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BACKGROUND: Studies have utilized psychological questionnaires to identify the psychological distress among certain surgical populations. RESEARCH QUESTION: Is there an additional psychological burden among patients undergoing surgical treatment for their symptomatic degenerative cervical disease? MATERIALS AND METHODS: Patients>18 years of age with symptomatic, degenerative cervical spine disease were included and prospectively enrolled. Correlations and multivariable logistic regression analysis assessed the relationship between these mental health components (PCS, FABQ) and the severity of disability described by the NDI, EQ-5D, and mJOA score. Patient distress scores were compared to previously published benchmarks for other diagnoses. RESULTS: 47 patients were enrolled (age: 56.0 years,BMI: 29.7kg/m2). Increasing neck disability and decreasing EQ-5D were correlated with greater PCS and FABQ(all P<0.001). Patients with severe psychological distress at baseline were more likely to report severe neck disability, while physician-reported mJOA had weaker associations. Compared to historical controls of lumbar patients, patients in our study had greater levels of psychological distress, as measured by FABQ (40.0 vs. 17.6; P<0.001) and PCS (27.4 vs. 19.3;P<0.001). DISCUSSION AND CONCLUSION: Degenerative cervical spine patients seeking surgery were found to have a significant level of psychological distress, with a large portion reporting severe fear avoidance beliefs and catastrophizing pain at baseline. Strong correlation was seen between patient-reported functional metrics, but less so with physician-reported signs and symptoms. Additionally, this population demonstrated higher psychological burden in certain respects than previously identified benchmarks of patients with other disorders. Preoperative treatment to help mitigate this distress, impact postoperative outcomes, and should be further investigated. LEVEL OF EVIDENCE: Level III.
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Vértebras Cervicales , Cuello , Humanos , Persona de Mediana Edad , Vértebras Cervicales/cirugía , Salud Mental , Dolor , Costo de Enfermedad , Evaluación de la Discapacidad , Resultado del TratamientoRESUMEN
BACKGROUND: Several studies have emphasized that the magnetically controlled growing rod (MCGR) technique decreases complications and costs and could be considered a safe procedure for treating patients with early onset scoliosis (EOS). To the best of our knowledge, the sagittal profile of patients with an implanted MCGR has not been sufficiently studied before. OBJECTIVE: The objectives of this study were twofold: firstly, to evaluate the influence of MCGR on the coronal, sagittal and axial planes. Secondly, to analyze changes of cervical alignment post-MCGR implantation. MATERIAL AND METHODS: This was a retrospective study of patients with EOS who underwent MCGR from 2012 to 2018. Patients were included if they presented with a thoracic or lumbar curvature greater than 40° (Cobb angle) and Risser's sign 0. Global analysis of all patients was reported. Patients were stratified preoperatively by thoracic alignment into a hypokyphotic or kyphotic group. Furthermore, the study population was divided into an anteriorly aligned group and a posteriorly aligned group. Sagittal alignment parameters and parameters of coronal and axial plane were measured and the preoperative to postoperative change was compared then analyzed 1 year after surgery. No external funding was procured for this research and the authors' conflicts of interest are not pertinent to the present work. RESULTS: A total of 21 patients were included in the study. There was a significant coronal correction of the structural and compensatory curves (pâ¯< 0.01). Before and after surgery, the coronal C7 plumbline was unchanged and remained within the normal range. Postoperatively, a significant derotation of the apical vertebra in thoracic and lumbar curves was observed (pâ¯< 0.05). Global analysis of the sagittal profile revealed a significant decrease of TK (pâ¯< 0.001) and T9SPi (pâ¯= 0.002) with a simultaneous significant increase of T1T3 angle (pâ¯= 0.015) and T1T4 angle (pâ¯= 0.015). No significant changes of the sagittal parameters of cervical, lumbar and spinopelvic parameters were noted. Among all groups, cervical parameters did not reveal any statistically significant changes. At 1year follow up the T1T3 angle (pâ¯= 0.01) and T1T4 angle (pâ¯= 0.03) were significantly increased. All other measured parameters of sagittal, coronal and axial profile were unchanged. CONCLUSION: The implantation of MCGR had a significant impact on the sagittal profile. Notwithstanding, no further compensatory mechanisms of the cervical spine and pelvis had to be recruited to safeguard sagittal alignment.
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Cifosis , Escoliosis , Fusión Vertebral , Estudios de Seguimiento , Fijación de Fractura , Humanos , Estudios Retrospectivos , Escoliosis/diagnóstico por imagen , Escoliosis/cirugía , Columna Vertebral/diagnóstico por imagen , Columna Vertebral/cirugía , Vértebras TorácicasRESUMEN
BACKGROUND: Several studies have emphasized the importance of restoring thoracic kyphosis (TK) in the setting of AIS, but very few have discussed changes in cervical spine alignment following surgery. Aim of this study was to evaluate reciprocal cervical alignment change after modification of global and regional thoracolumbar alignment with surgery in the setting of adolescent idiopathic scoliosis (AIS). METHODS: Baseline and 2-yrs follow-up radiographs of AIS patients (n = 81) were analysed measuring cervical parameters (upper cervical: C2-C0, McGregor Slope; lower cervical: C2-C7, C2-C7 sagittal vertical axis (SVA), C2-T3, C2-T3SVA, C2-T1Harrison (C2-T1Ha), T1 Slope (T1S)), thoracic, lumbar, pelvic and global alignment parameters. Post-operatively, patients were grouped twice; based on changes in TK and SVA. Cervical alignment was compared between groups. Pearson correlation was conducted to examine the relationship between changes in TK, SVA, and cervical alignment. RESULTS: Stratification by change in TK, revealed significant alteration of lower cervical alignment T1S [p < 0.001]), C2-T3 [p = 0.019], C2-T1Ha [p = 0.043]), but there was no reciprocal change in the upper cervical spine. Stratification by SVA revealed a significant coexisting change in the lower cervical spine (T1S [p < 0.001], C2-C7SVA [p = 0.034], C2-T3 [p = 0.023], C2-T3SVA [p = 0.001]). SVA change was not associated to a change in the upper cervical spine. The correlation analysis showed that with a post-operative increase in TK, the cervical spine became more lordotic. Changes in TK were significantly correlated with: ΔT1S, ΔC2-C7, ΔC2-T3, and ΔC2-T3SVA. Similarly, increased cervical kyphosis was found when SVA was decreased post-operatively. Furthermore, there was a significant correlation between change of SVA and both ΔC2-T3 and ΔC2-T3SVA. CONCLUSIONS: In surgically treated AIS patients, changes in global and regional alignment of the thoracolumbar and cervical spinal segments exhibit interdependence. Thus, surgical planning with regard to sagittal deformity in AIS patients should account for the post-operative impact on cervical alignment.
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Cifosis/cirugía , Lordosis/cirugía , Escoliosis/cirugía , Adolescente , Vértebras Cervicales/cirugía , Femenino , Estudios de Seguimiento , Humanos , Vértebras Lumbares/cirugía , Masculino , Periodo Posoperatorio , Radiografía , Estudios Retrospectivos , Vértebras Torácicas/cirugíaRESUMEN
BACKGROUND: The cervical spine is very complex, and it allows the largest range of motion relative to the rest of the spine. The fundamental function of the cervical spine is to maintain the head balanced over the trunk and to maintain horizontal gaze. The cervical spine must be both stable and flexible to guarantee function. Changes of the sagittal profile of the cervical spine may affect function and quality of life. The relationship between full body alignment and maintaining gaze necessitates a thorough understanding of the cranio-spino-pelvic alignment as a component of balance. QUESTION: Now the question is, what kind of sagittal profile does the cervical spine need for proper function? In the literature, normal sagittal alignment of the cervical spine is controversial. In general, there is the assumption that the alignment is lordotic. Does the data in the literature support this? RESULTS: The present literature review supports the following facts: Ideal cervical spine alignment is mostly lordotic, but not always; ideal cervical spine alignment can be lordotic, neutral or kyphotic; ideal cervical spine alignment is driven by the necessity of supporting the head and maintaining horizontal gaze; the cervical spine is in harmony with regional alignment (thoracic kyphosis) and sagittal global alignment (SVA): TK (↑)â¯â T1 Slope (↑)â¯â CL (↑), TK (↓)â¯â T1 Slope (↓)â¯â CL (↓), SVA >50â¯mm: the cervical curve should be lordotic to maintain horizontal gaze, SVA <0â¯mm: the cervical curve should be kyphotic to maintain horizontal gaze.
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Cifosis , Lordosis , Humanos , Calidad de Vida , Radiografía , Columna VertebralRESUMEN
Although surgical techniques pertaining to adult spinal deformity (ASD) have advanced over the last decade, proximal junctional kyphosis (PJK) is still a complication following surgery for ASD that continues to significantly challenge clinicians. This article aimed to report on the prevalence of PJK as well as enhance understanding of surgically modifiable and non-modifiable risk factors of PJK to guide management of this postoperative complication of ASD. As the understanding of the pathogenesis as well as surgical modifications aimed at reducing the incidence of PJK have advanced, so too should clinicians' ability to implement more patient-specific operative plans and improve outcomes following realignment surgery for ASD.
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Cifosis , Fusión Vertebral , Adulto , Anciano , Humanos , Cifosis/epidemiología , Cifosis/cirugía , Prevalencia , Estudios Retrospectivos , Factores de Riesgo , Resultado del TratamientoRESUMEN
INTRODUCTION: In degenerative adult spinal deformity (ASD), sagittal malalignment and rotatory subluxation (RS) correlate with clinical symptomatology. RS is defined as axial rotation with lateral listhesis. Stereoradiography, recently developed for medical applications, provides full-body standing radiographs and 3D reconstruction of the spine, with low radiation dose. HYPOTHESIS: 3D stereoradiography improves analysis of RS and of its relations with transverse plane and spinopelvic parameters and clinical impact. MATERIAL AND METHODS: One hundred and thirty adults with lumbar ASD and full-spine EOS® radiographs (EOS Imaging, Paris, France) were included. Spinopelvic sagittal parameters and lateral listhesis in the coronal plane were measured. The transverse plane study parameters were: apical axial vertebral rotation (apex AVR), axial intervertebral rotation (AIR) and torsion index (TI). Two groups were compared: with RS (lateral listhesis>5mm) and without RS (without lateral listhesis exceeding 5mm: non-RS). Correlations between radiologic and clinical data were assessed. RESULTS: RS patients were significantly older, with larger Cobb angle (37.4° vs. 26.6°, P=0.0001), more severe sagittal deformity, and greater apex AVR and TI (respectively: 22.9° vs. 11.3°, P<0.001; and 41.0° vs. 19.9°, P<0.001). Ten percent of patients had AIR>10° without visible RS on 2D radiographs. RS patients reported significantly more frequent low back pain and radiculalgia. DISCUSSION: In this EOS® study, ASD patients with RS had greater coronal curvature and sagittal and transverse deformity, as well as greater pain. Further transverse plane analysis could allow earlier diagnosis and prognosis to guide management. LEVEL OF EVIDENCE: 4, retrospective study.