A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery

Williamson, Tyler; Lebovic, Jordan; Schoenfeld, Andrew J.; Imbo, Bailey; Joujon-Roche, Rachel; Tretiakov, Peter; Krol, Oscar; Bennett-Caso, Claudia; Owusu-Sarpong, Stephane; Dave, Pooja; McFarland, Kimberly; Mir, Jamshaid; Dhillon, Ekamjeet S.; Koller, Heiko; Diebo, Bassel G.; Vira, Shaleen; Lafage, Renaud; Lafage, Virginie; Passias, Peter G.

doi:10.1097/bsd.0000000000001442

Cited by 2 publications

(5 citation statements)

References 28 publications

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“…Implementation of this approach has demonstrated superior 2-year HRQoL outcomes, reduced rates of DJK and reoperation, and higher rates of attaining optimal outcomes. 54 There are limitations that this hierarchical approach has not been confirmed in other studies. Despite the limitations, this is the first attempt to provide stepwise approach to cervical realignment surgery by prioritizing cervical parameters.…”

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 92%

“…4B ). In these instances, we adopt an approach that extends the LIV beyond the PT spine while avoiding the apex, which is in line with the recommendations set forth by Williamson et al [ 54 ]. This stratagem harmonizes with our objective of integrating the global compensatory status, thereby mitigating potential complications or malalignment issues stemming from cervical realignment surgery.…”

Section: Integrated Approach and Practical Recommendations For Csd As...mentioning

confidence: 93%

“…The LIV inclination is defined as the angle between the vertical plumb line and the best-fit line crossing the center of the LIV, LIV-1, and LIV-2. Williamson et al [ 54 ] sought to devise a stepwise approach by prioritizing cervical parameters in order to address cervical realignment surgery to improve clinical outcomes and reduce DJK and reoperation. The study revealed through adjusted analysis using the analysis of covariance and multivariable regression that this hierarchical approach led to a significantly lower rate of poor clinical outcomes.…”

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 99%

“…The study revealed through adjusted analysis using the analysis of covariance and multivariable regression that this hierarchical approach led to a significantly lower rate of poor clinical outcomes. Implementation of this approach has demonstrated superior 2-year HRQoL outcomes, reduced rates of DJK and reoperation, and higher rates of attaining optimal outcomes [ 54 ]. There are limitations that this hierarchical approach has not been confirmed in other studies.…”

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 99%

“…Based on these significant findings, an individualized cervical realignment strategy has been recently proposed, with a primary focus on correcting C2S and LIV selection. 54 A hierarchical approach recommends first correcting C2S to below 10°, followed by selecting a stable LIV, defined as the LIV with an inclination angle (Fig. 5) ranging from 0° to 40°, and finally achieving correction of cSVA below 35 mm (Fig.…”

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 99%

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Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets

Lee,

Hyun,

Kim

2023

Neurospine

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Cervical spinal deformity (CSD) is a complex condition characterized by abnormal curvature and cervical spine alignment. It can lead to a multitude of symptoms, including chronic pain, neurological deficits, and functional impairments, severely impacting an individual’s health-related quality of life (HRQoL). Surgical intervention is often necessary to address the deformity and alleviate symptoms, but optimal surgical strategies remain a topic of ongoing research and debate. This narrative review aims to provide an in-depth overview of the surgical management of CSD, focusing on optimizing patient outcomes and enhancing readers’ understanding of the complexities involved. We begin by discussing the importance of preoperative assessment, including comprehensive radiographic evaluation and careful consideration of the global spinal alignment. The relationship between the cervical spine and the reciprocal changes that occur are explored to guide surgeons in their decision-making process. Furthermore, we delve into the selection of fusion levels, emphasizing the significance of identifying the primary driver of deformity. We review the current literature on optimal alignment targets and strategies to optimize surgical planning. By providing a comprehensive analysis of the surgical management of CSD, this review aims to enhance the readers’ knowledge and assist surgeons in making informed decisions when planning and executing surgical interventions. Understanding the intricacies of CSD correction and the latest advancements in the field can ultimately improve patient outcomes and enhance HRQoL for individuals suffering from this challenging condition.

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Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 92%

Section: Integrated Approach and Practical Recommendations For Csd As...mentioning

confidence: 93%

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 99%

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 99%

Section: Optimal Alignment Targets For Csd: Insights From Recent Rese...mentioning

confidence: 99%

See 3 more Smart Citations

Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets

Lee,

Hyun,

Kim

2023

Neurospine

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Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra Is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

Williamson,

Koslosky,

Lebovic

et al. 2024

Clinical Spine Surgery

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Background: The association of Hounsfield units (HU) and junctional pathologies in adult cervical deformity (ACD) surgery has not been elucidated. Objective: Assess if the bone mineral density of the LIV, as assessed by HUs, is prognostic for the risk of complications after ACD surgery. Study Design/Setting: Retrospective cohort study. Methods: HUs were measured on preoperative CT scans. Means comparison test assessed differences in HUs based on the occurrence of complications, linear regression assessed the correlation of HUs with risk factors, and multivariable logistic regression followed by a conditional inference tree derived a threshold for HUs based on the increased likelihood of developing a complication. Results: In all, 107 ACD patients were included. Thirty-one patients (29.0%) developed a complication (18.7% perioperative), with 20.6% developing DJK and 11.2% developing DJF. There was a significant correlation between lower LIVs and lower HUs (r=0.351, P=0.01), as well as age and HUs at the LIV. Age did not correlate with change in the DJK angle (P>0.2). HUs were lower at the LIV for patients who developed a complication and an LIV threshold of 190 HUs was predictive of complications (OR: 4.2, [1.2–7.6]; P=0.009). Conclusions: Low bone mineral density at the lowest instrumented vertebra, as assessed by a threshold lower than 190 Hounsfield units, may be a crucial risk factor for the development of complications after cervical deformity surgery. Preoperative CT scans should be routinely considered in at-risk patients to mitigate this modifiable risk factor during surgical planning. Level of Evidence: Level—III

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A Hierarchical Approach to Realignment Strategies in Adult Cervical Deformity Surgery

Cited by 2 publications

References 28 publications

Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets

Optimizing Surgical Strategy for Cervical Spinal Deformity: Global Alignment and Surgical Targets

Lower Hounsfield Units at the Planned Lowest Instrumented Vertebra Is an Independent Risk Factor for Complications Following Adult Cervical Deformity Surgery

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