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. 2025 Sep 26.
doi: 10.1097/BRS.0000000000005521. Online ahead of print.

Does Coronal Plane Deformity Matter in Cervicothoracic Kyphosis Corrective Surgery? The Prevalence of Cervical Scoliosis and Influence on the Outcomes of Cervical Deformity Surgery

Wesley M Durand, Andrew Kim  1 , Shay Bess  2 , Douglas Burton  3 , Jeffrey L Gum  4 , Munish C Gupta  5 , Richard Hostin  6 , Khaled M Kebaish  1 , Michael P Kelly  7 , Han Jo Kim  8 , Eric Klineberg  9 , Virginie Lafage  10 , Gregory Mundis  11 , Paul Park  12 , Peter G Passias  13 , Themistocles S Protopsaltis  13 , Daniel Riew  14 , Frank Schwab  10 , Christopher I Shaffrey  15 , Justin S Smith  16 , Christopher P Ames  17 , Sang Hun Lee  1 ; International Spine Study Group
Affiliations

Does Coronal Plane Deformity Matter in Cervicothoracic Kyphosis Corrective Surgery? The Prevalence of Cervical Scoliosis and Influence on the Outcomes of Cervical Deformity Surgery

Wesley M Durand et al. Spine (Phila Pa 1976). .

Abstract

Study design: Retrospective review of a prospective, multicenter adult cervical deformity (CD) database.

Objective: Investigate the prevalence and clinical significance of combined cervical scoliosis (CS) and cervical kyphosis (CK) among patients undergoing surgical management of CD.

Summary of background data: Although adult CD patients may have both CS and CK, few studies have confirmed prevalence of CK and CS and associated radiographic and clinical findings.

Methods: Patients undergoing surgery for CD (defined as C2-C7 ≥10° kyphosis, cervical sagittal vertical axis (SVA) >4 cm, or C2-C7 coronal Cobb angle ≥10°) were included. CS was defined as C2-C7 coronal Cobb angle ≥10°.

Results: 114 patients were included (mean age 62.5 y, 51.8% female). 14 patients (12.3%) had combined CS and CK, and 100 patients (87.7%) had CK alone. Pre-operative maximum cervical coronal Cobb angle was 3.9° in the CK alone group and 14.6° in the combined CS and CK group. In the combined CS and CK group, this value improved to 8.1° post-operatively (P=0.0007 vs. pre-operative), but CS ≥10° was still present in 3 patients, with a mean correction percentage of only 48.0% of initial CS.No significant differences were observed between the CK only and combined CS and CK groups with regard to baseline sagittal parameters, change between immediate post-operative and baseline sagittal parameters, surgical approach, age, or baseline HRQOL. Patients with combined CS and CK were more frequently female than patients with CK alone (85.7% vs. 41.2%, P=0.0066).

Conclusions: The vast majority of patients presented with CK alone (88%), and only 12% of adult CD patients had combined CS and CK. Because of the significant residual coronal plane deformity-approximately 50%-surgical correction should be focused on both coronal and sagittal plane deformity in the combined CS and CK group.

Keywords: Cervical corrective surgery; Cervical deformity; Cervical kyphosis; Cervical scoliosis; Cervicothoracic kyphosis; Outcomes.

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Conflict of interest statement

The authors report no conflicts of interest.