(AS2) Critical Analysis of the Presence of Spinal Cord Dysfunction Among Adult Cervical Deformity at Presentation and the Effect of Corrective Surgery on Resolution of Symptoms
Director of Spinal Deformities Program Hoag Spine Institute Irvine, United States
Disclosure(s):
Peter G. Passias, MD: Cerapedics: Consultant (Ongoing); Globus Medical: Consultant (Ongoing); Journal of Neurosurgery: Spine: Board Member/Officer/Trustee (Ongoing); Medtronic: Consultant (Ongoing); Nuvasive: Consultant (Ongoing); Royal Biologics: Consultant (Ongoing); Spine: Board Member/Officer/Trustee (Ongoing); Terumo: Consultant (Ongoing)
Introduction: The impact and prevalence of myelopathy due to spinal cord dysfunction in adult cervical deformity surgery remains understudied.
Methods: CD patients ≥18 years old with complete baseline (BL) and 3M post-operative HRQL and radiographic data. Patient baseline and post-operative myelopathy signs and symptoms were assessed. Mild myelopathy was defined as mJOA 15-17, Moderate 12-14, and Severe < 12. Means comparison tests assessed baseline clinical, radiographic, and demographic factors between patients with severe and mild/moderate myelopathy. One way ANOVA analyzed BL and post-operative myelopathy/improvements among morphotypes.
Results: 127 CD patients met inclusion. 30% had mild, 31% had moderate, and 22% had severe myelopathy. Patients with severe myelopathy were more frail, with greater comorbidity burden, disability, and BL deformity (TS-CL [46 vs35], CL [16 vs 3] all p < .05). After surgical intervention, 69% of patients had resolution of neurological symptoms, and 38% improved in degree of myelopathy. (Post-operative myelopathy: 33% mild, 37% moderate, and 15% severe). Patients with severe myelopathy showed improvements in NDI (54 to 45) and mJOA (10 to 12), however, maintained greater disability (45 vs 34) and myelopathy when compared to mild/moderate patients p < .05. Based on 90 patients with morphotype data, Focal(F) patients had the highest rates of severe BL myelopathy (50% vs Coronal(C):40%, Flatneck(FN): 14%, Cervicothoracic(CT): 14%, p=.03), and comparable rates of improved BL neuro symptoms (CT [58%], FN[57%], F[54%], C[50%], p=.59). C patients (75%), followed by FN (57%) showed the highest rates of achieving good clinical outcome (CT [35%], F [42%], p=.15).
Conclusion : Surgical correction shows substantial efficacy in resolution of myelopathy and improvements in functional status among adult cervical deformity patients, however, patients with a high degree of myelopathy maintained a greater disability and neurological impairment post-operatively. Patients with a Focal or Coronal deformity sub-type were found to have the greatest burden of myelopathic symptoms.
