280 Are We Getting Better at Treating Adult Cervical Deformity? Complication Rate Trends Analysis in Adult Cervical Deformity Over 10 Years

Abstract

INTRODUCTION: Adult cervical deformity patients can have significant impact on quality of life. Realignment surgery has proven to be effective in a select group of these patients, however despite advancements in the field, complications are not uncommon. Evaluation of outcomes overtime can be insightful on aspects that surgeons have been improving on and those that remain to be a nuance. METHODS: Adult Cervical Deformity(ACD) patients with a minimum 2-year follow-up and less than 10 levels fused were included. Patients were stratified into quartiles by date of surgery, with the middle two quartiles being merged to form three categories: Early(E), Middle(M), Recent(R). ANCOVA was used to assess complication rates and PROMs amongst tertiles controlling for age, gender, osteoporosis, CCI, mFI, TS-CL, cSVA, and levels fused. Multivariate analyses were used to assess differences in surgical, radiographic, and clinical outcomes over time. RESULTS: 570 patients were included. Age, CCI, and mFI were highest in R cohort. No difference at baseline in Ames modifiers amongst cohorts. Controlled analysis depicted lowest rates of complications in R (E: 62.5%, M: 72.7%, R: 45.5%). Major complication rates decreased from 59.8% in E to 15.0% in last cohort. Rates of DJK decreased from M to R (39.6% to 12.7%, p = .011), with rate of DJF being lowest in R and highest in M (20% in M, 12% in E, 6.7% in R, p = 0.046). Reoperation rates decreased from 18.8% in E to 12.4% in R. Neurological complications decreased as well from 38.5% in E to 2.1% in R (p = 0.044). Cardiopulmonary complication rates decreased from 24.8% in M to 3.5% in R. CONCLUSIONS: Complication rates decreased over a 10 year period amongst cases, despite having higher age, frailty, comorbidities, mJOA, and no difference in baseline deformity between early and recent cases.