Patients With Preoperative Cervical Deformity Experience Similar Clinical Outcomes to Those Without Deformity Following 1-3 Level Anterior Cervical Decompression and Fusion.

Autor:	Karamian BA; Rothman Orthopaedic Institute at Thomas Jefferson University., Mao JZ; Rothman Orthopaedic Institute at Thomas Jefferson University., Viola A 3rd; Philadelphia College of Osteopathic Medicine, Philadelphia, PA., Ju DG; Rothman Orthopaedic Institute at Thomas Jefferson University., Canseco JA; Rothman Orthopaedic Institute at Thomas Jefferson University., Toci GR; Rothman Orthopaedic Institute at Thomas Jefferson University., Bowles DR; Rothman Orthopaedic Institute at Thomas Jefferson University., Reiter DM; Rothman Orthopaedic Institute at Thomas Jefferson University., Semenza NC; Rothman Orthopaedic Institute at Thomas Jefferson University., Woods BI; Rothman Orthopaedic Institute at Thomas Jefferson University., Lee JK; Rothman Orthopaedic Institute at Thomas Jefferson University., Hilibrand AS; Rothman Orthopaedic Institute at Thomas Jefferson University., Kaye ID; Rothman Orthopaedic Institute at Thomas Jefferson University., Kepler CK; Rothman Orthopaedic Institute at Thomas Jefferson University., Vaccaro AR; Rothman Orthopaedic Institute at Thomas Jefferson University., Schroeder GD; Rothman Orthopaedic Institute at Thomas Jefferson University.
Jazyk:	angličtina
Zdroj:	Clinical spine surgery [Clin Spine Surg] 2022 Jun 01; Vol. 35 (5), pp. E466-E472. Date of Electronic Publication: 2021 Dec 20.
DOI:	10.1097/BSD.0000000000001291
Abstrakt:	Study Design: Retrospective cohort study. Objective: The aim was to compare the outcomes of patients with incompletely corrected cervical deformity against those without deformity following short-segment anterior cervical decompression and fusion for clinically significant radiculopathy or myelopathy. Summary of Background Data: Cervical deformity has increasingly been recognized as a driver of disability and has been linked to worse patient-reported outcomes measures (PROMs) after surgery. Methods: Patients 18 years or above who underwent 1-3 level anterior cervical decompression and fusion to address radiculopathy and/or myelopathy at a single institution between 2014 and 2018 with at least 1 year of PROMs were reviewed. Patients were categorized based on cervical deformity into 2 groups: sagittal vertebral axis (cSVA) ≥40 mm as the deformity group, and cSVA <40 mm as the nondeformity group. Patient demographics, surgical parameters, preoperative and postoperative radiographs, and minimum 1-year PROMs were compared. Results: Of the 230 patients, 191 (83%) were in the nondeformity group and 39 (17%) in the deformity group. Patients with deformity were more likely to be male (69.2% vs. 40.3%, P<0.001) and have a greater body mass index (32.8 vs. 29.7, P=0.028). The deformity group had significantly greater postoperative cSVA (44.2 vs. 25.1 mm, P<0.001) but also had significantly greater ∆cSVA (-4.87 vs. 0.25 mm, P=0.007) than the nondeformity group. Both groups had significant improvements in visual analog scale arm, visual analog scale neck, Short-Form 12 Physical Component Score, and neck disability index (NDI) (P<0.001). However, the deformity group experienced significantly greater ∆NDI and ∆mental component score (MCS)-12 scores (-19.45 vs. -11.11, P=0.027 and 7.68 vs. 1.32, P=0.009). Conclusions: Patients with preoperative cervical sagittal deformity experienced relatively greater improvements in NDI and MCS-12 scores than those without preoperative deformity. These results suggest that complete correction of sagittal alignment is not required for patients to achieve significant clinical improvement. Level of Evidence: III. Competing Interests: Dr Schroeder has received funds to travel from AOSpine and Medtronic. Dr Vaccaro has consulted or has done independent contracting for DePuy, Medtronic, Stryker Spine, Globus, Stout Medical, Gerson Lehrman Group, Guidepoint Global, Medacorp, Innovative Surgical Design, Orthobullets, Ellipse, and Vertex. He has also served on the scientific advisory board/board of directors/committees for Flagship Surgical, AO Spine, Innovative Surgical Design, and Association of Collaborative Spine Research. Dr Vaccaro has received royalty payments from Medtronic, Stryker Spine, Globus, Aesculap, Thieme, Jaypee, Elsevier, and Taylor Francis/Hodder and Stoughton. He has stock/stock option ownership interests in Replication Medica, Globus, Paradigm Spine, Stout Medical, Progressive Spinal Technologies, Advanced Spinal Intellectual Properties, Spine Medica, Computational Biodynamics, Spinology, In Vivo, Flagship Surgical, Cytonics, Bonovo Orthopaedics, Electrocore, Gamma Spine, Location Based Intelligence, FlowPharma, R.S.I., Rothman Institute and Related Properties, Innovative Surgical Design, and Avaz Surgical. He has also served as deputy editor/editor of Spine. In addition, Dr Vaccaro has also provided expert testimony. He has also served as deputy editor/editor of Clinical Spine Surgery. The remaining authors declare no conflict of interest. (Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.)
Databáze:	MEDLINE
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