The Health Impact of Adult Cervical Deformity in Patients Presenting for Surgical Treatment: Comparison to United States Population Norms and Chronic Disease States Based on the EuroQuol-5 Dimensions Questionnaire

Smith, Justin S.; Line, Breton; Bess, Shay; Shaffrey, Christopher I.; Kim, Hee Jin; Mundis, Gregory M.; Scheer, Justin K.; Klineberg, Eric O.; O’Brien, Michael F.; Hostin, Richard A.; Gupta, Munish C.; Daniels, Alan H.; Kelly, Michael P.; Gum, Jeffrey L.; Schwab, Frank J.; Lafage, Virginie; Lafage, Renaud; Ailon, Tamir; Passias, Peter G.; Protopsaltis, Themistocles S.; Albert, Todd J.; Riew, K. Daniel; Hart, Robert A.; Burton, Doug; Deviren, Vedat; Ames, Christopher P.; Group, International Spine Study

doi:10.1093/neuros/nyx028

Cited by 80 publications

(63 citation statements)

References 34 publications

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“…Additionally, a recent study demonstrated that CD has a substantial health impact on this population, with the CD patients in that study having a mean EQ-5D score that was comparable to the bottom 25th percentile of scores for other cohorts, including renal failure, stroke, and emphysema patients. 23 The substantial health impact of CD on these patients, in conjunction with previous studies that have shown that CD patients have a wide range of comorbidities and frailty indicators that put patients at risk for complications, could contribute to the occurrence of an overall poor outcome. 9 It is also worth noting that although the rate of an overall poor outcome was 20.2%, when looking individually at the rates of a suboptimal outcome for each specific factor (radiographic, clinical, or complications/reoperation), the rates of poor outcomes are much higher.…”

Section: Figmentioning

confidence: 93%

Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery

Horn

Passias

et al. 2020

Journal of Neurosurgery: Spine

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OBJECTIVECervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery.METHODSThe authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2–7 Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2–7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25°. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope–cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC).RESULTSIn total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients’ conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0–11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2–12 kyphosis, TS-CL, C2–T3 SVA, C2–T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9–39), worse baseline neurological status (OR 11.4, 95% CI 1.8–70.8), baseline pelvic tilt > 20° (OR 0.92, 95% CI 0.85–0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1–4.1), preoperative C2–T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9–1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09–10.3).CONCLUSIONSOf all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct.

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Section: Figmentioning

confidence: 93%

Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery

Horn

Passias

et al. 2020

Journal of Neurosurgery: Spine

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“…7 In fact, ACD has been shown to be associated with disability scores (based on HRQoL questionnaires) similar to illnesses such as blindness, renal failure, and stroke. 8 There is an ongoing accumulation of evidence that, like in adult spinal deformity (ASD), ACD surgery is able to achieve excellent radiographic correction and provide significant improvement in pain and disability based on HRQoL scores. [9][10][11] Postoperative cSVA and chin brow vertical angle (CBVA) are 2 radiographic measures that have been closely associated with improvements in ADL and HRQoL outcomes.…”

Section: Introductionmentioning

confidence: 99%

Three-Column Osteotomy for the Treatment of Rigid Cervical Deformity

Lau

Ames

2020

Neurospine

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Adult cervical deformity (ACD) has been shown to have a substantial impact on quality of life and overall health, with moderate to severe deformities resulting in significant disability and dysfunction. Fortunately, surgical management and correction of cervical sagittal imbalance can offer significant benefits and improvement in pain and disability. ACD is a heterogenous disease and specific surgical correction strategies should reflect deformity type (driver of deformity) and patient-related factors. Spinal rigidity is one of the most important considerations as soft tissue releases and osteotomies play a crucial role in cervical deformity correction. For ankylosed, fixed, and severe deformity, 3-column osteotomy (3CO) is often warranted. A 3CO can be done through combined anteriorposterior (vertebral body resection) and posterior-only approaches (open or closed wedge pedicle subtraction osteotomies [PSOs]). This article reviews the literature for currently published studies that report results on the use of 3CO for ACD, with a special concentration on posterior based 3CO (open and closed wedge PSO). More specifically, this review discusses the indications, radiographic corrective ability, and associated complications.

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“…Cervicothoracic deformity encompasses a variety of pathologies that afflict the subaxial cervical spine and/or upper thoracic spine and result in considerable functional distress and morbidity. 1,2 Surgical correction of cervicothoracic deformities can result in considerable improvements in quality of life [3][4][5][6] and are accomplished through a variety of approaches and techniques based on severity and location of primary deformity. Subaxial cervical kyphosis can be corrected via anterior, posterior, or a combination of anterior and posterior approaches while deformity stemming from the upper thoracic spine is addressed primarily with posteriorly-based surgical techniques.…”

Section: Introductionmentioning

confidence: 99%

The “Rail Technique” for Correction of Cervicothoracic Kyphosis: Case Report and Surgical Technique Description

Theologis

Gupta

2020

Neurospine

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Cervicothoracic deformity correction often necessitates a shortening operation, consisting of a 3-column osteotomy (3CO). While effective, segmental compression and in situ and cantilever bending often place screws under considerable stress and may jeopardize deformity correction. In this report, we present the surgical technique of a novel method, the "rail technique," to shorten across a vertebral column resection (VCR) for cervicothoracic deformity correction. A 65-year-old woman with a history of a C5-pelvis posterior instrumented fusion (PSIF) presented with chin-on-chest deformity after a prior proximal junctional failure/kyphosis at T4 (30° T3-5) above a prior T5-pelvis PSIF that was stabilized in situ. She underwent an uncomplicated revision C2-T10 PSIF with shortening across a T4 VCR using the "rail technique." Postoperatively, radiographs demonstrated excellent restoration of and normalization of cervical sagittal alignment, thoracic kyphosis, focal T3-5 kyphosis (7°), and global sagittal alignment. At 1-year postoperation, she was without neck pain and reported significant improvements in self-image, mental health, satisfaction, and subscale Scoliosis Research Society-22 scores compared to preoperative values. The "rail technique" is a safe and effective method for shortening over a 3CO to correct the cervicothoracic deformity.

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The Health Impact of Adult Cervical Deformity in Patients Presenting for Surgical Treatment: Comparison to United States Population Norms and Chronic Disease States Based on the EuroQuol-5 Dimensions Questionnaire

Abstract: The health impact of symptomatic ACSD is substantial, with negative impact across all EQ-5D domains. The mean ACSD EQ-5D index was comparable to the bottom 25th percentile values for blindness/low vision, emphysema, renal failure, and stroke.

Cited by 80 publications

References 34 publications

Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery

Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery

Three-Column Osteotomy for the Treatment of Rigid Cervical Deformity

The “Rail Technique” for Correction of Cervicothoracic Kyphosis: Case Report and Surgical Technique Description

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