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Cervical Versus Thoracolumbar Spinal Deformities

A Comparison of Baseline Quality-of-Life Burden

Passias, Peter G., MD*; Poorman, Gregory W., BA*; Lafage, Virginie, PhD; Smith, Justin, MD; Ames, Christopher, MD§; Schwab, Frank, MD; Shaffrey, Chris, MD; Segreto, Frank A., BS*; Horn, Samantha R., BA*; Bortz, Cole A., BA*; Varlotta, Christopher G., BS*; Hockley, Aaron, MD*; Wang, Charles, MD*; Daniels, Alan, MD; Neuman, Brian, MD#; Hart, Robert, MD**; Burton, Douglas, MD††; Javidan, Yashar, MD‡‡; Line, Breton, BSME*,*; LaFage, Renaud, MS; Bess, Shay, MD§§; Sciubba, Daniel, MD∥∥ ISSG

doi: 10.1097/BSD.0000000000000743

Study Design: Retrospective analysis of 2 prospectively collected multicenter databases, one for cervical deformity (CD) and the other for general adult spinal deformity.

Objective: To investigate the relative quality-of-life and disability burden in patients with uncompensated cervical, thoracolumbar, or cervical and thoracolumbar deformities.

Summary of Background Data: The relative quality-of-life burden of cervical and thoracolumbar deformities have never been compared with each other. This may have significant implications when deciding on the appropriate treatment intervention for patients with combined thoracolumbar and cervical deformities.

Methods: When defining CD C2–C7 sagittal vertical axis (SVA)>4 cm was used while a C7–S1 SVA>5 cm was used to defined thoracolumbar deformity. Patients with both SVA criteria were defined as “combined.” Primary analysis compared patients in the different groups by demographic, comorbidity data, and quality-of-life scores [EuroQOL 5 dimensions questionnaire (EQ-5D)] using t tests. Secondary analysis matched deformity groups with propensity scores matching based on baseline EQ-5D scores. Differences in disease-specific metrics [the Oswestry Disability Index, Neck Disability Index, modified Japanese Orthopaedic Association questionnaire (mJOA)] were analyzed using analysis of variance tests and post hoc analysis.

Results: In total, 212 patients were included in our analysis. Patients with CD only had less neurological deficits (mJOA: 14.6) and better EQ-5D (0.746) scores compared with patients with combined deformities (11.9, 0.716), all P<0.05. Regarding propensity score–matched deformity cohorts, 99 patients were matched with similar quality-of-life burden, 33 per deformity cohort. CD only patients had fewer comorbidities (1.03 vs. 2.12 vs. 2.70; P<0.001), whereas patients with combined deformity had more baseline neurological impairment compared with CD only patients (mJOA: 12.00 vs. 14.25; P=0.050).

Conclusions: Combined deformity patients were associated with the lowest quality-of-life and highest disability. Furthermore, regarding deformity cohorts matched by similar baseline quality-of-life status (EQ-5D), patients with combined deformities were associated with significantly worse neurological impairments. This finding implies that quality of life may not be a direct reflection of a patient’s disability status, especially in patients with combined cervical and thoracolumbar deformities.

Level of Evidence: Level III.

*Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center, Orthopaedic Hospital, NYU School of Medicine, Spine Institute

Department of Orthopaedics, Hospital for Special Surgery, New York, NY

Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

§Department of Neurological Surgery, University of California San Francisco, San Francisco, CA

Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA

Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI

#Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, MD

**Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA

††Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS

‡‡Department of Orthopaedic Surgery, University of California Davis Medical Center, Davis, CA

§§Department of Orthopaedic Surgery, Presbyterian/St. Luke’s Medical Center, Rocky Mountain Hospital for Children, Denver, CO

∥∥Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, MD

The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes.

P.G.P.: Medicrea, Spinewave—consulting fees; Zimmer Biomet—speaking fees; CSRS—grants to the institution. V.L.: Depuy Synthes, Nuvasive, K2M, Medtronic—paid lectures; Nemaris—board member and shareholder. J.S. and C.A.: DePuy Synthes, Medtronic, Stryker—consulting fees; Zimmer Biomet—royalties; Fish & Richardson, PC—patents. F.S.: SRS, DePuy Spine (through ISSGF)—grants; Zimmer Biomet, NuVasive, K2M, MSD, Medicrea—speaking/teaching arrangements, consulting; Nemaris Inc.—board of directors, shareholder; K2M, MSD—royalties. C.S.: Medtronic, Zimmer Biomet—royalties, patents, consultant; Nuvasive—royalties, patents, consultant, stockholder; K2M, Stryker, In Vivo—consultant; NIH, Department of Defense, ISSG, DePuy Synthes, AO—grants. A.D.: Osseus, DePuy Synthes, Globus, and Stryker—consultant; Quad Rod Inc.—patent. B.N. and Y.J.: DePuy Synthes—grants payed to the ISSGF. R.H.: Globus, Seaspine, DePuy Synthes—personal fees; Medtronic—grants; CSRS, ISSLS—board member; ISSG—Executive Committee; OHSU—patent. D.B.: DePuy Synthes—consultant, royalties, and research support. S.B.: K2 Medical—consultant, royalties, research support; Allosource—consultant; Pioneer—royalties; Innovasis, Nuvasive—royalties, research support; DePuy Synthes Spine—research support; Stryker—research. D.S.: Medtronic—consulting fees. The remaining authors declare no conflict of interest.

Reprints: Peter G. Passias, MD, Department of Orthopaedic Surgery, NYU Medical Center, Orthopaedic Hospital, New York Spine Institute, 301 East 17th Street, New York, NY 10003 (e-mail:

Received April 12, 2018

Accepted September 21, 2018

© 2018 by Lippincott Williams & Wilkins, Inc.