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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...
Autores principales: | , , , , , , , , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
MDPI
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584313/ https://www.ncbi.nlm.nih.gov/pubmed/34768346 http://dx.doi.org/10.3390/jcm10214826 |
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author | Kim, Han Jo Virk, Sohrab Elysee, Jonathan Ames, Christopher Passias, Peter Shaffrey, Christopher Mundis, Gregory Protopsaltis, Themistocles Gupta, Munish Klineberg, Eric Hart, Robert Smith, Justin S. Bess, Shay Schwab, Frank Lafage, Renaud Lafage, Virginie |
author_facet | Kim, Han Jo Virk, Sohrab Elysee, Jonathan Ames, Christopher Passias, Peter Shaffrey, Christopher Mundis, Gregory Protopsaltis, Themistocles Gupta, Munish Klineberg, Eric Hart, Robert Smith, Justin S. Bess, Shay Schwab, Frank Lafage, Renaud Lafage, Virginie |
author_sort | Kim, Han Jo |
collection | PubMed |
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) (p < 0.01) and longer fusions with the LIV below T7 (p < 0.01). There were no differences in the UIV between all deformity types (p = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (p < 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 | Online Article Text |
id | pubmed-8584313 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
spelling | pubmed-85843132021-11-12 Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity Kim, Han Jo Virk, Sohrab Elysee, Jonathan Ames, Christopher Passias, Peter Shaffrey, Christopher Mundis, Gregory Protopsaltis, Themistocles Gupta, Munish Klineberg, Eric Hart, Robert Smith, Justin S. Bess, Shay Schwab, Frank Lafage, Renaud Lafage, Virginie J Clin Med Article 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) (p < 0.01) and longer fusions with the LIV below T7 (p < 0.01). There were no differences in the UIV between all deformity types (p = 0.19). All four types of deformities had significant improvement in NRS neck pain post-op (p < 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. MDPI 2021-10-21 /pmc/articles/PMC8584313/ /pubmed/34768346 http://dx.doi.org/10.3390/jcm10214826 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/). |
spellingShingle | Article Kim, Han Jo Virk, Sohrab Elysee, Jonathan Ames, Christopher Passias, Peter Shaffrey, Christopher Mundis, Gregory Protopsaltis, Themistocles Gupta, Munish Klineberg, Eric Hart, Robert Smith, Justin S. Bess, Shay Schwab, Frank Lafage, Renaud Lafage, Virginie Surgical Strategy for the Management of Cervical Deformity Is Based on Type of Cervical Deformity |
title | 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_short | 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 |
topic | Article |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8584313/ https://www.ncbi.nlm.nih.gov/pubmed/34768346 http://dx.doi.org/10.3390/jcm10214826 |
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