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Concomitant cervical positive alignment strongly associated with inferior outcomes
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Researchers of this retrospective review found adult patients with thoracolumbar deformity and concomitant cervical positive alignment experienced inferior outcomes and failure to reach a minimum clinically important difference at 2-year follow-up compared with patients who do not have cervical deformity.
Researchers conducted the review of a multicenter prospective database of 182 patients with adult spinal deformity who underwent surgical treatment and had 2-year follow-up. The patients were grouped by the presence of preoperative cervical deformity (CD) into four subgroups. Patients were grouped by those with cervical positive sagittal malalignment (CPSM) C2-7 sagittal vertical axis greater than or equal to 4 cm, those with cervical kyphosis (CK) C2-7 with greater than a 0° angle, those with both CPSM and CK (BOTH), and finally those with no baseline CD (NONE).
Researchers used Mental Component Summary (MCS) and Physical Component Summary (PCS) scores, Oswestry Disability Index (ODI), health-related quality of life (HRQoL) and Scoliosis Research Society-22 questionnaire (SRS-22) scores, and minimum clinically important difference (MCID) at 2-year follow-up as primary outcome measures.
In all, 45 patients were included in the CPSM group; 37 patients were in the CK group; 16 patients were in the BOTH group; and 84 patients were in the NONE group. Researchers noted patients with preoperative CD and those without had similar baseline thoracolumbar measurements and similar correction rates at 2 years. In addition, those with and those without preoperative CD had similar baseline HRQoL, and the CPSM, CK and NONE groups all experienced at least some HRQoL improvement. However, at 2-year follow-up, the CPSM group had worse mean HRQoL scores compared with the NONE group for ODI, PCS, SRS-22 activity, pain, appearance, satisfaction and SRS-22 total score. There were no significant differences in 2-year mean HRQoL scores between the CK and NONE groups, researchers noted.
Patients with preoperative CPSM were significantly less likely to reach 2-year MCDI for ODI, PCS, SRS-22 activity, pain and appearance than the NONE group.
“Concomitant 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 compared with patients without CD. This is despite having similar baseline HRQOL and experiencing significant improvements in HRQoL scores as well as sagittal thoracolumbar radiographic correction,” researchers concluded in the study. – by Robert Linnehan
Disclosure: Researchers report funding for the International Spine Study Group Foundation, through which this study was conducted, was obtained through research grants from DePuy Spine and individual donations.
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