Postoperative Cervical Deformity in 215 Thoracolumbar Patients with Adult Spinal Deformity: Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-up

Peter G. Passias, Alex Soroceanu, Justin Smith, Anthony Boniello, Sun Yang, Justin K. Scheer, Frank Schwab, Christopher Shaffrey, Han Jo Kim, Themistocles Protopsaltis, Gregory Mundis, Munish Gupta, Eric Otto Klineberg, Virginie Lafage, Christopher Ames

Research output: Contribution to journalArticle

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Abstract

Study Design. Retrospective review of prospective multicenter database. Objective. Quantify the incidence of new onset cervical deformity (CD) after adult spinal deformity surgery of the thoracolumbar spine, identify predictors of development, and determine the impact on outcomes. Summary of Background Data. High prevalence of residual CD has been identified after surgical treatment of adult spinal deformity. Development of new onset CD is less understood and its clinical impact unclear. Methods. A total of 215 patients with complete 2-year follow-up and full-length radiographs met inclusion criteria. CD was defined by T1 slope minus Cervical Lordosis (CL) more than 20°, C2-C7 sagittal vertical axis more than 40 mm, or C2-C7 kyphosis more than 10°. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new onset CD. The impact of CD on health-related quality of life and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. Results. The overall rate of CD at 2 years after surgery was 63%. Univariate analysis revealed that patients who developed new onset CD postoperatively had higher incidence of diabetes (7.35% vs. 1.28%, P = 0.05), increased preoperative C2-C7 sagittal vertical axis (P = 0.04) and C2 slope (P = 0.038), and smaller diameter rods used at surgery (P = 0.032). Independent predictors of new onset CD at 2 years included: diabetes (odds ratio, 10.49; P = 0.046) and increased preoperative T1 slope minus cervical lordosis (odds ratio, 1.08/; P = 0.022). Ending instrumentation below T4 was a negative predictor (odds ratio, 0.31; P = 0.019). Patients with and without CD experienced improvements in 2-year 36-Item Short Form Health Survey (P = 0.0001), Oswestry Disability Index (P = 0.0001), and Scoliosis Research Society (P = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction (P = 0.28). Conclusion. A total of 47.7% of patients without preoperative CD developed new onset postoperative CD after thoracolumbar surgery. Independent predictors of new onset CD at 2 years included diabetes, higher preoperative T1 slope minus cervical lordosis, and ending instrumentation above T4. Significant improvements in health-related quality of life scores occurred despite the development of postoperative CD.

Original languageEnglish (US)
Pages (from-to)283-291
Number of pages9
JournalSpine
Volume40
Issue number5
DOIs
StatePublished - Mar 1 2015

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Lordosis
Odds Ratio
Logistic Models
Quality of Life
Kyphosis
Incidence
Scoliosis
Health Surveys
Spine
Databases
Patient Reported Outcome Measures
Research
Therapeutics

Keywords

  • adult deformity surgery
  • cervical deformity
  • HRQOL
  • incidence
  • outcome
  • predictors
  • satisfaction

ASJC Scopus subject areas

  • Clinical Neurology
  • Orthopedics and Sports Medicine
  • Medicine(all)

Cite this

Postoperative Cervical Deformity in 215 Thoracolumbar Patients with Adult Spinal Deformity : Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-up. / Passias, Peter G.; Soroceanu, Alex; Smith, Justin; Boniello, Anthony; Yang, Sun; Scheer, Justin K.; Schwab, Frank; Shaffrey, Christopher; Kim, Han Jo; Protopsaltis, Themistocles; Mundis, Gregory; Gupta, Munish; Klineberg, Eric Otto; Lafage, Virginie; Ames, Christopher.

In: Spine, Vol. 40, No. 5, 01.03.2015, p. 283-291.

Research output: Contribution to journalArticle

Passias, PG, Soroceanu, A, Smith, J, Boniello, A, Yang, S, Scheer, JK, Schwab, F, Shaffrey, C, Kim, HJ, Protopsaltis, T, Mundis, G, Gupta, M, Klineberg, EO, Lafage, V & Ames, C 2015, 'Postoperative Cervical Deformity in 215 Thoracolumbar Patients with Adult Spinal Deformity: Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-up', Spine, vol. 40, no. 5, pp. 283-291. https://doi.org/10.1097/BRS.0000000000000746
Passias, Peter G. ; Soroceanu, Alex ; Smith, Justin ; Boniello, Anthony ; Yang, Sun ; Scheer, Justin K. ; Schwab, Frank ; Shaffrey, Christopher ; Kim, Han Jo ; Protopsaltis, Themistocles ; Mundis, Gregory ; Gupta, Munish ; Klineberg, Eric Otto ; Lafage, Virginie ; Ames, Christopher. / Postoperative Cervical Deformity in 215 Thoracolumbar Patients with Adult Spinal Deformity : Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-up. In: Spine. 2015 ; Vol. 40, No. 5. pp. 283-291.
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title = "Postoperative Cervical Deformity in 215 Thoracolumbar Patients with Adult Spinal Deformity: Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-up",
abstract = "Study Design. Retrospective review of prospective multicenter database. Objective. Quantify the incidence of new onset cervical deformity (CD) after adult spinal deformity surgery of the thoracolumbar spine, identify predictors of development, and determine the impact on outcomes. Summary of Background Data. High prevalence of residual CD has been identified after surgical treatment of adult spinal deformity. Development of new onset CD is less understood and its clinical impact unclear. Methods. A total of 215 patients with complete 2-year follow-up and full-length radiographs met inclusion criteria. CD was defined by T1 slope minus Cervical Lordosis (CL) more than 20°, C2-C7 sagittal vertical axis more than 40 mm, or C2-C7 kyphosis more than 10°. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new onset CD. The impact of CD on health-related quality of life and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. Results. The overall rate of CD at 2 years after surgery was 63{\%}. Univariate analysis revealed that patients who developed new onset CD postoperatively had higher incidence of diabetes (7.35{\%} vs. 1.28{\%}, P = 0.05), increased preoperative C2-C7 sagittal vertical axis (P = 0.04) and C2 slope (P = 0.038), and smaller diameter rods used at surgery (P = 0.032). Independent predictors of new onset CD at 2 years included: diabetes (odds ratio, 10.49; P = 0.046) and increased preoperative T1 slope minus cervical lordosis (odds ratio, 1.08/; P = 0.022). Ending instrumentation below T4 was a negative predictor (odds ratio, 0.31; P = 0.019). Patients with and without CD experienced improvements in 2-year 36-Item Short Form Health Survey (P = 0.0001), Oswestry Disability Index (P = 0.0001), and Scoliosis Research Society (P = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction (P = 0.28). Conclusion. A total of 47.7{\%} of patients without preoperative CD developed new onset postoperative CD after thoracolumbar surgery. Independent predictors of new onset CD at 2 years included diabetes, higher preoperative T1 slope minus cervical lordosis, and ending instrumentation above T4. Significant improvements in health-related quality of life scores occurred despite the development of postoperative CD.",
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author = "Passias, {Peter G.} and Alex Soroceanu and Justin Smith and Anthony Boniello and Sun Yang and Scheer, {Justin K.} and Frank Schwab and Christopher Shaffrey and Kim, {Han Jo} and Themistocles Protopsaltis and Gregory Mundis and Munish Gupta and Klineberg, {Eric Otto} and Virginie Lafage and Christopher Ames",
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TY - JOUR

T1 - Postoperative Cervical Deformity in 215 Thoracolumbar Patients with Adult Spinal Deformity

T2 - Prevalence, Risk Factors, and Impact on Patient-Reported Outcome and Satisfaction at 2-Year Follow-up

AU - Passias, Peter G.

AU - Soroceanu, Alex

AU - Smith, Justin

AU - Boniello, Anthony

AU - Yang, Sun

AU - Scheer, Justin K.

AU - Schwab, Frank

AU - Shaffrey, Christopher

AU - Kim, Han Jo

AU - Protopsaltis, Themistocles

AU - Mundis, Gregory

AU - Gupta, Munish

AU - Klineberg, Eric Otto

AU - Lafage, Virginie

AU - Ames, Christopher

PY - 2015/3/1

Y1 - 2015/3/1

N2 - Study Design. Retrospective review of prospective multicenter database. Objective. Quantify the incidence of new onset cervical deformity (CD) after adult spinal deformity surgery of the thoracolumbar spine, identify predictors of development, and determine the impact on outcomes. Summary of Background Data. High prevalence of residual CD has been identified after surgical treatment of adult spinal deformity. Development of new onset CD is less understood and its clinical impact unclear. Methods. A total of 215 patients with complete 2-year follow-up and full-length radiographs met inclusion criteria. CD was defined by T1 slope minus Cervical Lordosis (CL) more than 20°, C2-C7 sagittal vertical axis more than 40 mm, or C2-C7 kyphosis more than 10°. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new onset CD. The impact of CD on health-related quality of life and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. Results. The overall rate of CD at 2 years after surgery was 63%. Univariate analysis revealed that patients who developed new onset CD postoperatively had higher incidence of diabetes (7.35% vs. 1.28%, P = 0.05), increased preoperative C2-C7 sagittal vertical axis (P = 0.04) and C2 slope (P = 0.038), and smaller diameter rods used at surgery (P = 0.032). Independent predictors of new onset CD at 2 years included: diabetes (odds ratio, 10.49; P = 0.046) and increased preoperative T1 slope minus cervical lordosis (odds ratio, 1.08/; P = 0.022). Ending instrumentation below T4 was a negative predictor (odds ratio, 0.31; P = 0.019). Patients with and without CD experienced improvements in 2-year 36-Item Short Form Health Survey (P = 0.0001), Oswestry Disability Index (P = 0.0001), and Scoliosis Research Society (P = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction (P = 0.28). Conclusion. A total of 47.7% of patients without preoperative CD developed new onset postoperative CD after thoracolumbar surgery. Independent predictors of new onset CD at 2 years included diabetes, higher preoperative T1 slope minus cervical lordosis, and ending instrumentation above T4. Significant improvements in health-related quality of life scores occurred despite the development of postoperative CD.

AB - Study Design. Retrospective review of prospective multicenter database. Objective. Quantify the incidence of new onset cervical deformity (CD) after adult spinal deformity surgery of the thoracolumbar spine, identify predictors of development, and determine the impact on outcomes. Summary of Background Data. High prevalence of residual CD has been identified after surgical treatment of adult spinal deformity. Development of new onset CD is less understood and its clinical impact unclear. Methods. A total of 215 patients with complete 2-year follow-up and full-length radiographs met inclusion criteria. CD was defined by T1 slope minus Cervical Lordosis (CL) more than 20°, C2-C7 sagittal vertical axis more than 40 mm, or C2-C7 kyphosis more than 10°. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new onset CD. The impact of CD on health-related quality of life and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders. Results. The overall rate of CD at 2 years after surgery was 63%. Univariate analysis revealed that patients who developed new onset CD postoperatively had higher incidence of diabetes (7.35% vs. 1.28%, P = 0.05), increased preoperative C2-C7 sagittal vertical axis (P = 0.04) and C2 slope (P = 0.038), and smaller diameter rods used at surgery (P = 0.032). Independent predictors of new onset CD at 2 years included: diabetes (odds ratio, 10.49; P = 0.046) and increased preoperative T1 slope minus cervical lordosis (odds ratio, 1.08/; P = 0.022). Ending instrumentation below T4 was a negative predictor (odds ratio, 0.31; P = 0.019). Patients with and without CD experienced improvements in 2-year 36-Item Short Form Health Survey (P = 0.0001), Oswestry Disability Index (P = 0.0001), and Scoliosis Research Society (P = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction (P = 0.28). Conclusion. A total of 47.7% of patients without preoperative CD developed new onset postoperative CD after thoracolumbar surgery. Independent predictors of new onset CD at 2 years included diabetes, higher preoperative T1 slope minus cervical lordosis, and ending instrumentation above T4. Significant improvements in health-related quality of life scores occurred despite the development of postoperative CD.

KW - adult deformity surgery

KW - cervical deformity

KW - HRQOL

KW - incidence

KW - outcome

KW - predictors

KW - satisfaction

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