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. 2019 Jan 15;19(1):7.
doi: 10.1186/s12893-019-0471-2.

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

W Pepke  1 , H Almansour  1 , R Lafage  2 , B G Diebo  3 , B Wiedenhöfer  4 , F Schwab  2 , V Lafage  2 , M Akbar  5
Affiliations

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

W Pepke et al. BMC Surg. .

Abstract

Background: Several 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).

Methods: Baseline 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.

Results: Stratification 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.

Conclusions: In 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.

Keywords: AIS; Adolescent scoliosis; Cervical alignment; Cervical spine; Deformity.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
Flow diagram illustrating the process of inclusion and exclusion of study cohort
Fig. 2
Fig. 2
Lateral radiographs illustrating cervical spine parameters. C2-T1 Ha = C2-T1 Harrison posterior tangent method. PT = pelvic tilt; PI = pelvic incidence; SS = sacral slope; LL = lumbar lordosis; TK = thoracic kyphosis; SVA = sagittal vertical axis; MGS = McGregor slope
Fig. 3
Fig. 3
a Comparison of subgroups: decreased, stable, and increased thoracic kyphosis (TK) with ΔT1 Slope and ΔC2-T3; p = statistical significance, p < 0.05. b Comparison of subgroups: decreased, stable, and increased sagittal vertical axis (SVA) with ΔT1 Slope, ΔC2-T3, ΔC2-C7 SVA and ΔC2-T3 SVA; p = statistical significance, p < 0.05
Fig. 4
Fig. 4
a Diagram with correlation analysis of subgroup: pre-to post-operative change in thoracic kyphosis (TK) with ΔT1 Slope, ΔC2-C7, ΔC2-T3, ΔC2-T3 SVA; p = statistical significance, p < 0.05. b Diagram with correlation analysis of subgroup: pre-to post-operative change in sagittal vertical axis (SVA) with ΔT1 Slope, ΔC2-T3, ΔC2-T3 SVA; p = statistical significance, p < 0.05
See this image and copyright information in PMC

References

    1. Borden AG, Rechtman AM, Gershon-Cohen J. The normal cervical lordosis. Radiology. 1960;74:806–809. doi: 10.1148/74.5.806. - DOI - PubMed
    1. Hardacker JW, Shuford RF, Capicotto PN, Pryor PW. Radiographic standing cervical segmental alignment in adult volunteers without neck symptoms. Spine. 1997;22:1472–1480. doi: 10.1097/00007632-199707010-00009. - DOI - PubMed
    1. Le Huec JC, Demezon H, Aunoble S. Sagittal parameters of global cervical balance using EOS imaging: normative values from a prospective cohort of asymptomatic volunteers. Eur Spine J. 2015;24:63–71. doi: 10.1007/s00586-014-3632-0. - DOI - PubMed
    1. Hey HW, Lau ET, Wong CG, Tan KA, Liu GK, Wong HK. Cervical Alignment Variations in Different Postures and Predictors of Normal Cervical Kyphosis - A New Understanding. Spine. 2017;42(21):1614–21. - PubMed
    1. Yukawa Y, Kato F, Suda K, Yamagata M, Ueta T, Yoshida M. Normative data for parameters of sagittal spinal alignment in healthy subjects: an analysis of gender specific differences and changes with aging in 626 asymptomatic individuals. Eur Spine J. 2018;27(2):426–32. - PubMed