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

TitleComparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery.
Publication TypeJournal Article
Year of Publication2019
AuthorsSmith JS, Shaffrey CI, Kim HJo, Passias P, Protopsaltis T, Lafage R, Mundis GM, Klineberg E, Lafage V, Schwab FJ, Scheer JK, Kelly M, D Hamilton K, Gupta M, Deviren V, Hostin R, Albert T, K Riew D, Hart R, Burton D, Bess S, Ames CP
JournalGlobal Spine J
Volume9
Issue3
Pagination303-314
Date Published2019 May
ISSN2192-5682
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 ( = .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.

DOI10.1177/2192568218794164
Alternate JournalGlobal Spine J
PubMed ID31192099
PubMed Central IDPMC6542159