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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;
- 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
- et al.
Published Web Location
https://doi.org/10.1177/2192568218794164Abstract
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.Many UC-authored scholarly publications are freely available on this site because of the UC's open access policies. Let us know how this access is important for you.
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