Friday, September 28, 2018 9:00 AM–10:00 AM best papers Friday: 152. Anterior reconstruction provides better outcomes when correcting mild flexible cervical deformity

Abstract

BACKGROUND CONTEXT The correction of mild flexible cervical deformity (CD) can be addressed through different surgical approaches. Each approach results in a unique complication profile, but the capacity for realignment of the cervical spine in mild flexible CD has not previously been evaluated. We aimed to determine whether an anterior, posterior, or combined anteroposterior approach in this setting resulted in different clinical or radiographic outcomes. PURPOSE To determine whether an anterior approach utilized for correction of mild flexible CD results in better clinical and radiographic outcomes, when compared to posterior or combined anteroposterior approaches. STUDY DESIGN/SETTING Retrospective review of prospective, multicenter CD database. PATIENT SAMPLE A total of 121 operative CD patients. OUTCOME MEASURES Radiographic parameters, HRQOLs (NDI, NRS, dysphagia), complications, reoperations, OR time, length of stay, estimated blood loss. METHODS A prospective database of operative cervical deformity patients was analyzed. Inclusion criteria were cervical kyphosis>10˚, cervical scoliosis>10˚, cSVA>4cm or CBVA>25˚. Mild cervical deformity was defined by cSVA of 3-5cm and/or kyphosis of 5° on preop flexion or extension radiographs. Groups were categorized by anterior (A), posterior (P), and anteroposterior (AP) approach, and 1-way ANCOVA was utilized to compare radiographic, operative, and clinical outcomes, while controlling for cSVA and TS-CL Statistical significance set at p RESULTS A total of 121 patients met inclusion and with similar avg age and female predominance in each group. Preop cSVA (45.3; 39.3mm vs. 26.1mm; p CONCLUSIONS The anterior approach for mild flexible cervical deformity resulted in greater C2-7 lordosis and better C2S, while leading to a lower NDI in comparison to the posterior approach alone. EBL and OR time were also lower with the anterior approach, while all approaches had similar rates of complications and reoperations.