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. 2019 May;9(3):303-314.
doi: 10.1177/2192568218794164. Epub 2018 Aug 16.

Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery

Justin S Smith  1 , Christopher I Shaffrey  1 , Han Jo Kim  2 , Peter Passias  3 , Themistocles Protopsaltis  3 , Renaud Lafage  2 , Gregory M Mundis Jr  4 , Eric Klineberg  5 , Virginie Lafage  2 , Frank J Schwab  2 , Justin K Scheer  6 , Michael Kelly  7 , D Kojo Hamilton  8 , Munish Gupta  7 , Vedat Deviren  9 , Richard Hostin  10 , Todd Albert  2 , K Daniel Riew  11 , Robert Hart  12 , Doug Burton  13 , Shay Bess  14 , Christopher P Ames  9
Affiliations

Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery

Justin S Smith et al. Global Spine J. 2019 May.

Abstract

Study design: Retrospective cohort study.

Objective: Factors that predict outcomes for adult cervical spine deformity (ACSD) have not been well defined. To compare ACSD patients with best versus worst outcomes.

Methods: This study was based on a prospective, multicenter observational ACSD cohort. Best versus worst outcomes were compared based on Neck Disability Index (NDI), Neck Pain Numeric Rating Scale (NP-NRS), and modified Japanese Orthopaedic Association (mJOA) scores.

Results: Of 111 patients, 80 (72%) had minimum 1-year follow-up. For NDI, compared with best outcome patients (n = 28), worst outcome patients (n = 32) were more likely to have had a major complication (P = .004) and to have undergone a posterior-only procedure (P = .039), had greater Charlson Comorbidity Index (P = .009), and had worse postoperative C7-S1 sagittal vertical axis (SVA; P = .027). For NP-NRS, compared with best outcome patients (n = 26), worst outcome patients (n = 18) were younger (P = .045), had worse baseline NP-NRS (P = .034), and were more likely to have had a minor complication (P = .030). For the mJOA, compared with best outcome patients (n = 16), worst outcome patients (n = 18) were more likely to have had a major complication (P = .007) and to have a better baseline mJOA (P = .030). Multivariate models for NDI included posterior-only surgery (P = .006), major complication (P = .002), and postoperative C7-S1 SVA (P = .012); models for NP-NRS included baseline NP-NRS (P = .009), age (P = .017), and posterior-only surgery (P = .038); and models for mJOA included major complication (P = .008).

Conclusions: Factors distinguishing best and worst ACSD surgery outcomes included patient, surgical, and radiographic factors. These findings suggest areas that may warrant greater awareness to optimize patient counseling and outcomes.

Keywords: adult; cervical deformity; outcomes; surgery.

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Conflict of interest statement

Declaration of Conflicting Interests: The author(s) declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
Change in Neck Disability Index (NDI) scores from preoperative baseline to minimum 1-year follow-up for 77 patients surgically treated for adult cervical deformity. Each patient had a preoperative baseline NDI score of at least 20 points. Cutoffs for best and worst outcomes are indicated.
Figure 2.
Figure 2.
Change in Neck Pain Numeric Rating Scale (NP-NRS) scores from preoperative baseline to minimum 1-year follow-up for 74 patients surgically treated for adult cervical deformity. Each patient had a preoperative baseline NP-NRS score of at least 3. Cutoffs for best and worst outcomes are indicated.
Figure 3.
Figure 3.
Change in modified Japanese Orthopaedic Association (mJOA) scores from preoperative baseline to minimum 1-year follow-up for 64 patients surgically treated for adult cervical deformity. Cutoffs for best and worst outcomes are indicated.
See this image and copyright information in PMC

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