Related Experiment Video
Updated: May 11, 2025
Modified Posterior Vertebral Column Resection for Patients with Thoracolumbar Kyphotic Deformity
Published on: September 16, 2022
When Does the Construct Need to Extend further Into the Thoracic Spine in Patients Undergoing Correction for Cervical
Oluwatobi O Onafowokan1, Nathan Lorentz2, Matthew Galetta2
1Duke Spine Division, Departments of Neurological and Orthopaedic Surgery, Duke School of Medicine, NC.
Study Design:
Retrospective cohort study of prospectively enrolled cervical deformity patients.
Objective:
To investigate patients in whom fusion to the thoracic spine was warranted.
Summary Of Background Data:
Thoracolumbar malalignment is often seen in patients presenting with cervical deformities. For cervical deformity (CD) patients, it is not always clear where in the thoracic spine to end the construct.
Methods:
Patients were stratified into upper and lower thoracic groups: T1-T4 [Short Fusion], beyond T4 [Long Fusion]. Optimal outcome (OO) at 2 years postop was defined as: (1) did not have DJF and (2) had Virk et al good clinical outcome [≥2 of the following: NDI <20 or meeting MCID, mild myelopathy (mJOA ≥14), NRS-Neck ≤5 or improved by ≥2 points from baseline]. Univariate analysis compared variables between short and long fusion groups. Multivariate analysis analyzed associations between groups and factors related to treatment success and failures.
Results:
One hundred forty-four cervical deformity patients were included (60.3±9.0 y, 60% F, 29.4±7.6 kg/m 2 , levels fused: 7.8±3.2). Eighty-two percent of patients had short fusions, whereas 18% had long fusions. 44.4% met the optimal outcome criteria, with no difference by fusion length ( P =0.171). Factors associated with achieving OO in long fusions: baseline sacral slope ≤33.5 degrees (OR: 15.0), not undergoing high-grade osteotomy (OR: 12.3) and being Ames descriptor type C (OR: 13.5); all P <0.05. Factors associated with failure to achieve OO in short fusions: levels fused >6 (OR: 4.3), Ames descriptor type CT (OR: 11.5), Ames cSVA modifier grade 1 or 2 at BL (OR: 4.56), and Flatneck sagittal morphotype (OR: 4.5); all P <0.05.
Conclusion:
The choice of lower instrumented vertebra (LIV) in cervical deformity fusions may be influenced by multiple factors. In patients with global malalignment, severe frailty, flatneck deformity morphotype, and Ames type CT descriptor types, LIVs beyond T4 are associated with treatment success.
Level Of Evidence:
Level III.
More Related Videos
04:19Minimally Invasive Treatment for Thoracolumbar Burst Fracture Using Sagittal Alignment Screws and A Trauma Reduction Device
Published on: November 8, 2024
07:12Laminectomy for the Removal of Thoracic Ossification of the Ligamentum Flavum TOLF Using Ultrasonic and Conventional Osteotomes
Published on: April 21, 2023
Related Concept Videos
01:16Vertebral Column: Regions and Curvature
Regions of the Vertebral Column
In an adult, the spine is subdivided into five regions: the cervical, the thoracic, the lumbar, the sacral, and the coccygeal region. The spine initially develops as a series of 33 vertebrae; after 20 years of age, the nine bones in the sacral region, five sacral, and four coccygeal bones fuse to form...
01:20The Thoracic Cage: Ribs
Parts of a Typical Rib
A typical rib has a head, neck, and body. The posterior end of the rib is called the head, followed by a narrow neck. The head articulates primarily with the costal...
01:30General Structure of a Vertebra
01:09Overview of the Axial Skeleton
The axial skeleton of the...
01:28Articulations of the Vertebral Column
01:26Flail Chest-II
Assessment:
1. Clinical Evaluation:
History: