Trends in Outcomes of a Prospective Consecutively Enrolled Single-Center Adult Cervical Deformity Series.
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 Dec 2022
15 Dec 2022
Historique:
received:
06
03
2022
accepted:
20
06
2022
pubmed:
26
8
2022
medline:
1
12
2022
entrez:
25
8
2022
Statut:
ppublish
Résumé
Retrospective cohort. The aim was to describe the two-year outcomes for patients undergoing surgical correction of cervical deformity (CD). Adult CD has been shown to compromise health-related quality of life. While advances in spinal realignment have shown promising short-term clinical results in this parameter, the long-term outcomes of CD corrective surgery remain unclear. Operative CD patients >18 years with two-year (2Y) health-related quality of life/radiographic data were included. Improvement in radiographic, neurologic, and health-related quality of life outcomes were reported. Patients with a prior cervical fusion and patients with the greatest and smallest change based on Neck Disability Index (NDI), numeric rating scale (NRS) neck, modified Japanese Orthopaedic Association (mJOA) were compared using multivariable analysis controlling for age, and frailty, and invasiveness. One hundred and fifty-eight patients were included in this study. By 2Y, 96.3% of patients improved in Ames cervical sagittal vertical axis modifier, 34.2% in T1 slope minus cervical lordosis (TS-CL), 42.0% in horizontal gaze modifier, and 40.9% in SVA modifier. In addition, 65.5% of patients improved in Passias CL modifier, 53.3% in TS-CL modifier, 100% in C2-T3 modifier, 88.9% in C2S modifier, and 81.0% in MGS modifier severity by 2Y. The cohort significantly improved from baseline to 2Y in NDI, NRS Neck, and mJOA, all P <0.05. 59.3% of patients met minimal clinically important difference for NDI, 62.3% for NRS Neck, and 37.3% for mJOA. Ninety-seven patients presented with at least one neurologic deficit at baseline and 63.9% no longer reported that deficit at follow-up. There were 45 (34.6%) cases of distal junctional kyphosis (DJK) (∆DJKA>10° between lower instrumented vertebra and lower instrumented vertebra-2), of which 17 were distal junctional failure (distal junctional failure-DJK requiring reoperation). Patients with the greatest beneficial change were less likely to have had a complication in the two-year follow-up period. Correction of CD results in notable clinical and radiographic improvement with most patients achieving favorable outcomes after two years. However, complications including DJK or failure remain prevalent.
Sections du résumé
STUDY DESIGN
METHODS
Retrospective cohort.
OBJECTIVE
OBJECTIVE
The aim was to describe the two-year outcomes for patients undergoing surgical correction of cervical deformity (CD).
BACKGROUND
BACKGROUND
Adult CD has been shown to compromise health-related quality of life. While advances in spinal realignment have shown promising short-term clinical results in this parameter, the long-term outcomes of CD corrective surgery remain unclear.
MATERIALS AND METHODS
METHODS
Operative CD patients >18 years with two-year (2Y) health-related quality of life/radiographic data were included. Improvement in radiographic, neurologic, and health-related quality of life outcomes were reported. Patients with a prior cervical fusion and patients with the greatest and smallest change based on Neck Disability Index (NDI), numeric rating scale (NRS) neck, modified Japanese Orthopaedic Association (mJOA) were compared using multivariable analysis controlling for age, and frailty, and invasiveness.
RESULTS
RESULTS
One hundred and fifty-eight patients were included in this study. By 2Y, 96.3% of patients improved in Ames cervical sagittal vertical axis modifier, 34.2% in T1 slope minus cervical lordosis (TS-CL), 42.0% in horizontal gaze modifier, and 40.9% in SVA modifier. In addition, 65.5% of patients improved in Passias CL modifier, 53.3% in TS-CL modifier, 100% in C2-T3 modifier, 88.9% in C2S modifier, and 81.0% in MGS modifier severity by 2Y. The cohort significantly improved from baseline to 2Y in NDI, NRS Neck, and mJOA, all P <0.05. 59.3% of patients met minimal clinically important difference for NDI, 62.3% for NRS Neck, and 37.3% for mJOA. Ninety-seven patients presented with at least one neurologic deficit at baseline and 63.9% no longer reported that deficit at follow-up. There were 45 (34.6%) cases of distal junctional kyphosis (DJK) (∆DJKA>10° between lower instrumented vertebra and lower instrumented vertebra-2), of which 17 were distal junctional failure (distal junctional failure-DJK requiring reoperation). Patients with the greatest beneficial change were less likely to have had a complication in the two-year follow-up period.
CONCLUSION
CONCLUSIONS
Correction of CD results in notable clinical and radiographic improvement with most patients achieving favorable outcomes after two years. However, complications including DJK or failure remain prevalent.
Identifiants
pubmed: 36007013
doi: 10.1097/BRS.0000000000004457
pii: 00007632-202212150-00002
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
1694-1700Informations de copyright
Copyright © 2022 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors report no conflicts of interest.
Références
Scheer JK, Tang JA, Smith JS, et al. Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19:141–59.
Deviren V, Scheer JK, Ames CP. Technique of cervicothoracic junction pedicle subtraction osteotomy for cervical sagittal imbalance: report of 11 cases. J Neurosurg Spine. 2011;15:174–81.
Suk KK-SK, Kim KK-TK, Lee SS-HS, et al. Significance of chin-brow vertical angle in correction of kyphotic deformity of ankylosing spondylitis patients. Spine. 2003;28:2001–5.
Passias PG, Jalai CM, Smith JS, et al. Characterizing adult cervical deformity and disability based on existing cervical and adult deformity classification schemes at presentation and following correction. Neurosurgery. 2018;82:192–201.
Horn SR, Passias PG, Oh C, et al. Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery. J Neurosurg Spine. 2019;32:182–90.
Lau D, Joshi RS, Haddad AF, et al. Incidence and risk factors of mechanical complications after posterior-based osteotomies for correction of moderate to severe adult cervical deformity: 1-year and 2-year follow-up. Neurosurgery. 2022;90:207–14.
Passias PG, Vasquez-Montes D, Poorman GW, et al. Predictive model for distal junctional kyphosis after cervical deformity surgery. Spine J. 2018;18:2187–94.
Kato S, Oshima Y, Matsubayashi Y, et al. Minimum clinically important difference and patient acceptable symptom state of Japanese Orthopaedic Association Score in Degenerative Cervical Myelopathy Patients. Spine (Phila Pa 1976). 2019;44:691–97.
Soroceanu A, Smith JS, Lau D, et al. Establishing the minimum clinically important difference in Neck Disability Index and modified Japanese Orthopaedic Association scores for adult cervical deformity. J Neurosurg Spine. 2020;33:441–45.
Carreon LY, Glassman SD, Campbell MJ, et al. Neck Disability Index, short form-36 physical component summary, and pain scales for neck and arm pain: the minimum clinically important difference and substantial clinical benefit after cervical spine fusion. Spine J. 2010;10:469–74.
Young B a, Walker MJ, Strunce JB, et al. Responsiveness of the Neck Disability Index in patients with mechanical neck disorders. Spine J. 2009;9:802–808.
Khan I, Pennings JS, Devin CJ, et al. Clinically meaningful improvement following cervical spine surgery: 30% reduction versus absolute point-change MCID values. Spine. 2021;46:717–25.
Ames CP, Smith JS, Eastlack R, et al. Reliability assessment of a novel cervical spine deformity classification system. J Neurosurg Spine. 2015;23:673–83.
Passias P, Pierce K, Brown A, et al. Redefining cervical spine deformity classification through novel cutoffs: an assessment of the relationship between radiographic parameters and functional neurological outcomes. J Craniovertebr Junction Spine. 2021;12:157–64.
Passias P, Pierce K, Passano B, et al. What are the major drivers of outcomes in cervical deformity surgery? J Craniovertebr Junction Spine. 2021;12:376–80.
Passias PG, Horn SR, Oh C, et al. Evaluating cervical deformity corrective surgery outcomes at 1-year using current patient-derived and functional measures: are they adequate? J Spine Surg. 2018;4:295–303.
Pierce KE, Passias PG, Brown AE, et al. Predictors of superior recovery kinetics in adult cervical deformity correction. Spine (Phila Pa 1976). 2021;46:559–66.
Ailon T, Smith JS, Shaffrey CI, et al. Outcomes of operative treatment for adult cervical deformity: a prospective multicenter assessment with 1-year follow-up. Neurosurgery. 2018;83:1031–9.
Smith JS, Buell TJ, Shaffrey CI, et al. Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up. J Neurosurg Spine. 2020;33:588–600.
Passias PG, Horn SR, Oh C, et al. Predicting the occurrence of postoperative distal junctional kyphosis in cervical deformity patients. Neurosurgery. 2020;86:E38–46.
Shah NV, Jain I, Moattari CR, et al. Comparing predictors of complications following Anterior Cervical Discectomy and Fusion (ACDF), Total Disc Replacement (TDR), and combined ACDF-TDR with minimum 2-year follow-up. Spine J. 2018;18:S79.
Koller H, Ames C, Mehdian H, et al. Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project. Eur Spine J. 2019;28:324–44.
Passias PG, Bortz CA, Segreto FA, et al. Development of a modified cervical deformity frailty index: a streamlined clinical tool for preoperative risk stratification. Spine. 2019;44:169–76.
Berjano P, Damilano M, Pejrona M, et al. Revision surgery in distal junctional kyphosis. Eur Spine J. 2020;29:86–102.