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Final Program


Final Program

941 - Does Cervicothoracic Flexibility Affect Clinical Outcomes in Patients Undergoing Multi-Level Posterior Cervical Fusions?

Friday, February 28, 2025
5:00 PM - 6:30 PM MST
Objectives: Quantify and compare the imaging measurements between the two imaging modalities and determine if cervicothoracic flexibility had an impact on cervical alignment or clinical outcome.

Design: 227 adult patients with a three or more level posterior cervical fusion were assessed. Data included demographics and radiographic measurements from both XR films and correlate measures from MRI/CT scans, surgical complications, as well as patient reported outcome measures for pain (Visual Analog Scale, VAS) and disability (Oswestry Disability Index, ODI).

Results: Median Δ T1 Slope was 9°, with a range of -1° to 45°. T1 Slope cohorts:  Group I with a Δ of < 4°; Group II ≥4° to < 15°; Group III ≥15°. Significant differences between Group I and Group III existed in VAS and ODI. For Δ C2-C7 Lordosis, the median Δ value was 4°, with a range of -11° to 44°; Group I had a Δ lordosis of < 2°; Group II ≥2 to < 7°; Group III ≥7°. Significant differences between Group I and III existed in VAS and ODI. Median Δ C2-C7 SVA was 14.37mm, with a range of 37.6mm to 110.2mm. SVA Group I had a Δ of < 7.87mm; Group II ≥7.87mm to < 27.82mm; Group III ≥27.82mm. There were significant differences between Group I and Group III in VAS and ODI. Revision and complication rates positively correlated with increased Δ measurement.

Conclusions:

Larger Δ or cervical and upper thoracic flexibility between XR and MRI/CT measurements are positively correlated with higher complication and revision rates. In those patients in whom the delta between the simulated T1 slope from supine studies and the upright T1 slope was higher were found to have much greater post-operative cSVAs and reported significantly higher pain and disability scores compared to those with lower measurement Δ. Age was found to significantly impact Δ SVA measurement.