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Presentation #24: Outcomes of Operative Treatment for Adult Cervical Deformity: A Prospective Multicenter Assessment with One‐Year Follow‐up

Smith, Justin S. MD, PhD; Shaffrey, Christopher I. MD; Kim, Han Jo MD; Mundis, Gregory M. MD; Gupta, Munish C. MD; Klineberg, Eric O. MD; Schwab, Frank J. MD; Lafage, Virginie PhD; Lafage, Renaud BS; Passias, Peter G. MD; Protopsaltis, Themistocles S. MD; Neuman, Brian J. MD; Daniels, Alan H. MD; Ailon, Tamir FRCSC, MD, MPH; Scheer, Justin K. BS; Kebaish, Khaled M. MD; Hart, Robert A. MD; O'Brien, Michael MD; Burton, Douglas C. MD; Deviren, Vedat MD; Albert, Todd MD; Riew, Daniel K. MD; Bess, Robert Shay MD; Ames, Christopher P. MD; International Spine Study Group

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Spine Journal Meeting Abstracts: 2016 - Volume 2016 - Issue - p 138–139
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Introduction: Despite the potential for profound impact of adult cervical deformity (ACD) on function and health‐related quality of life, there remains a paucity of high‐quality studies that assess outcomes of surgical treatment for these patients. Our objective for the present study was to provide a prospective multicenter assessment of 1‐year outcomes following surgical treatment for ACD.

Materials and Methods: Surgically treated ACD patients eligible for 1‐yr follow‐up were identified from a prospectively collected multicenter database with consecutive enrollment. Baseline deformity characteristics, surgical parameters, and 1‐year outcomes were assessed. Standardized outcomes measures included Neck Disability Index (NDI, range 0 ‐ 100), neck pain numeric rating scale (NRS) score (range 0 ‐ 10), and EQ5D‐3S index (range 0 ‐ 1) and subscores (range 1 ‐ 3). Paired sample t‐tests were used to compare 1‐year and baseline measures.

Results: Of 77 ACD patients, 55 (71%) had 1‐year follow‐up (64% women, mean age 61 yrs, mean Charlson Comorbidity Index [CCI] of 0.6, previous cervical surgery in 44%). Diagnoses included: cervical sagittal imbalance (62%), cervical kyphosis (60%), proximal junctional kyphosis (8%), and coronal deformity (10%). Posterior fusion was performed in 85% (mean number of vertebral levels = 10), and anterior fusion was performed in 29% (mean number of vertebral levels = 5). Three‐column osteotomy was performed in 24% of patients. Mean operative time was 6.5 hrs and mean estimated blood loss was 0.9 L. At 1‐year following surgery, ACD patients had significant improvement in NDI (50.5 to 38.0, p < 0.001), neck pain NRS (6.9 to 4.3, p < 0.001), EQ5D index (0.51 to 0.66, p < 0.001), and EQ5D subscores: mobility (1.9 to 1.7, p=0.019), usual activities (2.2 to 1.9, p=0.007), pain/discomfort (2.4 to 2.1, p < 0.001), anxiety/depression (1.8 to 1.5, p = 0.014). A nonsignificant trend favoring improvement was observed for EQ5D self‐care (1.5 to 1.3, p = 0.070). Compared with patients that achieved 1‐year follow‐up, those lost to follow‐up did not differ significantly with regard to age, gender, CCI, number of fused anterior or posterior vertebral levels, or baseline NDI, neck pain NRS, or EQ5D scores.

Conclusions: Adult cervical deformity can produce significant pain and disability. Based on a prospective multicenter series of adults with cervical deformity, surgical treatment provided significant improvement in multiple measures of pain and function, including the NDI, neck pain NRS score, and EQ5D. Further follow‐up will be necessary to assess the durability of these surgical procedures and the resulting improved outcomes.

© 2016 Lippincott Williams & Wilkins, Inc.