T here is increasing recognition that complex interactions occur between cervical lordosis (CL), thoracic kyphosis, lumbar lordosis (LL), and pelvic rotation. 1 , 2 Being the most mobile segment of the spine, the cervical region can compensate for thoracic or lumbar malalignment to maintain an appropriate center of gravity (COG) and facilitate a horizontal gaze. 3 In patients with thoracolumbar deformity, reciprocal changes in the sagittal alignment of the cervical spine have been described frequently in the literature. 4 – 7 Furthermore, changes in
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Jichao Ye, Sean M. Rider, Renaud Lafage, Sachin Gupta, Ali S. Farooqi, Themistocles S. Protopsaltis, Peter G. Passias, Justin S. Smith, Virginie Lafage, Han-Jo Kim, Eric O. Klineberg, Khaled M. Kebaish, Justin K. Scheer, Gregory M. Mundis Jr., Alex Soroceanu, Shay Bess, Christopher P. Ames, Christopher I. Shaffrey, Munish C. Gupta, and
Andrei F. Joaquim and K. Daniel Riew
P osterior cervical approaches for the treatment of intradural spinal lesions, such as intramedullary or extramedullary tumors, require posterior decompressive techniques. Cervical spine deformity secondary to sagittal and/or coronal imbalance after a laminectomy may result in important cervical pain and functional deterioration, along with neurological deficits in the most severe cases. 2 , 10 , 21 In general, the majority of deformities secondary to cervical laminectomy occur in the sagittal plane, resulting in cervical kyphosis. 9 , 14 Many risk
Harel Deutsch, Regis W. Haid, Gerald E. Rodts, and Praveen V. Mummaneni
Postlaminectomy cervical kyphosis is an important consideration when performing surgery. Identifying factors predisposing to postoperative deformity is essential. The goal is to prevent postlaminectomy cervical kyphosis while exposing the patient to minimal additional morbidity. When postlaminectomy kyphosis does occur, surgical correction is often required and performed via an anterior, posterior, or combined approach. The authors discuss the indications for surgical approaches as well as clinical results.
Thoracolumbar spinal deformity: Part I. A historical passage to 1990
Historical vignette
Adam S. Kanter, David S. Bradford, David O. Okonkwo, Setti S. Rengachary, and Praveen V. Mummaneni
A nthropological and historical evidence of human spinal deformity and its treatment dates back at least 7 millennia. Skeletal remains and archeological artifacts of prehistoric man exhibit graphic depictions of spinal anomalies and pathological curvature. Ancient works dating back to before 3500 BC summon images of individuals with disfigured spinal columns who wore the burden of ridicule and odium in modern-day tales of religion and myth. 18 It was Hippocrates, in the 5th century BC, who described scoliosis for the first time with scientific prudence. 1
Matthew J. McGirt, Shlomi Constantini, and George I. Jallo
I ntramedullary spinal cord tumors are rare neoplasms that account for 6–8% of all central nervous system tumors but represent 20% of adult and 35% of pediatric spinal tumors. 2 , 4 Current treatment is aimed at radical or subtotal removal with adjuvant radiotherapy and/or chemotherapy, guided by histological results and tumor grade. 5 , 6 , 8 , 10 , 13–15 , 24 However, postoperative progressive spinal deformity, occurring in 16–100% of cases, often complicates functional outcome years after surgery. 7 , 12 , 21 , 22 , 28 It remains unclear which
Thoracolumbar spinal deformity: Part II. Developments from 1990 to today
Historical vignette
Fred C. Lam, Adam S. Kanter, David O. Okonkwo, James W. Ogilvie, and Praveen V. Mummaneni
I n the first part of this 2-part historical review, we outlined the early diagnostic and therapeutic strategies used in the management of spinal deformity. This review expands upon those early innovations and further details the advances from 1990 to the modern era. We begin with a review of the contemporary classification systems for spinal deformity. We will then discuss the surgical techniques and technologies that have become available over the last 2 decades for the correction and maintenance of spinal deformity. These major advances have been
Sarah F. Eby, Tricia St. Hilaire, Michael Glotzbecker, John Smith, Klane K. White, A. Noelle Larson, and the Children’s Spine Study Group
fusion surgery. For young children, fusion caused a very short thorax, resulting in thoracic insufficiency syndrome and severe pulmonary disease. Growing rods were developed to allow for ongoing thoracic growth with regular lengthening of the spine, either through surgical lengthening procedures every 6 months or using a magnetically controlled growing rod device in the clinic. The vertical expandable prosthetic titanium rib (VEPTR, DePuy Synthes) was designed to treat children with rib deformity. The semiconstrained device attaches to the ribs proximally and to the
Bong Ju Moon, Justin S. Smith, Christopher P. Ames, Christopher I. Shaffrey, Virginie Lafage, Frank Schwab, Morio Matsumoto, Jong Sam Baik, and Yoon Ha
P arkinson 's disease (PD) is a degenerative neurological condition characterized by tremor, rigidity, bradykinesia, and loss of postural reflexes. In addition, a postural deformity is often present in patients with PD. A retrospective observational study has suggested that up to one-third of patients with PD exhibit a postural deformity. 2 The overall prevalence of spinal deformities in PD has been reported to be higher than that of age-matched adults without PD. 20 Patients with PD may also have concomitant neuromuscular and degenerative diseases that
Samuel D. Pettersson, Paulina Skrzypkowska, Shan Ali, Tomasz Szmuda, Michał Krakowiak, Tadej Počivavšek, Fanny Sunesson, Justyna Fercho, and Grzegorz Miękisiak
P osterior cervical decompression surgery is a commonly used approach for the surgical treatment of cervical spondylotic myelopathy (CSM) and ossification of the posterior longitudinal ligament (OPLL). The procedure consists of either laminectomy or laminoplasty, which are both effective in relieving the compressed spinal cord. Despite their effectiveness in the short term, cervical kyphotic deformity (KD) is a common complication typically observed after 1 year of follow-up. 1 – 13 KD impairs the posterior drift of the spinal cord during forward flexion
Khoi D. Than, Paul Park, Kai-Ming Fu, Stacie Nguyen, Michael Y. Wang, Dean Chou, Pierce D. Nunley, Neel Anand, Richard G. Fessler, Christopher I. Shaffrey, Shay Bess, Behrooz A. Akbarnia, Vedat Deviren, Juan S. Uribe, Frank La Marca, Adam S. Kanter, David O. Okonkwo, Gregory M. Mundis Jr., Praveen V. Mummaneni, and the International Spine Study Group
M invasive surgery (MIS) techniques are increasingly used in spine surgery, including in the treatment of adult spinal deformity (ASD). Such techniques include minimally invasive transpsoas retroperitoneal approaches for lateral lumbar interbody fusion (LLIF) and minimally invasive transforaminal lumbar interbody fusion (MI-TLIF). Previous work has suggested that minimally invasive spinal deformity correction is associated with fewer intraoperative complications than open or hybrid techniques 9 with comparable clinical outcomes. 2 However, with the
