Lightning Podiums: Adult Spinal Deformity - Room 801A

Presented by: P. Passias

Author(s):

P. Passias(1), G. Poorman(1), V. Lafage(2), J. Smith(3), C. Ames(4), C. Shaffrey(5), S. Horn(1), C. Wang(1), C. Varlotta(1), C. Bortz(1), F. Segreto(1), N. Stekas(1), R. Hart(6), D. Burton(7), R. Lafage(2), S. Bess(8), D. Sciubba(9), International Spine Study Group

(1) New York University Langone Orthopedic Hospital, Division of Spinal Surgery, New York, NY, United States
(2) Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, NY, United States
(3) University of Virginia, Department of Neurosurgery, Charlottesville, VA, United States
(4) University of California San Francisco, Department of Neurosurgery, San Francisco, CA, United States
(5) University of Virginia, Department of Orthopaedic Surgery, Charlottesville, VA, United States
(6) Swedish Neuroscience Institute, Department of Orthopaedic Surgery, Seattle, WA, United States
(7) University of Kansas Medical Center, Department of Orthopaedic Surgery, Kansas City, KS, United States
(8) Denver International Spine Center, Department of Orthopaedic Surgery, Denver, CO, United States
(9) Johns Hopkins University, Department of Neurosurgery, Baltimore, MD, United States

Abstract

Introduction: Surgeons often must decide, in correcting deformities, the etiology of multiple curvatures in planning surgical intervention. The relative quality-of-life burden of cervical and thoracolumbar deformities has never been compared to each other. This may have significant implications in deciding treatment intervention on patients with both thoracolumbar and cervical deformities. The goal of this study was to determine the relative quality-of-life burden in patients with uncompensated cervical, thoracolumbar, or cervical and thoracolumbar deformities.

Methods: Retrospective analysis of two prospectively collected multi-center databases. C2-C7 SVA >4cm defined cervical deformity and C7-S1 SVA >5cm defined thoracolumbar deformity. Patients with both SVA criteria were defined as "both", and were compared to pure cervical and pure thoracolumbar sagittal deformities. Primary analysis compared patients, keeping different region groups separate, by demographic, comorbidity data, and quality of life scores (EQ-5D) between groups using t-tests. A secondary analysis merged both treatment groups with propensity scores matching based on baseline EQ-5D scores according to cervical, thoracolumbar, and both malalignment. Differences in disease-specific metrics (ODI, NDI, mJOA) were analyzed using ANOVA tests.

Results: 190 patients were included in our analysis. Gender (56.3%) and age (63.5 yrs) did not differ significantly by sagittal deformity category. BMI was significantly higher in patients with both cervical and thoracolumbar deformities (p=0.037). Baseline EQ-5D score was lower in patients with both deformities (p=0.022). In patients diagnosed and treated for cervical deformity, the "both" subgroup had a significantly higher comorbidity burden (p=0.017). Quality-of-life analysis between these subgroups revealed the lowest mJOA score in the "both" cohort (p=0.006). In patients diagnosed and treated for thoracolumbar deformity, the "both" cohort exhibited the highest comorbidities (p=0.014) and demonstrated the highest BMI (p=0.039). Matching patients from both databases based on baseline EQ-5D scores created deformity groups with similar quality of life burden. Cervical deformity patients had fewer comorbidities (p=0.000), while "both" patients had more baseline neurological impairment, as measured by the mJOA score (p=0.026). However, there were no significant differences in terms of ODI and NDI scoring (p=0.884 and p=0.496, respectively). Cervical deformity patients tended to be younger and had fewer posterior levels fused, although these values did not reach statistical significance (p=0.059 and p=0.062, respectively).

Conclusions: In this study, spinal deformity patients with both cervical and thoracolumbar malalignment were associated with the lowest quality-of-life scores. Additionally, patients who met criteria for cervical deformity tended to be younger with lower comorbidities despite similar baseline quality-of-life scores, possibly suggesting a significant impact of cervical malalignment on disability presenting at an earlier age. Collectively, these findings suggest an additive effect of cervical sagittal malalignment on thoracolumbar deformity resulting in increasing disability.