Peter G Passias1, Cyrus M Jalai1, Nancy Worley1, Shaleen Vira1, Justin K Scheer2, Justin S Smith3, Subaraman Ramachandran1, Alexandra Soroceanu4, Samantha R Horn1, Gregory W Poorman1, Themistocles S Protopsaltis1, Eric O Klineberg5, Daniel M Sciubba6, Han Jo Kim7, D Kojo Hamilton8, Renaud Lafage7, Virginie Lafage7, Christopher P Ames9. 1. Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York. 2. School of Medicine, University of California, San Diego, La Jolla, California. 3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia. 4. Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada. 5. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California. 6. Department of Neurosurgery, The Johns Hopkins University, Baltimore, Maryland. 7. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. 8. Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania. 9. Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
Abstract
PURPOSE: Evaluate the presence of new-onset cervical deformity (CD) in nonoperative adult spinal deformity (ASD) patients with extended follow-up, with consideration for predictors, prevalence, and impact on patient-reported outcomes. METHODS: Retrospective review of a prospective nonoperative ASD cohort. New onset CD patients at 1- (CD-1Y) and 2-year (CD-2Y) follow-up were defined as displaying baseline cervical alignment. Univariate analyses determined differences in radiographic parameters and outcome scores of CD and maintained-cervical-alignment patients. Multivariate binary logistic regression models determined new-onset CD predictors. RESULTS: A total of 143 patients were included (mean age 54 years, mean body mass index 25.6 kg/m2, 86% female). Cervical deformity rate was 38.5% at baseline. New-onset CD incidence at 1- and 2-year follow-up was 30.0% and 41.7%, respectively. Global sagittal profile comparison of CD-1Y/CD-2Y versus maintained cervical alignment cases revealed no differences (P > .05) at any interval. Baseline C2-C7 sagittal vertical axis (SVA) was associated with increased new-onset CD risk at 1 (odds ratio [OR] 1.14, P = .025) and 2 years (OR 1.04, P = .032); prior spine surgical history was associated with CD risk at 1-year follow-up (OR 6.75, P = .047); baseline C2 slope was associated with increased CD risk at 2-year follow-up (OR 1.12, P = .041). CD development did not significantly impact health-related quality of life (P > .05). CONCLUSIONS: Cervical deformity can manifest in nonoperative ASD patients: 30.0% at 1-year follow-up, and 41.7% at 2-year follow-up. Progressive CD manifested independently of thoracolumbar profile changes. Increased baseline C2-C7 SVA, C2 slope, and prior surgical history increased new-onset CD odds at 1 and 2 years.
PURPOSE: Evaluate the presence of new-onset cervical deformity (CD) in nonoperative adult spinal deformity (ASD) patients with extended follow-up, with consideration for predictors, prevalence, and impact on patient-reported outcomes. METHODS: Retrospective review of a prospective nonoperative ASD cohort. New onset CD patients at 1- (CD-1Y) and 2-year (CD-2Y) follow-up were defined as displaying baseline cervical alignment. Univariate analyses determined differences in radiographic parameters and outcome scores of CD and maintained-cervical-alignment patients. Multivariate binary logistic regression models determined new-onset CD predictors. RESULTS: A total of 143 patients were included (mean age 54 years, mean body mass index 25.6 kg/m2, 86% female). Cervical deformity rate was 38.5% at baseline. New-onset CD incidence at 1- and 2-year follow-up was 30.0% and 41.7%, respectively. Global sagittal profile comparison of CD-1Y/CD-2Y versus maintained cervical alignment cases revealed no differences (P > .05) at any interval. Baseline C2-C7 sagittal vertical axis (SVA) was associated with increased new-onset CD risk at 1 (odds ratio [OR] 1.14, P = .025) and 2 years (OR 1.04, P = .032); prior spine surgical history was associated with CD risk at 1-year follow-up (OR 6.75, P = .047); baseline C2 slope was associated with increased CD risk at 2-year follow-up (OR 1.12, P = .041). CD development did not significantly impact health-related quality of life (P > .05). CONCLUSIONS: Cervical deformity can manifest in nonoperative ASD patients: 30.0% at 1-year follow-up, and 41.7% at 2-year follow-up. Progressive CD manifested independently of thoracolumbar profile changes. Increased baseline C2-C7 SVA, C2 slope, and prior surgical history increased new-onset CD odds at 1 and 2 years.
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