Lightning Podiums: Cervical Degenerative - Room 802A

Presented by: C. Deflorimonte

Author(s):

P. Passias(1), S. Horn(1), C. Bortz(1), S. Ramachandran(1), D. Burton(2), T. Protopsaltis(1), R. Lafage(3), V. Lafage(3), B. Diebo(4), G. Poorman(1), F. Segreto(1), D. Ge(1), N. Frangella(1), J. Smith(5), C. Ames(6), C. Shaffrey(7), H.J. Kim(8), B. Neuman(9), A. Daniels(8), A. Soroceanu((1)0), E. Klineberg((1)(1)), International Spine Study Group

(1) New York University Langone Orthopedic Hospital, Division of Spinal Surgery, new york, NY, United States
(2) University of Kansas Medical Center, Department of Orthopedic Surgery, Kansas City, KS, United States
(3) Hospital for Special Surgery, Department of Orthopedics, New York, NY, United States
(4) SUNY Downstate Medical Center, Department of Orthopedics, Brooklyn, NY, United States
(5) University of Virginia, Department of Neurosurgery, Charlottesville, VA, United States
(6) University of California San Francisco, Department of Neurological Surgery, CA, United States
(7) University of Virginia, Charlottesville, VA, United States
(8) Hospital for Special Surgery, New York, NY, United States
(9) Johns Hopkins Medical Center, Baltimore, MD, United States
((1) 0) University of Calgary, Calgary, AB, Canada
((1) (1) ) University of California Davis, Davis, CA, United States

Abstract

Introduction: CD correction involves radiographic malalignment correction and procedures to improve motor function and pain. It is unknown whether alignment or myelopathy improvement drives patient outcomes. The aim of this study was to determine if alignment or myelopathy improvement drives patient outcomes following cervical deformity(CD) corrective surgery.

Methods: Retrospective review of multicenter database.Inclusion: CD patients with baseline/1-year radiographic and outcome scores. Cervical alignment improvement was defined by improvement in Ames CD modifiers. mJOA improvement was defined as: mild[15-17], moderate[12-14], severe[< 12]. Patient groups included those who only improved in alignment, those who only improved in mJOA, those who improved in both, and those who didn't improve. Changes in quality-of-life scores (NDI, EQ-5D, mJOA) were evaluated between groups.

Results: 70 patients(62yrs,51%F) were included. Overall pre-operative mJOA score was 13.04±2.35. At baseline, 21(30%) patients had mild myelopathy, 33(47%) moderate, and 16(23%) severe. 31/70(44%) patients improved in mJOA and 13(18.6%) met 1Y mJOA MCID. Distribution of improvement groups: 16/70(23%) alignment-only improvement, 13(19%) myelopathy-only improvement, 18(26%) alignment and myelopathy improvement, 23(33%) no improvement. EQ-5D improved in 11/16(69%) alignment-only patients, 11/18(61%) myelopathy/alignment improvement, 13/13(100%) myelopathy-only, and 10/23(44%) no myelopathy/alignment improvement. There weren't differences in decompression, baseline alignment, mJOA, EQ-5D or NDI between groups. Patients who improved only in myelopathy showed significant differences in baseline-1Y EQ-5D(baseline:0.74,1Y:0.83,p< 0.001). One-year C2-S1 SVA (mJOA r=-0.424,p=0.002; EQ-5D r=-0.261,p=0.050; NDI r=0.321,p=0.015) and C7-S1 SVA (mJOA r=-0.494,p< 0.001; EQ-5D r=-0.284,p=0.031; NDI r=0.334,p=0.010) were correlated with improvement in HRQLs.

Conclusions: Following CD-corrective surgery, improvements in myelopathy symptoms and functional score were associated with superior 1-year patient-reported outcomes. Although there were no relationships between cervical-specific sagittal parameters and patient outcomes, global parameters of C2-S1 SVA and C7-S1 SVA showed significant correlations with overall 1-year mJOA, EQ-5D, and NDI. These results highlight myelopathy improvement as a key driver of patient-reported outcomes, and confirm the importance of sagittal alignment in CD patients.