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: A substantial portion of adult spinal deformity patients presenting for surgery simultaneously suffer from cervical deformity. Cervical deformity may have a synergistic debilitating effect on patients. The additional impact of cervical deformity on adult spinal deformity patients and outcomes following surgery had not been adequately explored.
Methods: Operative ACD patients were included. Means comparison tests followed by bivariate analysis assessed differences in demographic, clinical, surgical, complication, post-operative alignment, durability of alignment and patient reported outcomes. IHS-adjusted PROMS were investigated as defined in the previous work of Passias et al.)
Results: 381 ASD patients included (Average age 61.1yrs). At BL, CD patients were older (61 vs 57), more frail (3.4 vs 2.8), had a higher CCI(1.7 vs 1.3), and rates of osteoporosis (23% vs 10%, all p < .05). CD patients had a higher ODI, lower SRS-Activity, SRS-Total, and SF-36 PCS (p < .05). CD patient had a larger TK (38 vs 29) and SVA(8.3 vs 4.3cm). Surgically, CD patients had an increased invasiveness, and usage of 3CO. Table 1. At two-year follow-up, CD patients showed worse clinical outcomes in ODI, SF-36 physical functioning and greater rates of PJF (14% vs 6%) and medical complications (22% vs 14%, p < .05). By two-years, CD patients maintained a greater degree of deformity in thoracic kyphosis T4-T12 (48 vs 41), SVA C2-C7 (3.6cm vs 2.8cm), SVA C7-S1 (3.7cm vs 2.7cm), and T1 slope (37 vs 28, all p < .05). IHS-Adjusted recovery kinetics show patients with CD had a worse overall recovery in their NRS Leg-Pain scores.
Conclusion : Patients with cervical deformity presenting for adult spinal deformity surgery are significantly older, more frail, with a greater number of comorbidities and degree of deformity. At two-year follow, patients with both cervical deformity and thoracolumbar deformity showed inferior patient reported outcomes and a higher degree of post-operative deformity.
