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

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 ( = .004) and to have undergone a posterior-only procedure ( = .039), had greater Charlson Comorbidity Index ( = .009), and had worse postoperative C7-S1 sagittal vertical axis (SVA; = .027). For NP-NRS, compared with best outcome patients (n = 26), worst outcome patients (n = 18) were younger ( = .045), had worse baseline NP-NRS ( = .034), and were more likely to have had a minor complication ( = .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 ( = .007) and to have a better baseline mJOA ( = .030). Multivariate models for NDI included posterior-only surgery ( = .006), major complication ( = .002), and postoperative C7-S1 SVA ( = .012); models for NP-NRS included baseline NP-NRS ( = .009), age ( = .017), and posterior-only surgery ( = .038); and models for mJOA included major complication ( = .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.