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The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes.

Publication ,  Journal Article
Passias, PG; Horn, SR; Bortz, CA; Ramachandran, S; Burton, DC; Protopsaltis, T; Lafage, R; Lafage, V; Diebo, BG; Poorman, GW; Segreto, FA ...
Published in: Spine (Phila Pa 1976)
August 2018

STUDY DESIGN: Retrospective review. OBJECTIVE: Determine whether alignment or myelopathy improvement drives patient outcomes after cervical deformity (CD) corrective surgery. SUMMARY OF BACKGROUND DATA: CD correction involves radiographic malalignment correction and procedures to improve motor function and pain. It is unknown whether alignment or myelopathy improvement drives patient outcomes. METHODS: Inclusion: Patients with CD with baseline/1-year radiographic and outcome scores. Cervical alignment improvement was defined by improvement in Ames CD modifiers. modified Japanese Orthopaedic Association (mJOA) improvement was defined as mild [15-17], moderate [12-14], severe [<12]. Patient groups included those who only improved in alignment, those who only improved in mJOA, those who improved in both, and those who did not improve. Changes in quality-of-life scores (neck disability index [NDI], EuroQuol-5 dimensions [EQ-5D], mJOA) were evaluated between groups. RESULTS: A total of 70 patients (62 yr, 51% F) were included. Overall preoperative mJOA score was 13.04 ± 2.35. At baseline, 21 (30%) patients had mild myelopathy, 33 (47%) moderate, and 16 (23%) severe. Out of 70 patients 30 (44%) improved in mJOA and 13 (18.6%) met 1-year mJOA minimal clinically important difference. Distribution of improvement groups: 16/70 (23%) alignment-only improvement, 13 (19%) myelopathy-only improvement, 18 (26%) alignment and myelopathy improvement, and 23 (33%) no improvement. EQ-5D improved in 11 of 16 (69%) alignment-only patients, 11 of 18 (61%) myelopathy/alignment improvement, 13 of 13 (100%) myelopathy-only, and 10 of 23 (44%) no myelopathy/alignment improvement. There were no differences in decompression, baseline alignment, mJOA, EQ-5D, or NDI between groups. Patients who improved only in myelopathy showed significant differences in baseline-1Y EQ-5D (baseline: 0.74, 1 yr:0.83, P < 0.001). One-year C2-S1 sagittal vertical axis (SVA; mJOA r = -0.424, P = 0.002; EQ-5D r = -0.261, P = 0.050; NDI r = 0.321, P = 0.015) and C7-S1 SVA (mJOA r = -0.494, P < 0.001; EQ-5D r = -0.284, P = 0.031; NDI r = 0.334, P = 0.010) were correlated with improvement in health-related qualities of life. CONCLUSION: After CD-corrective surgery, improvements in myelopathy symptoms and functional score were associated with superior 1-year patient-reported outcomes. Although there were no relationships between cervical-specific sagittal parameters and patient outcomes, global parameters of C2-S1 SVA and C7-S1 SVA showed significant correlations with overall 1-year mJOA, EQ-5D, and NDI. These results highlight myelopathy improvement as a key driver of patient-reported outcomes, and confirm the importance of sagittal alignment in patients with CD. LEVEL OF EVIDENCE: 3.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

August 2018

Volume

43

Issue

16

Start / End Page

1117 / 1124

Location

United States

Related Subject Headings

  • Spinal Cord Diseases
  • Retrospective Studies
  • Quality of Life
  • Prospective Studies
  • Patient Reported Outcome Measures
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female
 

Citation

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Passias, P. G., Horn, S. R., Bortz, C. A., Ramachandran, S., Burton, D. C., Protopsaltis, T., … International Spine Study Group (ISSG), . (2018). The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes. Spine (Phila Pa 1976), 43(16), 1117–1124. https://doi.org/10.1097/BRS.0000000000002610
Passias, Peter Gust, Samantha R. Horn, Cole A. Bortz, Subaraman Ramachandran, Douglas C. Burton, Themistocles Protopsaltis, Renaud Lafage, et al. “The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes.Spine (Phila Pa 1976) 43, no. 16 (August 2018): 1117–24. https://doi.org/10.1097/BRS.0000000000002610.
Passias PG, Horn SR, Bortz CA, Ramachandran S, Burton DC, Protopsaltis T, et al. The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes. Spine (Phila Pa 1976). 2018 Aug;43(16):1117–24.
Passias, Peter Gust, et al. “The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes.Spine (Phila Pa 1976), vol. 43, no. 16, Aug. 2018, pp. 1117–24. Pubmed, doi:10.1097/BRS.0000000000002610.
Passias PG, Horn SR, Bortz CA, Ramachandran S, Burton DC, Protopsaltis T, Lafage R, Lafage V, Diebo BG, Poorman GW, Segreto FA, Smith JS, Ames C, Shaffrey CI, Kim HJ, Neuman B, Daniels AH, Soroceanu A, Klineberg E, International Spine Study Group (ISSG). The Relationship Between Improvements in Myelopathy and Sagittal Realignment in Cervical Deformity Surgery Outcomes. Spine (Phila Pa 1976). 2018 Aug;43(16):1117–1124.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

August 2018

Volume

43

Issue

16

Start / End Page

1117 / 1124

Location

United States

Related Subject Headings

  • Spinal Cord Diseases
  • Retrospective Studies
  • Quality of Life
  • Prospective Studies
  • Patient Reported Outcome Measures
  • Orthopedics
  • Middle Aged
  • Male
  • Humans
  • Female