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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Published in:Journal of orthopaedic surgery and research Vol. 20; no. 1; pp. 653 - 9
Main Authors: Kim, Sung Taeck, Kim, Hyoungmin, Chang, Bong-Soon, Jang, Seonpyo, Lee, Junyeop, Chang, Sam Yeol
Format: Journal Article
Language:English
Published: London BioMed Central 15.07.2025
BioMed Central Ltd
BMC
Subjects:
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
Sagittal alignment
Neuromuscular scoliosis
Horizontal gaze
ISSN:1749-799X, 1749-799X
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Summary: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.
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ISSN:1749-799X
1749-799X
DOI:10.1186/s13018-025-06089-0