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

Justin S. Smith, Christopher I. Shaffrey, Han Jo Kim, Peter Passias, Themistocles Protopsaltis, Renaud Lafage, Gregory M. Mundis, Eric Otto Klineberg, Virginie Lafage, Frank J. Schwab, Justin K. Scheer, Michael Kelly, D. Kojo Hamilton, Munish Gupta, Vedat Deviren, Richard Hostin, Todd Albert, K. Daniel Riew, Robert Hart, Doug BurtonShay Bess, Christopher P. Ames, behalf of the International Spine Study Group on behalf of the International Spine Study Group

Research output: Contribution to journalArticle

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 (P =.004) and to have undergone a posterior-only procedure (P =.039), had greater Charlson Comorbidity Index (P =.009), and had worse postoperative C7-S1 sagittal vertical axis (SVA; P =.027). For NP-NRS, compared with best outcome patients (n = 26), worst outcome patients (n = 18) were younger (P =.045), had worse baseline NP-NRS (P =.034), and were more likely to have had a minor complication (P =.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 (P =.007) and to have a better baseline mJOA (P =.030). Multivariate models for NDI included posterior-only surgery (P =.006), major complication (P =.002), and postoperative C7-S1 SVA (P =.012); models for NP-NRS included baseline NP-NRS (P =.009), age (P =.017), and posterior-only surgery (P =.038); and models for mJOA included major complication (P =.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.

Original languageEnglish (US)
Pages (from-to)303-314
Number of pages12
JournalGlobal Spine Journal
Volume9
Issue number3
DOIs
StatePublished - May 1 2019

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Neck Pain
Spine
Orthopedics
Neck
Comorbidity
Counseling
Cohort Studies
Retrospective Studies

Keywords

  • adult
  • cervical deformity
  • outcomes
  • surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

Smith, J. S., Shaffrey, C. I., Kim, H. J., Passias, P., Protopsaltis, T., Lafage, R., ... on behalf of the International Spine Study Group, B. O. T. I. S. S. G. (2019). Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery. Global Spine Journal, 9(3), 303-314. https://doi.org/10.1177/2192568218794164

Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery. / Smith, Justin S.; Shaffrey, Christopher I.; Kim, Han Jo; Passias, Peter; Protopsaltis, Themistocles; Lafage, Renaud; Mundis, Gregory M.; Klineberg, Eric Otto; Lafage, Virginie; Schwab, Frank J.; Scheer, Justin K.; Kelly, Michael; Hamilton, D. Kojo; Gupta, Munish; Deviren, Vedat; Hostin, Richard; Albert, Todd; Riew, K. Daniel; Hart, Robert; Burton, Doug; Bess, Shay; Ames, Christopher P.; on behalf of the International Spine Study Group, behalf of the International Spine Study Group.

In: Global Spine Journal, Vol. 9, No. 3, 01.05.2019, p. 303-314.

Research output: Contribution to journalArticle

Smith, JS, Shaffrey, CI, Kim, HJ, Passias, P, Protopsaltis, T, Lafage, R, Mundis, GM, Klineberg, EO, Lafage, V, Schwab, FJ, Scheer, JK, Kelly, M, Hamilton, DK, Gupta, M, Deviren, V, Hostin, R, Albert, T, Riew, KD, Hart, R, Burton, D, Bess, S, Ames, CP & on behalf of the International Spine Study Group, BOTISSG 2019, 'Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery', Global Spine Journal, vol. 9, no. 3, pp. 303-314. https://doi.org/10.1177/2192568218794164
Smith JS, Shaffrey CI, Kim HJ, Passias P, Protopsaltis T, Lafage R et al. Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery. Global Spine Journal. 2019 May 1;9(3):303-314. https://doi.org/10.1177/2192568218794164
Smith, Justin S. ; Shaffrey, Christopher I. ; Kim, Han Jo ; Passias, Peter ; Protopsaltis, Themistocles ; Lafage, Renaud ; Mundis, Gregory M. ; Klineberg, Eric Otto ; Lafage, Virginie ; Schwab, Frank J. ; Scheer, Justin K. ; Kelly, Michael ; Hamilton, D. Kojo ; Gupta, Munish ; Deviren, Vedat ; Hostin, Richard ; Albert, Todd ; Riew, K. Daniel ; Hart, Robert ; Burton, Doug ; Bess, Shay ; Ames, Christopher P. ; on behalf of the International Spine Study Group, behalf of the International Spine Study Group. / Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery. In: Global Spine Journal. 2019 ; Vol. 9, No. 3. pp. 303-314.
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AU - Smith, Justin S.

AU - Shaffrey, Christopher I.

AU - Kim, Han Jo

AU - Passias, Peter

AU - Protopsaltis, Themistocles

AU - Lafage, Renaud

AU - Mundis, Gregory M.

AU - Klineberg, Eric Otto

AU - Lafage, Virginie

AU - Schwab, Frank J.

AU - Scheer, Justin K.

AU - Kelly, Michael

AU - Hamilton, D. Kojo

AU - Gupta, Munish

AU - Deviren, Vedat

AU - Hostin, Richard

AU - Albert, Todd

AU - Riew, K. Daniel

AU - Hart, Robert

AU - Burton, Doug

AU - Bess, Shay

AU - Ames, Christopher P.

AU - on behalf of the International Spine Study Group, behalf of the International Spine Study Group

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N2 - 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 (P =.004) and to have undergone a posterior-only procedure (P =.039), had greater Charlson Comorbidity Index (P =.009), and had worse postoperative C7-S1 sagittal vertical axis (SVA; P =.027). For NP-NRS, compared with best outcome patients (n = 26), worst outcome patients (n = 18) were younger (P =.045), had worse baseline NP-NRS (P =.034), and were more likely to have had a minor complication (P =.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 (P =.007) and to have a better baseline mJOA (P =.030). Multivariate models for NDI included posterior-only surgery (P =.006), major complication (P =.002), and postoperative C7-S1 SVA (P =.012); models for NP-NRS included baseline NP-NRS (P =.009), age (P =.017), and posterior-only surgery (P =.038); and models for mJOA included major complication (P =.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.

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