Operative treatment for adult cervical deformity offers significant improvements at three-year follow-up

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Justin Smith

Operative treatment for adult cervical deformity (ACD) provides significant improvements in health-related quality of life at a mean 3.4-year follow-up, despite high complication rates and a high rate of all-cause mortality that is reflective of the overall frailty of this patient population. This is the key message from research published by Justin Smith (University of Virginia, Charlottesville, USA) et al in the Journal of Neurosurgery: Spine.

These findings, according to the researchers, represents the largest and most comprehensive prospective effort to date designed to assess the intermediate-term outcomes and complications of operative treatment for ACD.

The main objective of the study—a multicentre, prospective observational study which was conducted at 13 centres across the United States through the International Spine Study Group (ISSG)—was to assess minimum two-year outcomes and complications of ACD surgery as “very few studies have focused on longer-term outcomes of operative ACD treatment”, note the researchers.

Demographics, complications, radiographic parameters, and patient-reported outcome measures (PROMs; Neck Disability Index, modified Japanese Orthopaedic Association, EuroQol-5D [EQ-5D], and numeric rating scale [NRS] score for neck and back pain) were evaluated, and analyses focused on patients with two or more years of follow-up.

Of the 169 patients with ACD who were eligible for the study, a total of 102 (60.4%) had a minimum two-year follow-up (mean 3.4 years, range 2–8.1 years). The mean age at surgery was 62 years (standard deviation: 11 years). Surgical approaches included anterior-only (22.8%), posterior-only (39.6%), and combined (37.6%).

The study found that mean PROMs significantly improved from baseline to last follow-up, including Neck Disability Index (from 47.3 to 33) and modified Japanese Orthopaedic Association score (from 12 to 12.8; for patients with baseline score ≤14), neck pain NRS score (from 6.8 to 3.8), back pain NRS score (from 5.5 to 4.8), EQ-5D score (from 0.74 to 0.78), and EQ-5D visual analogue scale score (from 59.5 to 66.6; all p≤0.04).

More than half of the patients (n=58, 56.9%) had at least one complication, with the most common complications including dysphagia, distal junctional kyphosis, instrumentation failure, and cardiopulmonary events.

The patients who did not achieve two-year follow-up (n=67) were similar to study patients based on baseline demographics, comorbidities, and PROMs. Over the course of follow-up, 23 of the total 169 enrolled patients were reported to have died. Notably, these represent all-cause mortalities during the course of follow-up and were not necessarily due to operative treatment.

Speaking to Spinal News International, Smith said: “This study is an important step forward in defining the outcomes and complications of surgery for ACD. These patients can be profoundly impacted by their spinal pathology, and ongoing research aimed to address indications, treatments, complication reduction, and outcomes through the ISSG aims to help improve the safety and outcomes of ACD surgery.”


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