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Surgical outcomes in rigid versus flexible cervical deformities.

Publication ,  Journal Article
Protopsaltis, TS; Stekas, N; Smith, JS; Soroceanu, A; Lafage, R; Daniels, AH; Kim, HJ; Passias, PG; Mundis, GM; Klineberg, EO; Hamilton, DK ...
Published in: J Neurosurg Spine
February 12, 2021

OBJECTIVE: Cervical deformity (CD) patients have severe disability and poor health status. However, little is known about how patients with rigid CD compare with those with flexible CD. The main objectives of this study were to 1) assess whether patients with rigid CD have worse baseline alignment and therefore require more aggressive surgical corrections and 2) determine whether patients with rigid CD have similar postoperative outcomes as those with flexible CD. METHODS: This is a retrospective review of a prospective, multicenter CD database. Rigid CD was defined as cervical lordosis (CL) change < 10° between flexion and extension radiographs, and flexible CD was defined as a CL change ≥ 10°. Patients with rigid CD were compared with those with flexible CD in terms of cervical alignment and health-related quality of life (HRQOL) at baseline and at multiple postoperative time points. The patients were also compared in terms of surgical and intraoperative factors such as operative time, blood loss, and number of levels fused. RESULTS: A total of 127 patients met inclusion criteria (32 with rigid and 95 with flexible CD, 63.4% of whom were females; mean age 60.8 years; mean BMI 27.4); 47.2% of cases were revisions. Rigid CD was associated with worse preoperative alignment in terms of T1 slope minus CL, T1 slope, C2-7 sagittal vertical axis (cSVA), and C2 slope (C2S; all p < 0.05). Postoperatively, patients with rigid CD had an increased mean C2S (29.1° vs 22.2°) at 3 months and increased cSVA (47.1 mm vs 37.5 mm) at 1 year (p < 0.05) compared with those with flexible CD. Patients with rigid CD had more posterior levels fused (9.5 vs 6.3), fewer anterior levels fused (1 vs 2.0), greater blood loss (1036.7 mL vs 698.5 mL), more 3-column osteotomies (40.6% vs 12.6%), greater total osteotomy grade (6.5 vs 4.5), and mean osteotomy grade per level (3.3 vs 2.1) (p < 0.05 for all). There were no significant differences in baseline HRQOL scores, the rate of distal junctional kyphosis, or major/minor complications between patients with rigid and flexible CD. Both rigid and flexible CD patients reported significant improvements from baseline to 1 year according to the numeric rating scale for the neck (-2.4 and -2.7, respectively), Neck Disability Index (-8.4 and -13.3, respectively), modified Japanese Orthopaedic Association score (0.1 and 0.6), and EQ-5D (0.01 and 0.05) (p < 0.05). However, HRQOL changes from baseline to 1 year did not differ between rigid and flexible CD patients. CONCLUSIONS: Patients with rigid CD have worse baseline cervical malalignment compared with those with flexible CD but do not significantly differ in terms of baseline disability. Rigid CD was associated with more invasive surgery and more aggressive corrections, resulting in increased operative time and blood loss. Despite more extensive surgeries, rigid CD patients had equivalent improvements in HRQOL compared with flexible CD patients. This study quantifies the importance of analyzing flexion-extension images, creating a prognostic tool for surgeons planning CD correction, and counseling patients who are considering CD surgery.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

February 12, 2021

Volume

34

Issue

5

Start / End Page

716 / 724

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

Citation

APA
Chicago
ICMJE
MLA
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Protopsaltis, T. S., Stekas, N., Smith, J. S., Soroceanu, A., Lafage, R., Daniels, A. H., … Ames, C. P. (2021). Surgical outcomes in rigid versus flexible cervical deformities. J Neurosurg Spine, 34(5), 716–724. https://doi.org/10.3171/2020.8.SPINE191185
Protopsaltis, Themistocles S., Nicholas Stekas, Justin S. Smith, Alexandra Soroceanu, Renaud Lafage, Alan H. Daniels, Han Jo Kim, et al. “Surgical outcomes in rigid versus flexible cervical deformities.J Neurosurg Spine 34, no. 5 (February 12, 2021): 716–24. https://doi.org/10.3171/2020.8.SPINE191185.
Protopsaltis TS, Stekas N, Smith JS, Soroceanu A, Lafage R, Daniels AH, et al. Surgical outcomes in rigid versus flexible cervical deformities. J Neurosurg Spine. 2021 Feb 12;34(5):716–24.
Protopsaltis, Themistocles S., et al. “Surgical outcomes in rigid versus flexible cervical deformities.J Neurosurg Spine, vol. 34, no. 5, Feb. 2021, pp. 716–24. Pubmed, doi:10.3171/2020.8.SPINE191185.
Protopsaltis TS, Stekas N, Smith JS, Soroceanu A, Lafage R, Daniels AH, Kim HJ, Passias PG, Mundis GM, Klineberg EO, Hamilton DK, Gupta M, Lafage V, Hart RA, Schwab F, Burton DC, Bess S, Shaffrey CI, Ames CP. Surgical outcomes in rigid versus flexible cervical deformities. J Neurosurg Spine. 2021 Feb 12;34(5):716–724.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

February 12, 2021

Volume

34

Issue

5

Start / End Page

716 / 724

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences