320 - Does Myelopathy or Alignment Improvement Drive Acute Post-operative Ou...

#320 Does Myelopathy or Alignment Improvement Drive Acute Post-operative Outcomes in Cervical Deformity Patients?

Value and Outcomes in Spine Surgery

Poster Presented by: P. Passias


P. Passias (1)
C. Jalai (1)
J. Smith (2)
S. Horn (1)
G. Poorman (1)
B. Beaubrun (1)
P. Zhou (1)
T. Protopsaltis (1)
B. Neuman (3)
D. Sciubba (4)
B. Diebo (5)
R. Lafage (6)
V. Lafage (6)
C. Ames (7)
C. Shaffrey (2)
International Spine Study Group

(1) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
(2) University of Virginia Medical Center, Neurosurgery, Charlottesville, VA, United States
(3) Johns Hopkins University School of Medicine, Orthopaedic Surgery, Baltimore, MD, United States
(4) Johns Hopkins University School of Medicine, Neurosurgery, Baltimore, MD, United States
(5) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(6) Hospital for Special Surgery, New York, NY, United States
(7) University of California at San Francisco, Neurological Surgery, San Francisco, CA, United States


Background: Surgical correction for cervical spine deformity (CSD) typically involves both radiographic malalignment correction, as well as nerve decompression for pain and motor skill improvement. It is unclear though whether acute patient outcomes are more driven by myelopathy or alignment improvements.

Purpose: Determine whether meeting targeted cervical alignment goals or reaching clinically relevant modified Japanese Orthopaedic Association (mJOA) score improvements drive overall patient outcomes following CSD surgery.

Study Design/Setting: Retrospective review of a prospective multi-center database.

Patient Sample: 69 patients with CSD met inclusion criteria.

Outcome Measures: 3 month EuroQOL five dimensions questionnaire (EQ-5D).

Methods: Inclusion: CSD patients ≥18yrs with pre/post-op radiographs and outcome scores. Cervical alignment improvement was determined by ranking patients´ pre- and post-operative cSVA and T1S-CL according to the following ranges: 0≤cSVA≤40mm, 0≤T1S-CL≤20°. Patients were divided into 4 groups based on BL-3M differences in myelopathy scores and cervical alignment: M: mJOA improvement only; A: Alignment improvement only; B: improvement in both categories; N: improvement in neither category. MJOA improvement was determined with previously published MCID values. At baseline, mJOA scores were ranked on severity (Mild [15-17]/Moderate [12-14]/Severe [< 12]). Bivariate correlations, independent t-tests, and ANOVA compared BL and 3M EQ5D scores between groups.

Results: Overall pre-operative mJOA score (r=-0.482, p< 0.001) and scores in the ´moderate´ (mJOA 15-17) category (r=-0.454, p=0.017) Were significantly correlated with baseline EQ5D. At 3M, mJOA was also correlated (r=-0.281, p=0.021) with EQ5D scores. Among pre-operative cSVA and T1S-CL, only cSVA was moderately correlated with baseline EQ5D (r=0.256, p=0.05), and either dichotomous alignment groups did not with 3M EQ5D. The change in mJOA from BL-3M was also significantly correlated with 3M EQ5D score (r=0.295, p=0.021). At 3M, 13 patients (%) reached MCID for mJOA. There were a total of 22 patients (31.9%) that improved in post-operative cervical alignment categories. The distribution of patients in improvement groups based on BL-3M changes were as follows: ´M´ (n=7), ´A´ (n=15), ´B´ (n=4), ´N´ (n=28). The pre-operative EQ5D scores among the improvement groups were all statistically similar (p>0.05 all cases). At 3M, the EQ5D score was significantly better only in the ´B´ patient group compared to the other improvement groups (p=0.33): ´M´: 43.57 ± 27.50; ´A´: 71.13 ± 22.27; ´B´: 36.25 ± 37.72; ´N´: 62.15 ± 24.75.

Conclusions: Patients that reach post-operative alignment and myelopathy improvement goals displayed better overall outcomes compared to those that only improved in selective categories. Pre-operative planning to take such factors into account is important for optimizing outcomes following CSD correction. Levels of Evidence: III