How sagittal alignment changes can affect independent horizontal gaze after neuromuscular scoliosis correction
Background When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a l...
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| Vydáno v: | Journal of orthopaedic surgery and research Ročník 20; číslo 1; s. 653 - 9 |
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BioMed Central
15.07.2025
BioMed Central Ltd BMC |
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| ISSN: | 1749-799X, 1749-799X |
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| Abstract | Background
When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS.
Materials and methods
Patients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control.
Results
88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6,
p
= 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1,
p
= 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018,
p
= 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020,
p
= 0.025) were associated with an inability to maintain horizontal gaze.
Conclusions
In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. |
|---|---|
| AbstractList | Abstract Background When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS. Materials and methods Patients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control. Results 88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze. Conclusions In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. Background When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS. Materials and methods Patients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control. Results 88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze. Conclusions In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS. 88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze. In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. Background When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS. Materials and methods Patients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control. Results 88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze. Conclusions In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. Keywords: Neuromuscular scoliosis, Horizontal gaze, Sagittal alignment When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS.BACKGROUNDWhen surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS.Patients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control.MATERIALS AND METHODSPatients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control.88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze.RESULTS88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze.In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS.CONCLUSIONSIn this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after surgery can cause difficulties in maintaining independent horizontal gaze. Typically, patients with weak neck flexors can experience a loss of head control during neck extension that cannot be restored to a neutral position to allow horizontal gaze. This study aimed to analyze the radiological factors associated with the ability to maintain an independent horizontal gaze following deformity correction surgery in patients with NMS. Patients who underwent deformity correction surgery for the NMS from 2013 to 2023 were included. We assessed whether the patient could maintain a horizontal gaze without a headrest after deformity correction. Clinical demographics and radiographic alignment parameters before and after surgery were collected. Multivariable logistic regression was performed to identify risk factors of postoperative loss of head control. 88 NMS patients were included in this study. After deformity correction, 31 (35%) patients could not maintain a horizontal gaze without a headrest at postoperative 3 months. The group of patients who maintained horizontal gaze had a significantly greater postoperative chin-brow vertical angle (4.3°±-10.6 vs. -4.7°±11.6, p = 0.003) and C7-S1 sagittal vertical axis (67.0 mm ± 46.5 vs. 29.3 mm ± 40.1, p = 0.002) than the group who could not. Logistic regression analysis showed that a greater increase of lumbar lordosis (odds ratio = 1.018, p = 0.039) and change in C7-S1 sagittal vertical axis (odds ratio = 1.020, p = 0.025) were associated with an inability to maintain horizontal gaze. In this study, the loss of ability to maintain independent horizontal gaze after deformity correction for NMS was associated with a greater increase in lumbar lordosis. Maintaining preoperative sagittal balance is crucial for head control in patients undergoing deformity correction for NMS. |
| ArticleNumber | 653 |
| Audience | Academic |
| Author | Kim, Hyoungmin Jang, Seonpyo Kim, Sung Taeck Lee, Junyeop Chang, Sam Yeol Chang, Bong-Soon |
| Author_xml | – sequence: 1 givenname: Sung Taeck surname: Kim fullname: Kim, Sung Taeck organization: Department of Orthopedic Surgery, Seoul National University Hospital – sequence: 2 givenname: Hyoungmin surname: Kim fullname: Kim, Hyoungmin organization: Department of Orthopedic Surgery, Seoul National University Hospital – sequence: 3 givenname: Bong-Soon surname: Chang fullname: Chang, Bong-Soon organization: Department of Orthopedic Surgery, Seoul National University Hospital – sequence: 4 givenname: Seonpyo surname: Jang fullname: Jang, Seonpyo organization: Department of Orthopedic Surgery, Seoul National University Hospital – sequence: 5 givenname: Junyeop surname: Lee fullname: Lee, Junyeop organization: Department of Orthopedic Surgery, Seoul National University Hospital – sequence: 6 givenname: Sam Yeol surname: Chang fullname: Chang, Sam Yeol email: hewl3102@gmail.com organization: Department of Orthopedic Surgery, Seoul National University Hospital |
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| Keywords | Sagittal alignment Neuromuscular scoliosis Horizontal gaze |
| Language | English |
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| Snippet | Background
When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment... When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment after... Background When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal alignment... Abstract Background When surgical correction for spinal deformity is performed for neuromuscular scoliosis (NMS) patients, sudden changes in sagittal spinal... |
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| SubjectTerms | Adolescent Adult Analysis Child Female Fixation, Ocular - physiology Horizontal gaze Humans Male Medical research Medicine Medicine & Public Health Medicine, Experimental Neuromuscular Diseases - complications Neuromuscular Diseases - diagnostic imaging Neuromuscular Diseases - physiopathology Neuromuscular Diseases - surgery Neuromuscular scoliosis Orthopedics Retrospective Studies Risk factors Sagittal alignment Scoliosis Scoliosis - diagnostic imaging Scoliosis - etiology Scoliosis - physiopathology Scoliosis - surgery Surgical Orthopedics Young Adult |
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| Title | How sagittal alignment changes can affect independent horizontal gaze after neuromuscular scoliosis correction |
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