Introduction: A high prevalence of cervical deformity (CD) has been identified among adult spinal deformity (ASD) patients undergoing surgical treatment. The clinical impact of this is uncertain. This study aims to quantify the difference in patient-reported outcomes among ASD patients based on presence of CD prior to treatment.
Methods: Retrospective review of a multicenter prospective database of surgical ASD patients with 2-year follow-up. CD was defined as: C2C7 SVA>4cm, cervical kyphosis (CK) C2C7angle>0. Univariate testing was performed using t-tests, or tests of proportion. Multivariate models determined impact of pre-op CD on Health Related Quality of Life (HRQL) scores (SF-36, ODI, SRS) and obtaining Minimally Clinically Important Difference (MCID) at 2 years.
Results: 235 patients met criteria, of which 65 with pre-op C2C7 SVA>4cm, 57 with CK. Patients with and without CD saw improvements in 2-year HRQL scores (p<0.001). Overall, patients with pre-op CD had inferior post-op HRQL and were less likely to achieve MCID for HRQL at 2-years. Those with pre-op SVA>4cm had worse ODI, PCS, SRS activity, appearance, pain, and total, and were less likely to meet MCID for ODI, PCS, SRS activity and pain scores (odds ratio 0.39 for ODI CI 0.19:0.81 p<0.05), (0.34 for PCS CI 0.16:0.72 p<0.05), (0.29 CI 0.14:0.62 p<0.05 SRS activity) (0.41 CI 0.20:0.86 p<0.05 SRS pain). Similarly, patients with CK had inferior 2-year HRQL scores. Patients without any CD were 4x more likely to reach 2-year SRS activity MCID (OR 0.40 CI 0.19:0.86 p<0.05).
Conclusions: Despite experiencing significant improvements in HRQL scores, pre-op CD in ASD patients is a strong predictor of inferior outcomes and failure to reach MCID at 2 year follow up. This information will help surgeons educate patients at risk for inferior outcomes and direct future research to improve patient outcomes.
Patient Care: The results of this study will help surgeons educate patients with preoperative cervical deformity that they may have inferior outcomes and that closer attention may be needed toward the cervical spine in thoracolumbar deformity patients.
Learning Objectives: By the conclusion of this session, participants should be able to: 1) appreciate that preop cervical deformity is present in thoracolumbar deformity patients and 2) understand that these patients are more likely to have inferior outcomes compared to those that don’t have preop cervical deformity.