Changes in Cervical Spinal Alignment After Thoracolumbar Corrective Surgery in Adult Patients With Adolescent Idiopathic Scoliosis

摘要

Study Design. Case-control study. Objective. To examine factors influencing cervical alignment after corrective surgery for adult patients with adolescent idiopathic scoliosis (AdIS) Summary of Background Data. Corrective surgery for spinal deformity influences postoperative cervical spinal alignment, but changes in the cervical alignment in adults with AdIS are scarcely reported. Methods. We retrospectively examined 85 patients with AdIS who underwent posterior corrective surgery for thoracic or lumbar major curve and were followed up for 2 years. Clinical characteristics, radiographic parameters, and health-related quality of life (HRQOL) were evaluated. Cervical deformity (CD) was defined as one of the following cases: (1) T1 tilt minus C2-C7 angle more than 20 degrees, (2) C2-C7 SVA more than 40 mm, (3) and C2-C7 angle less than -10 degrees. Patients were divided into those with and without CD based on the defined criteria; statistically relevant factors were analyzed. Results. There were 19 patients in the postoperative CD group. The average age at the time of surgery was lower in the CD group (26.5vs. 31.4). In the CD group, the average preoperative T1 tilt was smaller (1.1 degrees vs. 12.5 degrees), and the C2-C7 angle was kyphotic (-16.1 degrees vs. 3.0 degrees). The average kyphotic angle at thoracic spine (T5-T12) was lower in the CD group preoperatively (12.5 degrees vs. 19.5 degrees) and postoperatively (15.2 degrees vs. 20.8 degrees). HRQOL outcomes were comparable between the groups. Of the patients with preoperative CD, 51.5% (n = 17) maintained their deformity at the final follow-up, and baseline C2-C7 angle was lower than those who converted to non-CD following surgery (n = 16) (-17.0 degrees vs. -10.3 degrees). Conclusion. More than half of the patients with baseline CD maintained their cervical malalignment postoperatively. Patients with postoperative CD presented cervical kyphotic and thoracic hypokyphotic alignments before surgery. Because CD has the potential to lead to cervical degeneration, careful follow-up observation is necessary for these young patients.