High Preoperative T1 Slope is a Marker for Global Sagittal Malalignment.

IF 1.6 4区医学 Q3 CLINICAL NEUROLOGY Clinical Spine Surgery Pub Date : 2025-01-06 DOI:10.1097/BSD.0000000000001734

Fares Ani, Ethan W Ayres, Diann Woo, Dennis Vasquez-Montes, Avery Brown, Haddy Alas, Edem J Abotsi, Cole Bortz, Katherine E Pierce, Tina Raman, Micheal L Smith, Yong H Kim, Aaron J Buckland, Themistocles S Protopsaltis

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Abstract

Study design: Retrospective cohort study.

Objective: To develop parameter thresholds obtainable from cervical radiographs that correlate with concomitant thoracolumbar malalignment.

Summary of background data: T1 slope (T1S) is typically discussed in the context of cervical deformity and correlated with health-related quality of life outcomes. Prior research suggests that T1S is related to global alignment; however, a definition for "high" T1S has not been established. Most patients undergoing cervical surgery do not undergo full-spine imaging; therefore, obtaining a parameter associated with thoracolumbar malalignment from cervical radiographs would be beneficial.

Methods: A database of preoperative adult spinal deformity (ASD) patients was analyzed. Measures obtained from standing lateral radiographs included T1S, thoracic kyphosis (TK), sagittal vertical axis (SVA), T1-pelvic angle (TPA), pelvic tilt (PT), and pelvic incidence minus lumbar lordosis (PI-LL). Decision tree analysis was then used to determine the T1S corresponding to published thresholds for high TK (40 degrees), SVA (40 mm), TPA (25 degrees), and PT (25 degrees). Alignment between high and normal T1S patients was compared.

Results: Two hundred twenty-six preoperative patients were included (mean: 58±16 y 62%F). Larger T1S was correlated with greater SVA (r=0.365), TPA (r=0.302), TK (r=0.606), and PT (r=0.230) (all P<0.001). Decision tree analysis yielded a threshold of 30 degrees for high T1S, which 50% of patients had. Compared with patients with T1S <30 degrees, those with T1S >30 degrees had higher TK (41.5 vs. 25.8 degrees), SVA (78.7 vs. 33.7 mm), TPA (27.6 vs. 18.3 degrees), and PT (26.3 vs. 20.8 degrees), and PI-LL (18.2 vs. 11.7 degrees) (all P<0.05). Seventy-nine percent of patients with high T1S had high TK (T1S <30=13%), 69% had high SVA (T1S <30=38%), 66% had high TPA (T1S <30=37%), 60% had PT >25 degrees (T1S <30=42%), and 47% had PI-LL >20 degrees (T1S <30=34%) (all P<0.05).

Conclusion: Higher T1S was associated with worse global alignment. T1S was most strongly associated with TK. A T1S=30 degrees corresponded to high TK, SVA, TPA, and PT thresholds. Therefore, surgeons should consider obtaining full-spine radiographs if a T1S >30 degrees is present on cervical imaging.

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术前T1斜率高是全局矢状面排列失调的标志。

研究设计：回顾性队列研究。目的：开发可从颈椎x线片获得的参数阈值，这些参数阈值与伴随的胸腰椎错位有关。背景资料总结：T1斜率（T1S）通常在颈椎畸形的背景下讨论，并与健康相关的生活质量结果相关。先前的研究表明，T1S与全球对准有关；然而，“高”T1S的定义尚未确立。大多数接受颈椎手术的患者不接受全脊柱成像；因此，从颈椎x线片上获得与胸腰椎错位相关的参数将是有益的。方法：对术前成人脊柱畸形（ASD）患者数据库进行分析。站立侧位x线片测量包括T1S、胸椎后凸（TK）、矢状垂直轴（SVA）、t1 -骨盆角（TPA）、骨盆倾斜（PT）和骨盆发生率减去腰椎前凸（PI-LL）。然后使用决策树分析来确定T1S对应于公布的高TK（40度）、SVA（40毫米）、TPA（25度）和PT（25度）阈值。比较高T1S患者与正常T1S患者的对齐情况。结果：术前纳入226例患者（平均：58±16 y 62%F）。较大的T1S与较大的SVA （r=0.365）、TPA （r=0.302）、TK （r=0.606）和PT （r=0.230）相关(所有P30度患者的TK（41.5比25.8度）、SVA（78.7比33.7 mm）、TPA（27.6比18.3度）、PT（26.3比20.8度）和PI-LL（18.2比11.7度）相关（所有P25度患者的T1S为20度（T1S））。T1S与TK的相关性最强。T1S=30度对应高TK、SVA、TPA和PT阈值。因此，如果颈椎显像显示T1S bb0 - 30度，外科医生应考虑获得全脊柱x线片。

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来源期刊

Clinical Spine Surgery Medicine-Surgery

CiteScore

3.00

自引率

5.30%

发文量

236

期刊介绍： Clinical Spine Surgery is the ideal journal for the busy practicing spine surgeon or trainee, as it is the only journal necessary to keep up to date with new clinical research and surgical techniques. Readers get to watch leaders in the field debate controversial topics in a new controversies section, and gain access to evidence-based reviews of important pathologies in the systematic reviews section. The journal features a surgical technique complete with a video, and a tips and tricks section that allows surgeons to review the important steps prior to a complex procedure. Clinical Spine Surgery provides readers with primary research studies, specifically level 1, 2 and 3 studies, ensuring that articles that may actually change a surgeon’s practice will be read and published. Each issue includes a brief article that will help a surgeon better understand the business of healthcare, as well as an article that will help a surgeon understand how to interpret increasingly complex research methodology. Clinical Spine Surgery is your single source for up-to-date, evidence-based recommendations for spine care.