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Neurosurgery. 2018 Nov 1;83(5):1031-1039. doi: 10.1093/neuros/nyx574.

Outcomes of Operative Treatment for Adult Cervical Deformity: A Prospective Multicenter Assessment With 1-Year Follow-up.

Author information

1
Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
2
Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
3
Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
4
Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, La Jolla, California.
5
Department of Orthopaedic Surgery, Washington University, St Louis, Missouri.
6
Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California.
7
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
8
Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland.
9
Department of Orthopaedic Surgery, Brown University Alpert Medical School, Providence, Rhode Island.
10
Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois.
11
Department of Orthopaedics, University of Calgary, Calgary, Alberta, Canada.
12
Swedish Neuroscience Institute, Seattle, Washington.
13
Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas.
14
Department of Orthopaedics, University of Kansas Medical Center, Kansas City, Kansas.
15
Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California.
16
Department of Orthopaedic Surgery, Columbia University Medical Center, New York, New York.
17
Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado.
18
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.

Abstract

BACKGROUND:

Despite the potential for profound impact of adult cervical deformity (ACD) on function and health-related quality of life (HRQOL), there are few high-quality studies that assess outcomes of surgical treatment for these patients.

OBJECTIVE:

To determine the impact of surgical treatment for ACD on HRQOL.

METHODS:

We conducted a prospective cohort study of surgically treated ACD patients eligible for 1-yr follow-up. Baseline deformity characteristics, surgical parameters, and 1-yr HRQOL outcomes were assessed.

RESULTS:

Of 77 ACD patients, 55 (71%) had 1-yr follow-up (64% women, mean age of 62 yr, mean Charlson Comorbidity Index of 0.6, previous cervical surgery in 47%). Diagnoses included cervical sagittal imbalance (56%), cervical kyphosis (55%), proximal junctional kyphosis (7%) and coronal deformity (9%). Posterior fusion was performed in 85% (mean levels = 10), and anterior fusion was performed in 53% (mean levels = 5). Three-column osteotomy was performed in 24% of patients. One year following surgery, ACD patients had significant improvement in Neck Disability Index (50.5 to 38.0, P < .001), neck pain numeric rating scale score (6.9 to 4.3, P < .001), EuroQol 5 dimension (EQ-5D) index (0.51 to 0.66, P < .001), and EQ-5D subscores: mobility (1.9 to 1.7, P = .019), usual activities (2.2 to 1.9, P = .007), pain/discomfort (2.4 to 2.1, P < .001), anxiety/depression (1.8 to 1.5, P = .014).

CONCLUSION:

Based on a prospective multicenter series of ACD patients, surgical treatment provided significant improvement in multiple measures of pain and function, including Neck Disability Index, neck pain numeric rating scale score, and EQ-5D. Further follow-up will be necessary to assess the long-term durability of these improved outcomes.

PMID:
29281107
DOI:
10.1093/neuros/nyx574

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