دورية أكاديمية
The Importance of Incorporating Proportional Alignment in Adult Cervical Deformity Corrections Relative to Regional and Global Alignment: Steps Toward Development of a Cervical-Specific Score.
| العنوان: | The Importance of Incorporating Proportional Alignment in Adult Cervical Deformity Corrections Relative to Regional and Global Alignment: Steps Toward Development of a Cervical-Specific Score. |
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| المؤلفون: | Passias PG; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Williamson TK; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Pierce KE; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Schoenfeld AJ; New York Spine Institute, New York, NY.; Department of Orthopedic Surgery, Brigham and Women's Center for Surgery and Public Health, Boston, MA., Krol O; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Imbo B; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Joujon-Roche R; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Tretiakov P; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Ahmad S; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Bennett-Caso C; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Mir J; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Dave P; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., McFarland K; Departments of Orthopaedic and Neurological Surgery, NYU Langone Orthopedic Hospital, New York, NY.; New York Spine Institute, New York, NY., Owusu-Sarpong S; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY., Lebovic JA; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY., Janjua MB; Department of Neurotrauma, Neuro-oncology, and Spine, Mercy Health, Chicago, IL., de la Garza-Ramos R; Department of Neurological Surgery, Montefiore Medical Center/Albert Einstein College of Medicine, Bronx, NY., Vira S; Department of Orthopaedic Surgery, UT Southwestern Medical Center, Dallas, TX., Diebo B; Department of Orthopedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY., Koller H; International Center for Spinal Disorders and Deformity, Orthopedic Department II, Asklepios Clinics Bad Abbach, Bad Tölz, Germany., Protopsaltis TS; Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY., Lafage R; Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY., Lafage V; Department of Orthopaedic Surgery, Lenox Hill Hospital, New York, NY. |
| المصدر: | Spine [Spine (Phila Pa 1976)] 2024 Jan 15; Vol. 49 (2), pp. 116-127. Date of Electronic Publication: 2023 Oct 05. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 7610646 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1159 (Electronic) Linking ISSN: 03622436 NLM ISO Abbreviation: Spine (Phila Pa 1976) Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: Hagerstown, MD : Lippincott Williams & Wilkins Original Publication: Hagerstown, Md., Medical Dept., Harper & Row. |
| مواضيع طبية MeSH: | Lordosis*/diagnostic imaging , Lordosis*/surgery , Kyphosis*/surgery, Adult ; Humans ; Retrospective Studies ; Neck ; Cervical Vertebrae/diagnostic imaging ; Cervical Vertebrae/surgery |
| مستخلص: | Study Design/setting: Retrospective single-center study. Background: The global alignment and proportion score is widely used in adult spinal deformity surgery. However, it is not specific to the parameters used in adult cervical deformity (ACD). Purpose: Create a cervicothoracic alignment and proportion (CAP) score in patients with operative ACD. Methods: Patients with ACD with 2-year data were included. Parameters consisted of relative McGregor's Slope [RMGS = (MGS × 1.5)/0.9], relative cervical lordosis [RCL = CL - thoracic kyphosis (TK)], Cervical Lordosis Distribution Index (CLDI = C2 - Apex × 100/C2 - T2), relative pelvic version (RPV = sacral slope - pelvic incidence × 0.59 + 9), and a frailty factor (greater than 0.33). Cutoff points were chosen where the cross-tabulation of parameter subgroups reached a maximal rate of meeting the Optimal Outcome. The optimal outcome was defined as meeting Good Clinical Outcome criteria without the occurrence of distal junctional failure (DJF) or reoperation. CAP was scored between 0 and 13 and categorized accordingly: ≤3 (proportioned), 4-6 (moderately disproportioned), >6 (severely disproportioned). Multivariable logistic regression analysis determined the relationship between CAP categories, overall score, and development of distal junctional kyphosis (DJK), DJF, reoperation, and Optimal Outcome by 2 years. Results: One hundred five patients with operative ACD were included. Assessment of the 3-month CAP score found a mean of 5.2/13 possible points. 22.7% of patients were proportioned, 49.5% moderately disproportioned, and 27.8% severely disproportioned. DJK occurred in 34.5% and DJF in 8.7%, 20.0% underwent reoperation, and 55.7% achieved Optimal Outcome. Patients severely disproportioned in CAP had higher odds of DJK [OR: 6.0 (2.1-17.7); P =0.001], DJF [OR: 9.7 (1.8-51.8); P =0.008], reoperation [OR: 3.3 (1.9-10.6); P =0.011], and lower odds of meeting the optimal outcome [OR: 0.3 (0.1-0.7); P =0.007] by 2 years, while proportioned patients suffered zero occurrences of DJK or DJF. Conclusion: The regional alignment and proportion score is a method of analyzing the cervical spine relative to global alignment and demonstrates the importance of maintaining horizontal gaze, while also matching overall cervical and thoracolumbar alignment to limit complications and maximize clinical improvement. Competing Interests: P.G.P.: Allosource: other financial or material support; Cervical Scoliosis Research Society: research support; Globus Medical: paid presenter or speaker; Medicrea: paid consultant; Royal Biologics: paid consultant; SpineWave: paid consultant; Terumo: paid consultant; Zimmer: paid presenter or speaker. R.L.: Nemaris: stock or stock options. V.L.: DePuy, A Johnson & Johnson Company: paid presenter or speaker; European Spine Journal : editorial or governing board; Globus Medical: paid consultant; International Spine Study Group: board or committee member; Nuvasive: IP royalties; Scoliosis Research Society: Board or committee member; The Permanente Medical Group: paid presenter or speaker. The remaining authors report no conflicts of interest. (Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.) |
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| تواريخ الأحداث: | Date Created: 20231005 Date Completed: 20231218 Latest Revision: 20231218 |
| رمز التحديث: | 20231218 |
| DOI: | 10.1097/BRS.0000000000004843 |
| PMID: | 37796161 |
| قاعدة البيانات: | MEDLINE |
Full Text Finder | تدمد: | 1528-1159 |
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| DOI: | 10.1097/BRS.0000000000004843 |