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

Justin S. Smith, Christopher I. Shaffrey, Han Jo Kim, Peter Passias, Themistocles Protopsaltis, Renaud Lafage, Gregory M. Mundis, Eric Klineberg, Virginie Lafage, Frank J. Schwab, Justin K. Scheer, Michael Kelly, D. Kojo Hamilton, Munish Gupta, Vedat Deviren, Richard Hostin, Todd Albert, K. Daniel Riew, Robert Hart, Doug BurtonShay Bess, Christopher P. Ames, behalf of the International Spine Study Group on behalf of the International Spine Study Group

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)303-314
Number of pages12
JournalGlobal Spine Journal
Volume9
Issue number3
DOIs
StatePublished - May 1 2019

Keywords

  • adult
  • cervical deformity
  • outcomes
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Fingerprint Dive into the research topics of 'Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery'. Together they form a unique fingerprint.

  • Cite this

    Smith, J. S., Shaffrey, C. I., Kim, H. J., Passias, P., Protopsaltis, T., Lafage, R., Mundis, G. M., Klineberg, E., Lafage, V., Schwab, F. J., Scheer, J. K., Kelly, M., Hamilton, D. K., Gupta, M., Deviren, V., Hostin, R., Albert, T., Riew, K. D., Hart, R., ... on behalf of the International Spine Study Group, B. O. T. I. S. S. G. (2019). Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery. Global Spine Journal, 9(3), 303-314. https://doi.org/10.1177/2192568218794164