Cervical Spine Compensation in Adolescent Idiopathic Scoliosis

Norheim, Elizabeth P.; Carreon, Leah Y.; Sucato, Daniel J.; Lenke, Lawrence G.; Glassman, Steven D.

doi:10.1016/j.jspd.2014.11.008

Cited by 19 publications

(7 citation statements)

References 30 publications

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“…Cervical sagittal alignment, as a part of global sagittal alignment, may have an effect on HRQOL [2, 31, 32]. CK, which is considered as pathologic, may be associated with the development of cervical myelopathy and neck pain [31, 33]. However, the established relationship between CK and HRQOL is lacking.…”

Section: Discussionmentioning

confidence: 99%

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Liu

Wang

et al. 2019

J Orthop Surg Res

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Background Cervical kyphosis has been pointed out in asymptomatic populations. The purposes of this study were (1) to investigate the incidence of cervical kyphosis in asymptomatic populations, (2) to identify risk factors related to cervical kyphosis, and (3) to assess the relationship between cervical kyphosis and health-related quality of life (HRQOL). Methods A cohort of 235 asymptomatic volunteers’ records was retrospectively analyzed. Radiographic parameters of the coronal and sagittal planes were measured in the full-length spine x-ray. All patients were classified into two groups based on the cervical lordosis angle: cervical lordosis (CL) and cervical kyphosis (CK). HRQOL was evaluated by EQ-5D and SF-36 (PCS and MCS) questionnaires. Results CK was observed in 90 of 235 (38.3%) participants. There was a significant difference with regard to age between volunteers with CK and CL (32.23 ± 8.12 vs. 42.12 ± 6.14, p < 0.05). Several parameters had a significant relationship with CK, including TK, T1 slope, TIA, SVA, and CT. Logistic regression analysis identified age, TK, T1 slope, and SVA as independent risk factors of CK. In addition, there was a negative correlation between CK and the parameters of HRQOL (EQ-5D, − 0.63; PCS, − 0.68; MCS, − 0.59). Conclusions The incidence of CK in normal populations is 38.3%. Some spinal parameters are related to CK. CK is associated with the HRQOL.

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Section: Discussionmentioning

confidence: 99%

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Liu

Wang

et al. 2019

J Orthop Surg Res

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“…The PPSS is a multicenter database of surgically treated AIS managed by the Spinal Deformity Study Group. A stratified random sampling was done as previously described 11 to obtain a representative sample from all Lenke types (1-6), subtypes (A, B, and C) and thoracic curve modifiers (N, À, and þ). In brief, random numbers were assigned to each subject.…”

Section: Subjectsmentioning

confidence: 99%

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Ogura

Glassman

Sucato

et al. 2020

Global Spine Journal

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Study Design: Longitudinal cohort. Objectives: Posterior spinal fusion (PSF) using all-pedicle screw constructs has become the standard procedure in the treatment of adolescent idiopathic scoliosis (AIS). However, there have been several reports that all-pedicle screw constructs or the use of pedicle screws at the upper instrumented vertebrae (UIV) increases the incidence of proximal junctional kyphosis (PJK). We aimed to evaluate the impact of instrumentation type on the incidence of PJK following PSF for AIS. Methods: We performed a stratified random sampling from 3654 patients enrolled in a multicenter database of surgically treated AIS to obtain a representative sample from all Lenke types. Patients were then allocated into 3 groups based on the instrumentation type: all-pedicle screw (PS), hook at UIV with pedicle screws distally (HT), and hybrid constructs (HB). We measured proximal junctional angle (PJA) and defined PJK as PJA ≥ 10° and PJA progression of >10° at the final follow-up. Results: Fifteen (4.3%) of 345 cases had PJK. PJK was significantly more common in PS (11%) compared with HB (1%) and HT (0%) ( P < .001). PJK patients were similar to non-PJK patients regarding age, sex, curve type, UIV, and preoperative coronal Cobb angle. Thoracic kyphosis was significantly higher in the PJK group before surgery. Patients who developed PJK had a statistically significantly larger negative sagittal balance compared with the non-PJK group. Conclusion: The incidence of PJK was 4.3% and was more common in all-pedicle screw constructs. Using hooks at UIV might be a treatment strategy to limit PJK.

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“…Recent studies support the notion that a kyphotic cervical spine can also represent normal alignment [3, 4]. This controversy is pervasive in studies of both the general population [5, 6] and scoliosis patients [7, 8]. The lack of consensus on what constitutes normal cervical spine alignment may be explained by an incomplete understanding of how regional, global and cervical alignments interact.…”

Section: Introductionmentioning

confidence: 99%

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

et al. 2019

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BackgroundSeveral studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS).MethodsBaseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment.ResultsStratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA.ConclusionsIn surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment.

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Cervical Spine Compensation in Adolescent Idiopathic Scoliosis

Cited by 19 publications

References 30 publications

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Cervical kyphosis in asymptomatic populations: incidence, risk factors, and its relationship with health-related quality of life

Incidence of Proximal Junctional Kyphosis With Pedicle Screws at Upper Instrumented Vertebrae in Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis

Cervical spine alignment following surgery for adolescent idiopathic scoliosis (AIS): a pre-to-post analysis of 81 patients

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