PMID- 26360147 OWN - NLM STAT- MEDLINE DCOM- 20160517 LR - 20220318 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 24 IP - 1 DP - 2016 Jan TI - Association between preoperative cervical sagittal deformity and inferior outcomes at 2-year follow-up in patients with adult thoracolumbar deformity: analysis of 182 patients. PG - 108-15 LID - 10.3171/2015.3.SPINE141098 [doi] AB - OBJECTIVE: A high prevalence of cervical deformity (CD) has been identified among adult patients with thoracolumbar spinal deformity undergoing surgical treatment. The clinical impact of this is uncertain. This study aimed to quantify the differences in patient-reported outcomes among patients with adult spinal deformity (ASD) based on presence of CD prior to treatment. METHODS: A retrospective review was conducted of a multicenter prospective database of patients with ASD who underwent surgical treatment with 2-year follow-up. Patients were grouped by the presence of preoperative CD: 1) cervical positive sagittal malalignment (CPSM) C2-7 sagittal vertical axis >/= 4 cm; 2) cervical kyphosis (CK) C2-7 angle > 0; 3) CPSM and CK (BOTH); and 4) no baseline CD (NONE). Health-related quality of life (HRQOL) scores included the Physical Component Summary and Mental Component Summary (PCS and MCS) scores of the 36-Item Short Form Health Survey (SF-36), Oswestry Disability Index (ODI), Scoliosis Research Society-22 questionnaire (SRS-22), and minimum clinically important difference (MCID) of these scores at 2 years. Standard radiographic measurements were conducted for cervical, thoracic, and thoracolumbar parameters. RESULTS: One hundred eighty-two patients were included in this study: CPSM, 45; CK, 37; BOTH, 16; and NONE, 84. Patients with preoperative CD and those without had similar baseline thoracolumbar radiographic measurements and similar correction rates at 2 years. Patients with and without preoperative CD had similar baseline HRQOL and on average both groups experienced some HRQOL improvement. However, those with preoperative CPSM had significantly worse postoperative ODI, PCS, SRS-22 Activity, SRS-22 Appearance, SRS-22 Pain, SRS-22 Satisfaction, and SRS-22 Total score, and were less likely to meet MCID for ODI, PCS, SRS-22 Activity, and SRS-22 Pain scores with the following ORs and 95% CIs: ODI 0.19 (0.07-0.58), PCS 0.17 (0.06-0.47), SRS-22 Activity 0.23 (0.09-0.62), SRS-22 Pain 0.20 (0.08-0.53), and SRS-22 Appearance 0.34 (0.12-0.94). Preoperative CK did not have an effect on outcomes. Interestingly, despite correction of the thoracolumbar deformity, 53.3% and 51.4% of patients had persistent CPSM and persistent CK, respectively. CONCLUSIONS: Patients with thoracolumbar deformity without preoperative CD are likely to have greater improvements in HRQOL after surgery than patients with concomitant preoperative CD. Cervical positive sagittal alignment in adult patients with thoracolumbar deformity is strongly associated with inferior outcomes and failure to reach MCID at 2-year follow-up despite having similar baseline HRQOL to patients without CD. This was the first study to assess the impact of concomitant preoperative cervical malalignment in adult patients with thoracolumbar deformity. These results can help surgeons educate patients at risk for inferior outcomes and direct future research to identify an etiology and improve patient outcomes. Investigation into the etiology of the baseline cervical malalignment may be warranted in patients who present with thoracolumbar deformity. FAU - Scheer, Justin K AU - Scheer JK AD - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; FAU - Passias, Peter G AU - Passias PG AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; FAU - Sorocean, Alexandra M AU - Sorocean AM AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; FAU - Boniello, Anthony J AU - Boniello AJ AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; FAU - Mundis, Gregory M Jr AU - Mundis GM Jr AD - San Diego Center for Spinal Disorders, La Jolla; FAU - Klineberg, Eric AU - Klineberg E AD - Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California; FAU - Kim, Han Jo AU - Kim HJ AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York; FAU - Protopsaltis, Themistocles S AU - Protopsaltis TS AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; FAU - Gupta, Munish AU - Gupta M AD - Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California; FAU - Bess, Shay AU - Bess S AD - Rocky Mountain Hospital for Children, Denver, Colorado; FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and. FAU - Schwab, Frank AU - Schwab F AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York; FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurological Surgery, University of California, San Francisco, California. CN - International Spine Study Group LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20150911 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Adult MH - Aged MH - Follow-Up Studies MH - Humans MH - Kyphosis/*surgery MH - Lordosis/*surgery MH - Middle Aged MH - Postoperative Period MH - *Quality of Life MH - Retrospective Studies MH - Scoliosis/*surgery MH - Thoracic Vertebrae/*surgery MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - ASA = American Society of Anesthesiologists OT - ASD = adult spinal deformity OT - BMI = body mass index OT - CCI = Charlson Comorbidity Index OT - CD = cervical deformity OT - CK = cervical kyphosis OT - CL = cervical lordosis OT - CPSM = cervical positive sagittal malalignment OT - EBL = estimated blood loss OT - HRQOL = health-related quality of life OT - LL = lumbar lordosis OT - LOS = length of hospital stay OT - MCID = minimum clinically important difference OT - MCS = Mental Component Summary OT - ODI = Oswestry Disability Index OT - PCS = Physical Component Summary OT - PI-LL = mismatch between pelvic incidence and lumbar lordosis OT - PT = pelvic tilt OT - SF-36 = 36-Item Short Form Health Survey OT - SRS-22 = Scoliosis Research Society-22 questionnaire OT - SVA = sagittal vertical axis OT - T1S = T-1 slope OT - T1S-CL = mismatch between T-1 slope and cervical lordosis OT - TK = thoracic kyphosis OT - adult spinal deformity OT - cervical deformity OT - cervical sagittal alignment OT - cervical sagittal vertical axis OT - health-related quality of life OT - minimum clinically important difference EDAT- 2015/09/12 06:00 MHDA- 2016/05/18 06:00 CRDT- 2015/09/12 06:00 PHST- 2015/09/12 06:00 [entrez] PHST- 2015/09/12 06:00 [pubmed] PHST- 2016/05/18 06:00 [medline] AID - 10.3171/2015.3.SPINE141098 [doi] PST - ppublish SO - J Neurosurg Spine. 2016 Jan;24(1):108-15. doi: 10.3171/2015.3.SPINE141098. Epub 2015 Sep 11.