PMID- 34610683 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20211016 IS - 2586-6583 (Print) IS - 2586-6591 (Electronic) IS - 2586-6591 (Linking) VI - 18 IP - 3 DP - 2021 Sep TI - Prioritization of Realignment Associated With Superior Clinical Outcomes for Cervical Deformity Patients. PG - 506-514 LID - 10.14245/ns.2040540.270 [doi] AB - OBJECTIVE: To prioritize the cervical parameter targets for alignment. METHODS: Included: cervical deformity (CD) patients (C2-7 Cobb angle > 10 degrees , cervical lordosis > 10 degrees , cervical sagittal vertical axis [cSVA] > 4 cm, or chin-brow vertical angle > 25 degrees ) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical [C] or cervicothoracic [CT] Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA ( < 4 cm) and T1 slope minus cervical lordosis (TS-CL) ( < 15 degrees ) were excluded. Patients assessed: meeting minimum clinically important differences (MCID) for NDI ( < -15 DeltaNDI). Ratios of correction were found for regional parameters categorized by primary Ames driver (C or CT). Decision tree analysis assessed cutoffs for differences associated with meeting NDI MCID at 1Y. RESULTS: Seventy-seven CD patients (mean age, 62.1 years; 64% female; body mass index, 28.8 kg/m2). Forty-one point six percent of patients met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1Y for meeting MCID for NDI demonstrated an R2 of 0.820 (p = 0.032) included TS-CL, cSVA, McGregor's slope (MGS), C2 sacral slope, C2-T3 angle, C2-T3 SVA, cervical lordosis. By primary Ames driver, 67.5% of patients were C, and 32.5% CT. Ratios of change in predictors for MCID NDI patients for C and CT were not significant between the 2 groups (p > 0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: >/= 42.5 degrees C2-T3 angle, > 35.4 degrees cervical lordosis, < -31.76 degrees C2 slope, < -11.57-mm cSVA, < -2.16 degrees MGS, > -30.8-mm C2-T3 SVA, and