title: A comparative analysis of the prevalence and characteristics of cervical malalignment in adults presenting with thoracolumbar spine deformity based on variations in treatment approach over 2 years.
abstract: Characteristics specific to cervical deformity (CD) concomitant with adult thoracolumbar deformity (TLD) remains uncertain, particularly regarding treatment. This study identifies cervical malalignment prevalence following surgical and conservative TLD treatment through 2 years.
  
  
  
  Retrospective analysis of a prospective, multicenter adult spinal deformity (ASD) database. CD was defined in operative and non-operative ASD patients according to the following criteria: T1 Slope minus Cervical Lordosis (T1S-CL) ≥20°, C2-C7 Cervical Sagittal Vertical Axis (cSVA) ≥40 mm, C2-C7 kyphosis >10°. Differences in rates, demographics, health-related quality of life (HRQoL) scores for Oswestry Disability Index (ODI) and Scoliosis Research Society Questionnaire (SRS-22r), and radiographic variables were assessed between treatment groups (Op vs. Non-Op) and follow-up periods (baseline, 1-year, 2-year).
  
  
  
  Three hundred and nineteen (200 Op, 199 Non-Op) ASD patients were analyzed. Op patients' CD rates at 1 and 2 years were 78.9, and 63.0 %, respectively. Non-Op CD rates were 21.1 and 37.0 % at 1 and 2 years, respectively. T1S-CL mismatch and cSVA malalignment characterized Op CD at 1 and 2 years (p < 0.05). Op and Non-Op CD groups had similar cervical/global alignment at 1 year (p > 0.05 for all), but at 2 years, Op CD patients had worse thoracic kyphosis (TK), T1S-CL, CL, cSVA, C2-T3 SVA, and global SVA compared to Non-Ops (p < 0.05). Op CD patients had worse ODI, and SRS Activity at 1 and 2 years post-operative (p < 0.05), but had greater 2-year SRS Satisfaction scores (p = 0.019).
  
  
  
  In the first study to compare cervical malalignment at extended follow-up between ASD treatments, CD rates rose overall through 2 years. TLD surgery, resulting in higher CD rates characterized by T1S-CL and cSVA malalignment, produced poorer HRQoL. This information can aid in treatment method decision-making when cervical deformity is present concomitant with TLD.
authors.affiliation: Department of Orthopaedic Surgery, New York Spine Institute, New York University Medical Center-Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA.
authors.forename: Cyrus M
authors.initials: CM
authors.lastname: Jalai
authors.affiliation: Department of Orthopaedic Surgery, New York Spine Institute, New York University Medical Center-Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA. pgpassias@yahoo.com.
authors.forename: Peter G
authors.initials: PG
authors.lastname: Passias
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Renaud
authors.initials: R
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, New York Spine Institute, New York University Medical Center-Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA.
authors.forename: Gregory W
authors.initials: GW
authors.lastname: Poorman
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Bassel
authors.initials: B
authors.lastname: Diebo
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Barthélemy
authors.initials: B
authors.lastname: Liabaud
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University, Baltimore, MD, USA.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Neuman
authors.affiliation: Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, New York Spine Institute, New York University Medical Center-Hospital for Joint Diseases, 301 East 17th Street, New York, NY, 10003, USA.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, CA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007738:Kyphosis / Q000453:epidemiology / Q000601:surgery*; D008141:Lordosis / Q000453:epidemiology / Q000601:surgery*; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009333:Neck; D017060:Patient Satisfaction; D011184:Postoperative Period; D015995:Prevalence; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000453:epidemiology / Q000601:surgery*; D013122:Spinal Diseases / Q000453:epidemiology*; D011795:Surveys and Questionnaires; D013904:Thoracic Vertebrae / Q000601:surgery
keywords: Adult spinal deformity; Cervical deformity; Cervical spine malalignment; Health-related quality of life; Thoracolumbar deformity