Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity
Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothes...
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2021
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oai:doaj.org-article:fdb08037d4a14223840bd3614eff6aa12021-11-11T17:29:49ZSurgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity10.3390/jcm102148262077-0383https://doaj.org/article/fdb08037d4a14223840bd3614eff6aa12021-10-01T00:00:00Zhttps://www.mdpi.com/2077-0383/10/21/4826https://doaj.org/toc/2077-0383Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based on different morphologies of cervical deformity. Methods: Adult patients enrolled in a prospective cervical deformity database were classified into four deformity types (Flatneck (FN), Focal kyphosis (FK), Cervicothoracic kyphosis (CTK) and Coronal (C)), as previously described. We analyzed group differences in demographics, preoperative symptoms, health-related quality of life scores (HRQOLs), and surgical strategies were evaluated, and postop radiographic and HROQLs at 1+ year follow up were compared. Results: 90/109 eligible patients (mean age 63.3 ± 9.2, 64% female, CCI 1.01 ± 1.36) were evaluated. Group distributions included FN = 33%, FK = 29%, CTK = 29%, and C = 9%. Significant differences were noted in the surgical approaches for the four types of deformities, with FN and FK having a high number of anterior/posterior (APSF) approaches, while CTK and C had more posterior only (PSF) approaches. For FN and FK, PSF was utilized more in cases with prior anterior surgery (70% vs. 25%). For FN group, PSF resulted in inferior neck disability index compared to those receiving APSF suggesting APSF is superior for FN types. CTK types had more three-column osteotomies (3CO) (<i>p</i> < 0.01) and longer fusions with the LIV below T7 (<i>p</i> < 0.01). There were no differences in the UIV between all deformity types (<i>p</i> = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (<i>p</i> < 0.05) with their respective surgical strategies. Conclusions: The four types of cervical deformities had different surgical strategies to achieve improvements in HRQOLs. FN and FK types were more often treated with APSF surgery, while types CTK and C were more likely to undergo PSF. CTK deformities had the highest number of 3COs. This information may provide guidelines for the successful management of cervical deformities.Han Jo KimSohrab VirkJonathan ElyseeChristopher AmesPeter PassiasChristopher ShaffreyGregory MundisThemistocles ProtopsaltisMunish GuptaEric KlinebergRobert HartJustin S. SmithShay BessFrank SchwabRenaud LafageVirginie Lafageon behalf of the International Spine Study GroupMDPI AGarticlecervical deformityadult spinal deformitysurgical techniquesurgical strategycervical osteotomyMedicineRENJournal of Clinical Medicine, Vol 10, Iss 4826, p 4826 (2021) |
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| topic |
cervical deformity adult spinal deformity surgical technique surgical strategy cervical osteotomy Medicine R |
| spellingShingle |
cervical deformity adult spinal deformity surgical technique surgical strategy cervical osteotomy Medicine R Han Jo Kim Sohrab Virk Jonathan Elysee Christopher Ames Peter Passias Christopher Shaffrey Gregory Mundis Themistocles Protopsaltis Munish Gupta Eric Klineberg Robert Hart Justin S. Smith Shay Bess Frank Schwab Renaud Lafage Virginie Lafage on behalf of the International Spine Study Group Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
| description |
Objectives: Cervical deformity morphotypes based on type and location of deformity have previously been described. This study aimed to examine the surgical strategies implemented to treat these deformity types and identify if differences in treatment strategies impact surgical outcomes. Our hypothesis was that surgical strategies will differ based on different morphologies of cervical deformity. Methods: Adult patients enrolled in a prospective cervical deformity database were classified into four deformity types (Flatneck (FN), Focal kyphosis (FK), Cervicothoracic kyphosis (CTK) and Coronal (C)), as previously described. We analyzed group differences in demographics, preoperative symptoms, health-related quality of life scores (HRQOLs), and surgical strategies were evaluated, and postop radiographic and HROQLs at 1+ year follow up were compared. Results: 90/109 eligible patients (mean age 63.3 ± 9.2, 64% female, CCI 1.01 ± 1.36) were evaluated. Group distributions included FN = 33%, FK = 29%, CTK = 29%, and C = 9%. Significant differences were noted in the surgical approaches for the four types of deformities, with FN and FK having a high number of anterior/posterior (APSF) approaches, while CTK and C had more posterior only (PSF) approaches. For FN and FK, PSF was utilized more in cases with prior anterior surgery (70% vs. 25%). For FN group, PSF resulted in inferior neck disability index compared to those receiving APSF suggesting APSF is superior for FN types. CTK types had more three-column osteotomies (3CO) (<i>p</i> < 0.01) and longer fusions with the LIV below T7 (<i>p</i> < 0.01). There were no differences in the UIV between all deformity types (<i>p</i> = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (<i>p</i> < 0.05) with their respective surgical strategies. Conclusions: The four types of cervical deformities had different surgical strategies to achieve improvements in HRQOLs. FN and FK types were more often treated with APSF surgery, while types CTK and C were more likely to undergo PSF. CTK deformities had the highest number of 3COs. This information may provide guidelines for the successful management of cervical deformities. |
| format |
article |
| author |
Han Jo Kim Sohrab Virk Jonathan Elysee Christopher Ames Peter Passias Christopher Shaffrey Gregory Mundis Themistocles Protopsaltis Munish Gupta Eric Klineberg Robert Hart Justin S. Smith Shay Bess Frank Schwab Renaud Lafage Virginie Lafage on behalf of the International Spine Study Group |
| author_facet |
Han Jo Kim Sohrab Virk Jonathan Elysee Christopher Ames Peter Passias Christopher Shaffrey Gregory Mundis Themistocles Protopsaltis Munish Gupta Eric Klineberg Robert Hart Justin S. Smith Shay Bess Frank Schwab Renaud Lafage Virginie Lafage on behalf of the International Spine Study Group |
| author_sort |
Han Jo Kim |
| title |
Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
| title_short |
Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
| title_full |
Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
| title_fullStr |
Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
| title_full_unstemmed |
Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
| title_sort |
surgical strategy for the management of cervical deformity is based on type of cervical deformity |
| publisher |
MDPI AG |
| publishDate |
2021 |
| url |
https://doaj.org/article/fdb08037d4a14223840bd3614eff6aa1 |
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