PT  - JOURNAL ARTICLE
AU  - Passias, Peter G.
AU  - Pierce, Katherine E.
AU  - Horn, Samantha R.
AU  - Segar, Anand
AU  - Passfall, Lara
AU  - Kummer, Nicholas
AU  - Krol, Oscar
AU  - Bortz, Cole
AU  - Brown, Avery E.
AU  - Alas, Haddy
AU  - Segreto, Frank A.
AU  - Ahmad, Waleed
AU  - Naessig, Sara
AU  - Buckland, Aaron J.
AU  - Protopsaltis, Themistocles S.
AU  - Gerling, Michael
AU  - Lafage, Renaud
AU  - Schwab, Frank J.
AU  - Lafage, Virginie
TI  - Cervical Deformity Correction Fails to Achieve Age-Adjusted Spinopelvic Alignment Targets
AID  - 10.14444/8260
DP  - 2022 Jun 01
TA  - International Journal of Spine Surgery
PG  - 450--457
VI  - 16
IP  - 3
4099  - https://www.ijssurgery.com/content/16/3/450.short
4100  - https://www.ijssurgery.com/content/16/3/450.full
SO  - Int J Spine Surg2022 Jun 01; 16
AB  - Objective To assess whether surgical cervical deformity (CD) patients meet spinopelvic age-adjusted alignment targets, reciprocal, and lower limb compensation changes.Study Design Retrospective review.Methods CD was defined as C2-C7 lordosis >10°, cervical sagittal vertical angle (cSVA) >4 cm, or T1 slope minus cervical lordosis (TS-CL) >20°. Inclusion criteria were age >18 years and undergoing surgical correction with complete baseline and postoperative imaging. Published formulas were used to create age-adjusted alignment target for pelvic tilt (PT), pelvic incidence and lumbar lordosis (PI-LL), sagittal vertical angle (SVA), and lumbar lordosis and thoracic kyphosis (LL-TK). Actual alignment was compared with age-adjusted ideal values. Patients who matched ±10-year thresholds for age-adjusted targets were compared with unmatched cases (under- or overcorrected).Results A total of 120 CD patients were included (mean age, 55.1 years; 48.4% women; body mass index, 28.8 kg/m2). For PT, only 24.4% of patients matched age-adjusted alignment, 51.1% overcorrected for PT, and 24.4% undercorrected. For PI-LL, only 27.6% of CD patients matched age-adjusted targets, with 49.4% overcorrected and 23% undercorrected postoperatively. Forty percent of patients matched age-adjusted target for SVA, 41.3% overcorrected, and 18.8% undercorrected. CD patients who had worsened in TS-CL or cSVA postoperatively displayed increased TK (−41.1° to −45.3°, P = 1.06). With lower extremity compensation, CD patients decreased in ankle flexion angle postoperatively (6.1°–5.5°, P = 0.036) and trended toward smaller sacrofemoral angle (199.6–195.6 mm, P = 0.286) and knee flexion (2.6° to −1.1°, P = 0.269).Conclusions In response to worsening CD postoperatively, patients increased in TK and recruited less lower limb compensation. Almost 75% of CD patients did not meet previously established spinopelvic alignment goals, of whom a subset of patients were actually made worse off in these parameters following surgery. This finding raises the question of whether we should be looking at the entire spine when treating CD.Level of Evidence 3.