Does the Presence of Cervical Deformity in Patients with Baseline Mild Myelopathy Increase Operative Urgency in Adult Cervical Spinal Surgery?: A Retrospective Analysis

Introduction: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis in conjunction with pain, loss of function, and neurological sequelae. However, it remains difficult to assess if cervical deformity within the presence of mild myelopathy necessitates surgical treatment, or if non-operative treatment is sufficient.

Methods: CD patients ≥18yrs with baseline diagnoses of mild myelopathy with pre-(BL) and up to two-year (2Y) data were assessed, categorized as having cervical deformity (CD) or not (CD-) at baseline. Time to surgery was calculated as the days between initial BL visit and date of surgery. Patients with myelopathy symptoms extending greater than 1Y prior to surgery were considered delayed. Means comparison and multivariate regression analysis assessed correlations between increasing time to surgery and outcomes adjusting for BL age and frailty.

Results: 106 patients were included (58.11 ± 11.97 years, 48% female); 22 (20.8%) were CD-, while 84 (79.2%) were CD+. Overall, 9.5% of patients were considered to have delayed surgery. Linear regression revealed that both CD- and CD+ patients were more likely to require reoperation with increased time between initial visit and surgical admission (p < .001). Yet, for CD+ patients, adjusted logistic regression revealed that increasing time to surgery resulted in increased chance of major complication (p < .001). Conversely, CD+ patients who were operated on within 30 days of initial visit reported significantly lowered risk of major complication overall (p=.022), and lowered risk of reoperation (p=.043), even when controlling for the severity of deformity based upon baseline TS-CL.

Conclusion : The findings of the present study demonstrates that by delaying the time to surgery after initial visit, the risk of major complication or reoperation rise significantly in patients with cervical deformity and with mild baseline myelopathy. As such, operative treatment may present greater stability and lessened risk of deterioration of symptoms over time.