle at thoracic spine (T5-T12) was lower in the CD group preoperatively (12.5° vs. 19.5°) and postoperatively (15.2° vs. 20.8°). HRQOL outcomes were comparable between the groups. Of the patients with preoperative CD, 51.5% (n = 17) maintained their deformity at the final follow-up, and baseline C2-C7 angle was lower than those who converted to non-CD following surgery (n = 16) (-17.0° vs. -10.3°). CONCLUSION:More than half of the patients with baseline CD maintained their cervical malalignment postoperatively. Patients with postoperative CD presented cervical kyphotic and thoracic hypokyphotic alignments before surgery. Because CD has the potential to lead to cervical degeneration, careful follow-up observation is necessary for these young patients. LEVEL OF EVIDENCE:3.

journal_name

Spine (Phila Pa 1976)

journal_title

Spine

authors

Nagoshi N,Yagi M,Daimon K,Suzuki S,Tsuji O,Okada E,Fujita N,Nakamura M,Matsumoto M,Watanabe K

doi

10.1097/BRS.0000000000003410

subject

Has Abstract

pub_date

2020-07-01 00:00:00

pages

877-883

issue

eissn

0362-2436

issn

1528-1159

pii

00007632-202007010-00008

journal_volume

pub_type

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Changes in Cervical Spinal Alignment After Thoracolumbar Corrective Surgery in Adult Patients With Adolescent Idiopathic Scoliosis.