Compensatory alignment changes of cervical and thoracic spine after correction of lumbar degenerative scoliosis

doi:10.12307/2025.755

Abstract

Abstract: BACKGROUND: Compensatory changes in sagittal parameters of the cervicothoracic spine after orthopedic surgery in patients with lumbar degenerative scoliosis and their intrinsic relationship, as well as the impact of these changes on quality of life, are still lacking.
OBJECTIVE: To evaluate the compensatory alignment of cervical and thoracic vertebrae after correction of lumbar degenerative scoliosis.
METHODS: 103 patients who underwent surgical correction of lumbar degenerative scoliosis were included in this study. Patients’ demographic characteristics and spinal sagittal parameters were assessed, and prediction equations between changes in cervical sagittal parameters and lumbar deformity correction were attempted. Simultaneously, the SRS-22 scale was used to assess the quality of life of patients and to explore the relationship between the compensatory changes of the cervical and thoracic spine after correction and the patients’ health-related quality of life.
RESULTS AND CONCLUSION: (1) At 3 months and 2 years after surgery, all indicators of the cervical spine and thoracic spine were significantly improved compared with those before surgery (P < 0.05), but there was no significant change at 3 months after surgery compared with 2 years after surgery (P > 0.05). At 3 months and 2 years after surgery, the lumbar spine parameters including lumbar lordosis, C7-S1 sagittal vertical axis, and pelvic incident-lumbar lordosis had significant changes compared with those before surgery (P < 0.05), but the change was not significant at 3 months after surgery compared with 2 years after surgery (P > 0.05). (2) Correlation analysis showed that the lumbar lordosis was highly correlated with the C3-C7 cervical lordosis, C1-C7 cervical lordosis, C2-7 sagittal vertical axis, thoracic inlet angle, and C7-S1 sagittal vertical axis (|r| ≥ 0.5, P < 0.000 1). The lumbar lordosis was correlated with the thoracic kyphosis (r=-0.280). (3) Two prediction formulas were established for compensatory changes in cervical spine: cervical lordosis=0.524×, lumbar lordosis=-6.612, C2-7 sagittal vertical axis=-0.263×, and lumbar lordosis=-5.436 (P < 0.05, R2 > 0.6). (4) When postoperative C2-7 sagittal vertical axis was between 14.4 and 26.8 mm; cervical lordosis was between 9° and 41°, lumbar lordosis was between 42.7° and 68.7°, and sagittal vertical axis was between -40 and 40 mm, patients had better quality of life recovery. (5) It is indicated that significant compensatory changes in the sagittal plane of the cervical spine can be observed after correction of lumbar degenerative scoliosis. We found that each 1° increase in lumbar lordosis was associated with a corresponding increase of about 0.5° in cervical lordosis and a corresponding decrease of about 0.3 mm in the vertical axis of the C2–7 sagittal plane. Patient satisfaction was higher if compensatory changes were closer to normal sagittal plane.

Key words: cervical alignment, degenerative lumbar scoliosis, adaptive change, predictive equation, health-related quality of life, sagittal parameters of spine, orthopedic implants

CLC Number:

Cao Yong, Li Xin, Chen Zhigang, Gu Honglin, Lyu Shujun. Compensatory alignment changes of cervical and thoracic spine after correction of lumbar degenerative scoliosis[J]. Chinese Journal of Tissue Engineering Research, 2025, 29(33): 7196-7202.

Figures/Tables 8

References

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