P102. The relative impact of myelopathic degree on postoperative outcomes in operative cervical deformity patients based on deformity severity

Abstract

BACKGROUND CONTEXT Little is known of the impact of myelopathy severity in patients undergoing cervical deformity (CD) on postoperative patient-reported outcomes when stratified by baseline deformity severity. PURPOSE To investigate the impact of myelopathy severity on outcomes and satisfaction post-operatively over baseline deformity severity. STUDY DESIGN/SETTING Retrospective cohort study of a single-surgeon CD database PATIENT SAMPLE A total of 128 CD Patients. OUTCOME MEASURES HRQL Instruments: Neck Disability Index [NDI], Euro-Qol 5-Dimension questionnaire [EQ5D], meeting the Minimal Clinically Important Difference [MCID]; complications; reoperations METHODS Included: surgical adult CD patients (C2-C7 Cobb>10°, CL>10°, cSVA >4cm, or CBVA>25°) with baseline and 1-year HRQLs and radiographic follow-up. The modified Japanese Orthopaedic Association scale [mJOA] was utilized to assess baseline myelopathy severity (mJOA=18 was excluded). Moderate myelopathy: 12-17 mJOA scores at baseline; Severe myelopathy: 25°. TS-CL. Groups assessed: (1) severe myelopathy/deformity, (2) severe myelopathy and moderate deformity, (3) moderate myelopathy/deformity, (4) moderate myelopathy and severe deformity. Groups 2 and 4 were compared as mismatched groups. Univariate analyses were performed with a statistical cut-off p RESULTS A total of 128 CD patients were included (56.5±9.2 years, 46% female, 30.4±6.4kg/m2). The average Charlson Comorbidity Index (CCI) score was 0.56, 18% current smokers. Cohort surgical factors included, by approach, 27.9% anterior, 47.5% posterior and 24.6% combined (mean levels fused: 5). Mean total operative time was 588.5 minutes, with an EBL of 766.9ccs. Baseline mJOA score was 12.8±2.7, with a mean TS-CL of 25.9±16.1°. 30.5% of patients had severe baseline myelopathy, 69.5% Moderate mJOA. By baseline deformity severity, 35.2% were Moderate TS-CL, while 64.8% Severe. By myelopathy/deformity groups: (1) 11.1%, (2) 21%, (3) 34.6%, (4) 33.3%. At baseline, NDI score was the greatest in Group 2 at 69.4 (1: 69.1, 3: 57.1, 4: 52.6, p = 0.011), whereas Group 4 had the lowest EQ5D scores (p CONCLUSIONS Patients who present with moderate deformity and severe myelopathy have worse patient-reported outcomes compared to patients classified with severe deformity and moderate myelopathy. In moderate deformity, the myelopathy decompression and symptomatic alleviation plays more of a role, but, most importantly, in severe deformity, decompression is inadequate and realignment is necessary due to cord tension. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.