P126. Cervical and spinopelvic parameters predict patient-reported outcomes following cervical surgery

Abstract

BACKGROUND CONTEXT Recent studies have evaluated the correlation of health-related quality of life (HRQL) scores with radiographic parameters. This relationship may provide insight into the connection of patient-reported disability and disease burden caused by cervical diagnoses. PURPOSE To evaluate the association between spinopelvic sagittal parameters and HRQLs in patients with primary cervical diagnoses. STUDY DESIGN/SETTING Single center retrospective review. PATIENT SAMPLE A total of 90 cervical operative patients. OUTCOME MEASURES Spinopelvic sagittal parameters; Regional cervical alignment parameters; HRQL Outcome Instruments: modified Japanese Orthopedic Association scale (mJOA), Neck Disability Index (NDI). METHODS Patients >18yrs meeting criteria for primary cervical diagnoses(cSVA 68 complete disability. Cervical radiographic parameters assessed: cSVA, TS-CL, CBVA, C2-T3, CL, C2 Slope, MGS etc. Global radiographic alignment parameters assessed: PT, SVA, PI-LL, T1 Slope. Statistical analyses were performed to determine correlations between HRQLs and possible modifiers of CD. Pearson correlations were ran for all combinations at baseline (BL) and 1-year(1Y) for continuous BL and 1Y mJOA scores, as well as decline or improvement in those HRQLs at 1Y. Multiple linear regression models were constructed to investigate BL and 1Y alignment parameters as independent variables. RESULTS A total of 90 patients included (55.6 years, 52%F, 30.7±7kg/m2). By approach, 14.3% of patients underwent procedures by anterior approach, 56% posterior, and 30% had combined approaches. Average anterior levels fused: 3.6, posterior: 4.8, and mean total number of levels fused: 4.5. Mean operative time for the cohort was 902.5 minutes with an average estimated blood loss of 830 ccs. The mean baseline NDI score was 56.5, and a mJOA of 12.81. While BL NDI score correlated with gender (p=0.050), it did not correlate with BL global or cervical radiographic factors. An increased NDI score at 1-year postoperatively correlated with BL BMI(p=0.026). A decreased NDI score was associated with 1Y T12-S1 angle (p=0.009) and 1Y T10 L2 angle (p=0.013). Overall, BL mJOA score correlated with the BL radiographic factors of T1 slope(p=0.005), cervical lordosis(p=0.001), C2-T3(p=0.008), C2 sacral slope(p=0.050), SVA(p=0.010), and CL Apex(p=0.043), as well as gender(p=0.050). Linear regression modeling for the prior independent variables found a significance of p=0.046 and an R2 of 0.367. Year 1 mJOA scores correlated with 1Y values for maximum kyphosis(p=0.043) and TS-CL(p=0.010). At 1Y, a smaller mJOA score correlated with BL S1 sacral slope(p=0.014), pelvic incidence(p=0.009), L1-S1(p=0.012), T12-S1(p=0.008). The linear regression model for those 4 variables demonstrated an R2 of 0.169 and a p-value of 0.005. An increased mJOA score correlated with PI-LL difference at 1Y(p=0.012), L1-S1 difference(p=0.036), T12-S1 difference (0.006), maximum lordosis(p=0.026), T9-PA difference(p=0.010), and difference of T4-PA(p=0.008). CONCLUSIONS While the impact of preoperative sagittal and cervical parameters on mJOA was strong, the BL radiographic factors did not impact NDI scores. PostOp HRQL was significantly associated with sagittal parameters for mJOA (both worsening and improvement) and NDI scores (improvement). When cervical surgery has been indicated, radiographic alignment is important for PostOp HRQL. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.