eO
RIGINAL
ARTICLE
The Increased Prevalence of Cervical Spondylosis in Patients With Adult Thoracolumbar Spinal Deformity William W. Schairer, MD,* Alexandra Carrer, MD,* Michael Lu, MD,w and Serena S. Hu, MD*z
Study Design: Retrospective cohort study. Objective: To assess the concomitance of cervical spondylosis and thoracolumbar spinal deformity. Summary of Background Data: Patients with degenerative cervical spine disease have higher rates of degeneration in the lumbar spine. In addition, degenerative cervical spine changes have been observed in adult patients with thoracolumbar spinal deformities. However, to the best of our knowledge, there have been no studies quantifying the association between cervical spondylosis and thoracolumbar spinal deformity in adult patients. Methods: Patients seen by a spine surgeon or spine specialist at a single institution were assessed for cervical spondylosis and/or thoracolumbar spinal deformity using an administrative claims database. Spinal radiographic utilization and surgical intervention were used to infer severity of spinal disease. The relative prevalence of each spinal diagnosis was assessed in patients with and without the other diagnosis. Results: A total of 47,560 patients were included in this study. Cervical spondylosis occurred in 13.1% overall, but was found in 31.0% of patients with thoracolumbar spinal deformity (OR = 3.27, P < 0.0001). Similarly, thoracolumbar spinal deformity was found in 10.7% of patients overall, but was increased at 23.5% in patients with cervical spondylosis (OR = 3.26, P < 0.0001). In addition, increasing severity of disease was associated with an increased likelihood of the other spinal diagnosis. Patients with both diagnoses were more likely to undergo both cervical (OR = 3.23, P < 0.0001) and thoracolumbar (OR = 4.14, P < 0.0001) spine fusion. Conclusions: Patients with cervical spondylosis or thoracolumbar spinal deformity had significantly higher rates of the
Received for publication December 5, 2013; accepted May 12, 2014. From the Departments of *Orthopaedic Surgery; wRadiology, University of California San Francisco, San Francisco; and zDepartment of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA. This study received IRB approval by the Committee on Human Research at the University of California San Francisco, San Francisco, CA. S.S.H. certifies that she has received payments or benefits from consulting (Medtronic, Nuvasive), speaking (Medtronic, Synthes), stock (Nuvasive), and royalties (Nuvasive). The remaining authors declare no conflict of interest. Reprints: Serena S. Hu, MD, Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street—MC: 6342, Redwood City, CA 94063 (e-mail: [email protected]). Copyright r 2014 by Lippincott Williams & Wilkins
J Spinal Disord Tech
Volume 27, Number 8, December 2014
other spinal diagnosis. This correlation was increased with increased severity of disease. Patients with both diagnoses were significantly more likely to have received a spine fusion. Further research is warranted to establish the cause of this correlation. Clinicians should use this information to both screen and counsel patients who present for cervical spondylosis or thoracolumbar spinal deformity. Key Words: cervical spondylosis, thoracolumbar deformity, spinal deformity, scoliosis, kyphosis, concomitance, degenerative spine (J Spinal Disord Tech 2014;27:E305–E308)
C
ervical spondylosis is well described, and encompasses a broad set of degenerative diagnoses of the aging cervical spine.1 Although many patients are asymptomatic, spondylosis can cause radiculopathy and myelopathy, and patients with severe disease may be at increased risk for spinal cord injury.2 Intervertebral disk degeneration alters the biomechanics of the cervical spine, resulting in a loss of disk height with loss of the normal cervical lordosis that continues to alter the biomechanical loading of the disk and uncovertebral joints.3 Loss of cervical lordosis has been described in over half of patients with a spine fusion for adult idiopathic scoliosis, although at minimum 5 years of follow-up
RIGINAL
ARTICLE
The Increased Prevalence of Cervical Spondylosis in Patients With Adult Thoracolumbar Spinal Deformity William W. Schairer, MD,* Alexandra Carrer, MD,* Michael Lu, MD,w and Serena S. Hu, MD*z
Study Design: Retrospective cohort study. Objective: To assess the concomitance of cervical spondylosis and thoracolumbar spinal deformity. Summary of Background Data: Patients with degenerative cervical spine disease have higher rates of degeneration in the lumbar spine. In addition, degenerative cervical spine changes have been observed in adult patients with thoracolumbar spinal deformities. However, to the best of our knowledge, there have been no studies quantifying the association between cervical spondylosis and thoracolumbar spinal deformity in adult patients. Methods: Patients seen by a spine surgeon or spine specialist at a single institution were assessed for cervical spondylosis and/or thoracolumbar spinal deformity using an administrative claims database. Spinal radiographic utilization and surgical intervention were used to infer severity of spinal disease. The relative prevalence of each spinal diagnosis was assessed in patients with and without the other diagnosis. Results: A total of 47,560 patients were included in this study. Cervical spondylosis occurred in 13.1% overall, but was found in 31.0% of patients with thoracolumbar spinal deformity (OR = 3.27, P < 0.0001). Similarly, thoracolumbar spinal deformity was found in 10.7% of patients overall, but was increased at 23.5% in patients with cervical spondylosis (OR = 3.26, P < 0.0001). In addition, increasing severity of disease was associated with an increased likelihood of the other spinal diagnosis. Patients with both diagnoses were more likely to undergo both cervical (OR = 3.23, P < 0.0001) and thoracolumbar (OR = 4.14, P < 0.0001) spine fusion. Conclusions: Patients with cervical spondylosis or thoracolumbar spinal deformity had significantly higher rates of the
Received for publication December 5, 2013; accepted May 12, 2014. From the Departments of *Orthopaedic Surgery; wRadiology, University of California San Francisco, San Francisco; and zDepartment of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA. This study received IRB approval by the Committee on Human Research at the University of California San Francisco, San Francisco, CA. S.S.H. certifies that she has received payments or benefits from consulting (Medtronic, Nuvasive), speaking (Medtronic, Synthes), stock (Nuvasive), and royalties (Nuvasive). The remaining authors declare no conflict of interest. Reprints: Serena S. Hu, MD, Department of Orthopaedic Surgery, Stanford University School of Medicine, 450 Broadway Street—MC: 6342, Redwood City, CA 94063 (e-mail: [email protected]). Copyright r 2014 by Lippincott Williams & Wilkins
J Spinal Disord Tech
Volume 27, Number 8, December 2014
other spinal diagnosis. This correlation was increased with increased severity of disease. Patients with both diagnoses were significantly more likely to have received a spine fusion. Further research is warranted to establish the cause of this correlation. Clinicians should use this information to both screen and counsel patients who present for cervical spondylosis or thoracolumbar spinal deformity. Key Words: cervical spondylosis, thoracolumbar deformity, spinal deformity, scoliosis, kyphosis, concomitance, degenerative spine (J Spinal Disord Tech 2014;27:E305–E308)
C
ervical spondylosis is well described, and encompasses a broad set of degenerative diagnoses of the aging cervical spine.1 Although many patients are asymptomatic, spondylosis can cause radiculopathy and myelopathy, and patients with severe disease may be at increased risk for spinal cord injury.2 Intervertebral disk degeneration alters the biomechanics of the cervical spine, resulting in a loss of disk height with loss of the normal cervical lordosis that continues to alter the biomechanical loading of the disk and uncovertebral joints.3 Loss of cervical lordosis has been described in over half of patients with a spine fusion for adult idiopathic scoliosis, although at minimum 5 years of follow-up
