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Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients

OBJECTIVE: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied. METHODS: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-yea...

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Autores principales: Passias, Peter G., Pierce, Katherine E., Kummer, Nicholas, Krol, Oscar, Passfall, Lara, Janjua, M. Burhan, Sciubba, Daniel, Ahmad, Waleed, Naessig, Sara, Diebo, Bassel
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Korean Spinal Neurosurgery Society 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497248/
https://www.ncbi.nlm.nih.gov/pubmed/34610694
http://dx.doi.org/10.14245/ns.2040456.228
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author Passias, Peter G.
Pierce, Katherine E.
Kummer, Nicholas
Krol, Oscar
Passfall, Lara
Janjua, M. Burhan
Sciubba, Daniel
Ahmad, Waleed
Naessig, Sara
Diebo, Bassel
author_facet Passias, Peter G.
Pierce, Katherine E.
Kummer, Nicholas
Krol, Oscar
Passfall, Lara
Janjua, M. Burhan
Sciubba, Daniel
Ahmad, Waleed
Naessig, Sara
Diebo, Bassel
author_sort Passias, Peter G.
collection PubMed
description OBJECTIVE: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied. METHODS: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA = 18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes. RESULTS: One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m(2)) with a BL mJOA score of 12.8±2.7 and mean TS-CL of 25.9°±16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p=0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p<0.001). Neurologic exam factors were greater in severe myelopathy (p<0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p=0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p=0.004), EQ-5D (p=0.028), Numerical Rating Scale neck (p=0.046), and MCID for NDI (p=0.001). CONCLUSION: Addressing severe deformity had increased clinical weight in improving patient-reported outcomes compared to addressing severe myelopathy.
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spelling pubmed-84972482021-10-15 Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients Passias, Peter G. Pierce, Katherine E. Kummer, Nicholas Krol, Oscar Passfall, Lara Janjua, M. Burhan Sciubba, Daniel Ahmad, Waleed Naessig, Sara Diebo, Bassel Neurospine Original Article OBJECTIVE: Malalignment of the cervical spine can result in cord compression, leading to a myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied. METHODS: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA = 18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes. RESULTS: One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m(2)) with a BL mJOA score of 12.8±2.7 and mean TS-CL of 25.9°±16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p=0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p<0.001). Neurologic exam factors were greater in severe myelopathy (p<0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p=0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p=0.004), EQ-5D (p=0.028), Numerical Rating Scale neck (p=0.046), and MCID for NDI (p=0.001). CONCLUSION: Addressing severe deformity had increased clinical weight in improving patient-reported outcomes compared to addressing severe myelopathy. Korean Spinal Neurosurgery Society 2021-09 2021-09-30 /pmc/articles/PMC8497248/ /pubmed/34610694 http://dx.doi.org/10.14245/ns.2040456.228 Text en Copyright © 2021 by the Korean Spinal Neurosurgery Society https://creativecommons.org/licenses/by-nc/4.0/This is an open access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/ (https://creativecommons.org/licenses/by-nc/4.0/) ) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Original Article
Passias, Peter G.
Pierce, Katherine E.
Kummer, Nicholas
Krol, Oscar
Passfall, Lara
Janjua, M. Burhan
Sciubba, Daniel
Ahmad, Waleed
Naessig, Sara
Diebo, Bassel
Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients
title Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients
title_full Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients
title_fullStr Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients
title_full_unstemmed Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients
title_short Impact of Myelopathy Severity and Degree of Deformity on Postoperative Outcomes in Cervical Spinal Deformity Patients
title_sort impact of myelopathy severity and degree of deformity on postoperative outcomes in cervical spinal deformity patients
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8497248/
https://www.ncbi.nlm.nih.gov/pubmed/34610694
http://dx.doi.org/10.14245/ns.2040456.228
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