Assessing the Impact of Thoracolumbar Deformity on Cervical Disability and Pain: How the Back Affects the Neck

Abstract

Introduction Patients with thoracolumbar deformity employ compensatory mechanisms to maintain horizontal gaze, which may result in cervical malalignment. However, the effects of these reciprocal changes on regional cervical disability have not been well-studied in this pt population. The objective of this study is twofold: (1) to report baseline regional neck disability in adult spinal deformity (ASD) and (2) to define the relationship between neck disability and degree of cervical deformity. Patients and Methods This is a single center retrospective analysis of consecutive patients with ASD. Preoperative radiographs were analyzed for cervical, thoracic, lumbar, and spino-pelvic parameters. Preoperative disability was assessed using indices for neck disability (NDI), Oswestry disability (ODI), neck pain (VAS-neck), and back pain (VAS-back). Patients were also grouped into mild sagittal plane deformity (C7 SVA < 5 cm) and severe (> 10 cm). Correlations were made by linear regression, and comparisons between groups were made using student's t test. Results A total of 61 patients were assessed. Mean preoperative disability indices were as follows: NDI = 32, ODI = 49, VAS-neck = 3.2, and VAS-back = 6.9. Significant correlations were found between ODI and NDI ( p < 0.001, R = 0.61), ODI and VAS-back ( p < 0.001, R = 0.68), NDI and VAS-back ( p = 0.004, R = 0.39), and NDI and VAS-neck ( p < 0.001, R = 0.61). There were significant correlations between ODI and C7 sagittal vertical axis (SVA; p = 0.005), pelvic tilt ( p = 0.004), and pelvic incidence/lumbar lordosis mismatch ( p = 0.03). No other significant correlations were found between disability indices and radiographic parameters. No differences were found between patients with mild or severe sagittal deformity in NDI (31.8 vs. 31.5, respectively; p = 0.96) or VAS-neck (3.1 vs. 3.3, respectively; p = 0.80). Conclusion Patients with thoracolumbar deformity have moderate neck disability (NDI) and mild–moderate neck pain (VAS) preoperatively. There is a correlation between neck and low back regional disability, and NDI was highly correlated to back and neck pain. However, neither cervical disability nor severe sagittal deformity appears to correlate with neck disability or pain.