Abstract
ObjectiveIn this study, we evaluated factors affecting changes in cervical lordosis after deformity correction and during follow-up period in adult spinal deformity (ASD) patients with severe sagittal imbalance.MethodsSeventy-nine patients, with an average age of 71.6 years, who underwent long-segment fixation from T10 to S1 with sacropelvic fixation were included. We performed a comparative analysis of the radiographic parameters after surgery (Post) and at the last follow-up (Last). We calculated the Pearson’s correlation coefficient and performed multilinear regression analysis to predict independent parameters for Post and Last cervical lordosis (CL), T1 slope (T1S), and thoracic kyphosis (TK).ResultsHyperlordotic changes of -23.3° in CL before surgery was reduced to -7° after surgery, and Last CL had increased to -15.3°. T1S was reduced from 27° before surgery to 14.4° after surgery and had increased to 18.8° at the last follow-up. Through multilinear regression analysis, we found that Post CL and T1S were more significantly affected by the amount of LL correction (p = .045 and .049). The effect of Last T1S was significantly associated with the Last CL; the effect of Last TK, with the Last T1S; and the effect of Post PI-LL, with the Last TK (p < .05).ConclusionThe postoperative kyphotic change in CL in ASD patients with preoperative cervical hyperlordosis is not permanent and is affected by drastic LL correction and SVA restoration. To achieve spinopelvic harmony proportional to the difference in LL relative to PI, TK becomes modified over time to increase T1S and CL, in an effort to achieve optimal spine curvature.
Highlights
With increasing life expectancies, adult spinal deformity (ASD) is becoming more prevalent and the demand for surgical treatment of disabilities in the elderly with active lifestyles is increasing
T1 slope (T1S) was reduced from 27 ̊ before surgery to 14.4 ̊ after surgery and had increased to 18.8 ̊ at the last follow-up
We found that Post cervical lordosis (CL) and T1S were more significantly affected by the amount of LL correction (p = .045 and .049)
Summary
Adult spinal deformity (ASD) is becoming more prevalent and the demand for surgical treatment of disabilities in the elderly with active lifestyles is increasing. Many studies have already demonstrated the importance of sagittal balance restoration, which involves complex and challenging methods such as long-level constructs and osteotomy in patients with ASD [5,6,7]. The global sagittal alignment results from a complex chain of correlations. When performing long-level fusion, it is important to consider the effects of sagittal alignment and correction of lumbar lordosis on unfused segments. Studies conducted far have focused on proximal junctional kyphosis (PJK), sagittal decompensation, pseudarthrosis and pelvic parameters that change after deformity correction of ASD [10,11,12,13]. There is a lack of consensus among studies regarding changes in the cervical spine
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