Passias Peter G, Pierce Katherine E, Horn Samantha R, Segar Anand, Passfall Lara, Kummer Nicholas, Krol Oscar, Bortz Cole, Brown Avery E, Alas Haddy, Segreto Frank A, Ahmad Waleed, Naessig Sara, Buckland Aaron J, Protopsaltis Themistocles S, Gerling Michael, Lafage Renaud, Schwab Frank J, Lafage Virginie
Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA
Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital; New York Spine Institute, New York, NY, USA.
Int J Spine Surg. 2022 Jun;16(3):450-457. doi: 10.14444/8260.
To assess whether surgical cervical deformity (CD) patients meet spinopelvic age-adjusted alignment targets, reciprocal, and lower limb compensation changes.
Retrospective review.
CD was defined as C2-C7 lordosis >10°, cervical sagittal vertical angle (cSVA) >4 cm, or T1 slope minus cervical lordosis (TS-CL) >20°. Inclusion criteria were age >18 years and undergoing surgical correction with complete baseline and postoperative imaging. Published formulas were used to create age-adjusted alignment target for pelvic tilt (PT), pelvic incidence and lumbar lordosis (PI-LL), sagittal vertical angle (SVA), and lumbar lordosis and thoracic kyphosis (LL-TK). Actual alignment was compared with age-adjusted ideal values. Patients who matched ±10-year thresholds for age-adjusted targets were compared with unmatched cases (under- or overcorrected).
A total of 120 CD patients were included (mean age, 55.1 years; 48.4% women; body mass index, 28.8 kg/m). For PT, only 24.4% of patients matched age-adjusted alignment, 51.1% overcorrected for PT, and 24.4% undercorrected. For PI-LL, only 27.6% of CD patients matched age-adjusted targets, with 49.4% overcorrected and 23% undercorrected postoperatively. Forty percent of patients matched age-adjusted target for SVA, 41.3% overcorrected, and 18.8% undercorrected. CD patients who had worsened in TS-CL or cSVA postoperatively displayed increased TK (-41.1° to -45.3°, = 1.06). With lower extremity compensation, CD patients decreased in ankle flexion angle postoperatively (6.1°-5.5°, = 0.036) and trended toward smaller sacrofemoral angle (199.6-195.6 mm, = 0.286) and knee flexion (2.6° to -1.1°, = 0.269).
In response to worsening CD postoperatively, patients increased in TK and recruited less lower limb compensation. Almost 75% of CD patients did not meet previously established spinopelvic alignment goals, of whom a subset of patients were actually made worse off in these parameters following surgery. This finding raises the question of whether we should be looking at the entire spine when treating CD.
评估颈椎畸形（CD）手术患者是否达到年龄调整后的脊柱骨盆对线目标、相互关系以及下肢代偿变化。
回顾性研究。
CD定义为C2 - C7前凸>10°、颈椎矢状垂直角（cSVA）>4 cm或T1斜率减去颈椎前凸（TS - CL）>20°。纳入标准为年龄>18岁且接受手术矫正并有完整的基线和术后影像学资料。使用已发表的公式创建骨盆倾斜（PT）、骨盆入射角和腰椎前凸（PI - LL）、矢状垂直角（SVA）以及腰椎前凸和胸椎后凸（LL - TK）的年龄调整对线目标。将实际对线与年龄调整后的理想值进行比较。将年龄调整目标匹配±10年阈值的患者与未匹配病例（矫正不足或过度矫正）进行比较。
共纳入120例CD患者（平均年龄55.1岁；48.4%为女性；体重指数28.8 kg/m）。对于PT，仅24.4%的患者匹配年龄调整后的对线，51.1%的患者PT过度矫正，24.4%的患者PT矫正不足。对于PI - LL，术后仅27.6%的CD患者匹配年龄调整目标，49.4%的患者过度矫正，23%的患者矫正不足。40%的患者匹配SVA的年龄调整目标，41.3%的患者过度矫正，18.8%的患者矫正不足。术后TS - CL或cSVA恶化的CD患者显示TK增加（-41.1°至-45.3°，P = 1.06）。随着下肢代偿，CD患者术后踝关节屈曲角度减小（6.1° - 5.5°，P = 0.036），骶股角有变小趋势（199.6 - 195.6 mm，P = 0.286），膝关节屈曲度减小（2.6°至-1.1°，P = 0.269）。
为应对术后CD恶化，患者TK增加且下肢代偿减少。近75%的CD患者未达到先前确立的脊柱骨盆对线目标，其中一部分患者术后这些参数实际上变得更差。这一发现引发了在治疗CD时是否应关注整个脊柱的问题。
