P108. Outcomes of operative treatment for adult cervical deformity: a prospective, multicenter assessment with minimum 2-year followup

BACKGROUND CONTEXT Adult cervical deformity (ACD) can have profound impact on health-related quality of life (HRQL). Operative treatment for ACD is associated with high complication rates due to the complexity of surgery and the frailty of the patients affected. Very few studies have focused on outcomes of operative ACD treatment. PURPOSE To assess whether operative treatment for ACD significantly improves HRQL at minimum 2-yr followup. STUDY DESIGN/SETTING Multicenter, prospective cohort study. PATIENT SAMPLE Operatively treated ACD patients. OUTCOME MEASURES Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), EuroQol-5D (EQ-5D), and numeric rating scale (NRS) for neck and back pain. METHODS Operatively treated ACD patients were assessed at baseline, standardized follow-up intervals and through direct mailings. Patient-reported outcomes measures (PROMs) included: NDI, mJOA, EQ-5D and NRS for neck and back pain. Complications were classified as perioperative (=30 days) or delayed (>30 days). Analyses focused on patients with minimum 2-yr followup. RESULTS Of 169 ACD patients, the 102 (60%) with minimum 2-yr followup (mean=3.4 yrs, SD=1.9 yrs, range=2 to 8.1 yrs) had a mean age of 62 yrs (SD=11) and 64% were women. Surgical approaches included anterior-only (22.8%), posterior-only (39.6%) and combined (37.6%). The mean numbers of vertebrae fused anteriorly and posteriorly were 4.3 (SD=1.1) and 9.4 (SD=3.4), respectively, with 16% having a 3-column osteotomy. PROMs significantly improved from baseline to last follow-up, including NDI (47.3 to 33.0), mJOA (12.0 to 12.8; for patients with baseline score 0.05). Overall, 58 (56.9%) patients had at least 1 complication, 41 (40.2%) had at least 1 perioperative complication, and 35 (34.3%) had at least 1 delayed complication. The most common complications included dysphagia (18.6%), distal junctional kyphosis (6.9%), instrumentation failure (6.9%), cardiac events (6.9%), dysphonia (4.9%), nerve sensory deficit (3.9%) and respiratory failure (3.9%). For patients with at least 2-yr follow-up, 12 patients underwent a total of 15 reoperations (9 had 1 and 3 had 2). Notably, the 67 patients who did not achieve 2-yr follow-up were similar to study patients based on demographics, comorbidities and baseline PROMs. Reflective of the frailty of this patient population, there were 18 deaths among the 67 patients without minimum 2-yr followup. These deaths occurred between 0.2 and 34.8 months following surgery. Although most occurred at least 6 months after surgery and likely were not directly related to surgery, 4 occurred within 4 months of surgery, including 1 due OSA/narcotics, 1 due to pneumonia, and 2 with unknown causes. CONCLUSIONS This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of HRQL at minimum 2-yr (mean 3.4-yr) followup. These findings may prove useful for patient counseling in the context of the substantial impact of ACD. Further studies will be needed to assess the long-term durability and cost-effectiveness of surgical treatment for ACD. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Adult cervical deformity (ACD) can have profound impact on health-related quality of life (HRQL). Operative treatment for ACD is associated with high complication rates due to the complexity of surgery and the frailty of the patients affected. Very few studies have focused on outcomes of operative ACD treatment. To assess whether operative treatment for ACD significantly improves HRQL at minimum 2-yr followup. Multicenter, prospective cohort study. Operatively treated ACD patients. Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA), EuroQol-5D (EQ-5D), and numeric rating scale (NRS) for neck and back pain. Operatively treated ACD patients were assessed at baseline, standardized follow-up intervals and through direct mailings. Patient-reported outcomes measures (PROMs) included: NDI, mJOA, EQ-5D and NRS for neck and back pain. Complications were classified as perioperative (=30 days) or delayed (>30 days). Analyses focused on patients with minimum 2-yr followup. Of 169 ACD patients, the 102 (60%) with minimum 2-yr followup (mean=3.4 yrs, SD=1.9 yrs, range=2 to 8.1 yrs) had a mean age of 62 yrs (SD=11) and 64% were women. Surgical approaches included anterior-only (22.8%), posterior-only (39.6%) and combined (37.6%). The mean numbers of vertebrae fused anteriorly and posteriorly were 4.3 (SD=1.1) and 9.4 (SD=3.4), respectively, with 16% having a 3-column osteotomy. PROMs significantly improved from baseline to last follow-up, including NDI (47.3 to 33.0), mJOA (12.0 to 12.8; for patients with baseline score 0.05). Overall, 58 (56.9%) patients had at least 1 complication, 41 (40.2%) had at least 1 perioperative complication, and 35 (34.3%) had at least 1 delayed complication. The most common complications included dysphagia (18.6%), distal junctional kyphosis (6.9%), instrumentation failure (6.9%), cardiac events (6.9%), dysphonia (4.9%), nerve sensory deficit (3.9%) and respiratory failure (3.9%). For patients with at least 2-yr follow-up, 12 patients underwent a total of 15 reoperations (9 had 1 and 3 had 2). Notably, the 67 patients who did not achieve 2-yr follow-up were similar to study patients based on demographics, comorbidities and baseline PROMs. Reflective of the frailty of this patient population, there were 18 deaths among the 67 patients without minimum 2-yr followup. These deaths occurred between 0.2 and 34.8 months following surgery. Although most occurred at least 6 months after surgery and likely were not directly related to surgery, 4 occurred within 4 months of surgery, including 1 due OSA/narcotics, 1 due to pneumonia, and 2 with unknown causes. This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of HRQL at minimum 2-yr (mean 3.4-yr) followup. These findings may prove useful for patient counseling in the context of the substantial impact of ACD. Further studies will be needed to assess the long-term durability and cost-effectiveness of surgical treatment for ACD.