Cervical Deformity Patients Research Articles

296. Upper thoracic vs midthoracic lower instrumented endpoints have similar radiographic and clinical outcomes in cervical deformity patients

BACKGROUND CONTEXT Often patients with cervical deformity (CD) require extensive fusions that extend into the thoracic spine. However, factors that influence the treatment approach and level selection are poorly understood. PURPOSE To examine if there are significant differences between patients with CD who have a lowest instrumented vertebrae (LIV) to the upper thoracic (UT) vs the midthoracic (MT) spine. STUDY DESIGN/SETTING Comparative cohort study. PATIENT SAMPLE Prospective adult cervical deformity database. OUTCOME MEASURES NDI, mJOA, SWAL-QOL. METHODS A prospective CD database was analyzed for the following inclusion criteria: LIV between C7-T5 and a UIV of C2, and 1 yr min follow-up (f/u). Patient demographics, operative details, radiographic parameters and clinical outcomes were compared between those with a LIV from C7-T2 (UT) vs T3-T5 (MT). X2 and independent samples T-Tests were performed for statistical analysis RESULTS A total of 64 patients met inclusion criteria for the study and 46 were included in the analysis (avg. age 62, 58% female, avg 1yr f/u) with 22 in UT vs 24 in the MT groups. No differences were seen in age or revision case prevalence, EBL, operative time or surgical approach (anterior, posterior, combined) types between groups. MT patients had a higher pre-op cSVA, TS-CL, Max Kyphosis and T9PA and were treated with a larger number of PSOs (p CONCLUSIONS Similar radiographic and clinical outcomes can be expected for UT vs MT LIVs when treating CD. Those undergoing MT had larger cervical deformities and were more likely to undergo a PSO for correction. Despite this, there were no significant differences in the rates of major and minor complications or DJK. The MT group had a higher rate revision (5% vs 21%, p=0.19) that did not reach statistical significance. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

297. Preoperative extension lateral cervical radiographs are associated with osteotomy type, approach and postoperative cervical alignment following cervical deformity surgery

BACKGROUND CONTEXT Choosing the surgical approach and osteotomy type is challenging when surgically treating cervical deformity. Preoperative assessment of flexibility and final alignment would be useful for surgeons treating this complex problem. Currently extension lateral XR are inconstantly taken for the management of cervical deformity for planning purposes. PURPOSE Investigate the relationship of surgical procedure choice and the pre-operative flexibility of the cervical spine. Determine if extension lateral XR (ELXR) can also predict the final postoperative alignment. STUDY DESIGN/SETTING Retrospective review of prospective, consecutively enrolled multicenter cervical deformity database PATIENT SAMPLE A total of 106 cervical deformity patients OUTCOME MEASURES Surgical treatment, radiographic alignment parameters (SS, T1S-CL, cSVA, C2 slope, T1 slope) METHODS A prospective database of operative cervical deformity patients was analyzed. Inclusion was cervical kyphosis>10°, cervical scoliosis>10°, C2-C7 SVA>4cm or chin-brow vertical angle>25°. Patients were excluded if they did not have neutral and ELXR or did not have deformity limited to the cervical or cervicothoracic spine. The ELXR was compared to preoperative neutral lateral, and 3 mo alignment XR and type of surgical osteotomy based upon the Ames Classification. Statistical analysis included t-test and chi-squared. RESULTS A total of 106 from 164 patients met the inclusion criteria. Mean age of 60 yo, with 58% females. Of the study population, 43.4% of patients had prior cervical surgery. The evaluation of ELXR in patients who received grade 1-2 osteotomies (as compared to those who received grade 5,6 or 7), shows they have statistically lower T1S (23.06 vs 35.46; p=.021), lower T1S-CL (20.90 vs 36.29; p=.033), lower cSVA (24.66 vs 48.35; p 17 in the ELXR (46.77% vs 36.36%; p=.033). Overall, while surgery created a significant change in all radiographic parameters; the 3 month lateral XR and baseline ELXR were statistically similar for T1S-CL (26.04 vs 24.83; p=.542) and C2Slope (23.27 vs 22.87; p=.839). CONCLUSIONS Preoperative ELXR had a significant association with surgical approach and grade of osteotomy. The ELXR was statistically similar to the post-operative 3-month lateral XR and should be used to predict final cervical alignment. Obtaining ELXR is a critical alignment tool, and should be obtained as a part of the preoperative surgical plan. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P110. Redefining cervical spine deformity classification through novel cut-offs: an assessment of the relationship between radiographic parameters and functional neurological outcomes

BACKGROUND CONTEXT The current proposed cervical deformity (CD) classification system including cutoffs for C2-C7 sagittal vertical axis(cSVA), T1 slope minus C2-C7 lordosis (TS-CL), Chin Brow Vertical Angle (CBVA), and the modified Japanese Orthopaedic Association scale(mJOA) are based upon a modified Delphi approach and expert opinion. PURPOSE To investigate the relationship between cervical parameters and the Health Related Quality of Life (HRQL) measure, mJOA. STUDY DESIGN/SETTING Retrospective review of a prospective, consecutively enrolled CD database. PATIENT SAMPLE A total of 123 CD patients. OUTCOME MEASURES CD modifiers; HRQL Instrument: mJOA; Radiographic thresholds for moderate (M) and severe (S) deformity. METHODS Included: surgical adult CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4cm, or CBVA>25°). Radiographic parameters measured: C2-C7 lordosis (CL), T1 slope, C2-C7 SVA, TS-CL, C2-T3 angle, C2 slope, pelvic tilt (PT). Measured HRQLs: Reported mJOA scores, categorized by Tetreault et al.: 18 as none, 15-17 as mild, 12-14 as moderate and 0.05), Pearson correlations were run for all combinations. For significant correlations, linear and binary logistic regressions were performed to determine a possible threshold of radiographic measures for which the correlation with mJOA scores was most significant. A mJOA score of 14 and RESULTS A total of 123 CD patients were included (60.5±10.1 years, 65% female, 29.1±8.2 kg/m2). The average Charlson Comorbidity Index (CCI) score was 0.90. Cohort surgical factors included, by approach, 17.1% anterior, 50.4% posterior and 32.5% combined. Average anterior levels fused was 3.36, while the average posterior levels fused was 8.93, and the total average was 8.05 levels fused. The mean total operative time was 534.3 minutes, with an estimated blood loss (EBL) of 890.6 ccs. Baseline mJOA score was 13.54±2.8. Pearson correlations determined significant correlation between baseline mJOA scores and McGregor's Slope (-0.236, p=0.015), TS-CL (-0.246, p=0.006), CL (0.225, p=0.012), C2-T3 (0.180, p=0.046), C2 Slope (-0.234, p=0.009), and frailty (0.517, p 19° and 45°, x2= 7.8, p=0.005), CL (M: -21° to 3°, x2= 8.947, p=0.004; S: >3°, x2 =9.3, p=0.009), C2-T3 (M: -35° to -25°, x2 = 5.485, p=0.046; S: >-25°, x2 = 4.1, p=0.041), C2 Slope (M:33°to 49°, p=0.122; S: >49°, x2=5.7, p=0.008), and Frailty (Mild: 0.18 to 0.27, p=0.129; Severe: >0.27, p=0.002). CONCLUSIONS Novel thresholds were established for McGregor's Slope, TS-CL, C2-T3 angle, C2 Slope and frailty. Each correlated with moderate or severe neurologic myelopathy HRQL by way of mJOA score. These cut-off values can be utilized in classifying cervical deformity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P111. Simulated corrections of cervical deformity using in-construct measures demonstrate that insufficient corrections result in DJK

BACKGROUND CONTEXT Distal junctional kyphosis (DJK) is a major concern following cervical deformity (CD) correction, leading to failed realignment and revision surgery. Undercorrection may be the major factor associated with DJK, however it is difficult to assess because the DJK erodes the correction and worsens traditional measures like cSVA. In-construct measures have been proposed that measure alignment within the fusion separate from the DJK and subjacent compensation. PURPOSE To simulate cervical deformity corrections using surgical planning software to determine if undercorrection results in DJK. STUDY DESIGN/SETTING Retrospective analysis of a prospective, multicenter CD database. PATIENT SAMPLE A total of 69 CD patients. OUTCOME MEASURES Radiographic measures: C2 plumblines, in-construct measures and DJK angle change. METHODS A prospective database of operative CD patients was analyzed for severe DJK (kyphosis change>20° in LIV to LIV-2) and traditional DJK (change>10°). C2LIV-Tilt (angle of a line from the centroid of C2 to the centroid of the lower instrumented vertebra and a line along the posterior vertebral body wall of the LIV) was measured postoperatively and the correction was simulated in the preoperative X-ray to match the C2LIV-Tilt using planning software. Linear regression analysis using C2 pelvic angle (CPA) and Pelvic Tilt (PT) determined the simulated PT to match the virtual CPA. SVA measures were compared in patients with severe and traditional DJK and no DJK. Linear regression analysis was used to determine the C2-T4 and C2-T10 Tilts that correspond to DJK=10° and cSVA=4cm. RESULTS A total of 69 CD patients (mean age 61, 60% female) were included. Severe and traditional DJK occurred in 11 (16%) and 22 (32%) patients; 3 (4%) required DJK revision. Simulated corrections demonstrated that severe and traditional DJK pts had worse alignments compared to no DJK pts: cSVA (42.5 vs 33.0 vs 23.4mm, p .57, p CONCLUSIONS Simulated cervical deformity corrections demonstrated that severe DJK patients have insufficient corrections compared to patients without DJK. In-construct measures assess sagittal alignment within the fusion separate from DJK and subjacent compensation. They can be useful as intraoperative tools to gauge the adequacy of CD correction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

187. The impact of the lower instrumented level on outcomes in cervical deformity surgery

BACKGROUND CONTEXT The natural shift from a flexible lordotic to relatively fixed kyphotic spine demands special consideration in cervical deformity (CD) surgery. Rigid instrumentation may alter these dynamics considerably depending on a patient's primary driver of deformity and even apex of curvature. The lower instrumented vertebrae (LIV) in CD constructs may have varying effects on patient outcomes that are still poorly understood. PURPOSE To compare outcomes in CD patients undergoing instrumented correction according to the relation of LIV with primary driver of deformity. STUDY DESIGN/SETTING Retrospective review of a multicenter cervical fusion dataset. PATIENT SAMPLE Sixty-two patients undergoing cervical fusion. OUTCOME MEASURES Baseline (BL) and postop HRQLs: mJOA, NDI, EQ5D, Numeric Rating Scale for Neck/Back pain, distal junctional kyphosis (DJK) rate and magnitude. METHODS CD database inclusion: cervical kyphosis >10°, scoliosis (coronal Cobb>10°), positive cervical sagittal imbalance (cSVA>4 cm or TS-CL>10°), or CBVA>25°. Patients were stratified by primary driver of deformity: cervical (C) via Ames classification (TS-CL>20 or cSVA>40) and thoracic (T) via hyper/hypo-kyphosis (TK) from T4-T12 (60 10° LIV and LIV+2) rate up to 1 year. RESULTS Sixty-two CD patients (54.9 yrs, 62.8% F) were analyzed. Mean parameters at BL: TSCL 28.1, cSVA 26.9, T4-T12 angle 38.1. 21 pts had a C primary driver and 41 had a T primary driver by definition. One hundred percent of C primary drivers had LIVs below CL apex, while 9.2% of T primary drivers had LIVs below (caudal) to TK apex and 90.8% had LIVs above TK apex. No differences in HRQLs were found between C and T groups at BL and 3 mo postop. By 1 yr, C patients trended lower NDI (21.9 vs 29.0, p=0.245), lower NRS Neck pain (4.2 vs 5.1,p=0.358), and significantly higher EQ5D VAS (69.2 vs 52.4,p=0.040). When T pts with LIVs below TK apex were excluded, remaining T pts with LIV above apex had significantly higher 1 yr NDI than C pts (37.5vs21.9,p=.05). T patients also trended higher rates of postop DJK than C (19.5% vs 4.8%, p=0.119). No significant differences in mJOA were found (p>0.05). CONCLUSIONS Stopping prior to apex was more common in patients with a primary thoracic driver (T) and associated with deleterious effects. Those with a primary cervical driver (C) tended to have LIVs inclusive of CL apex with lower rates of post-op DJK. Additionally, T patients with LIVs above TK apex had significantly higher NDI and lower EQ5D VAS scores by 1-year. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

P103. PROMIS physical health domain scores are related to cervical deformity severity

BACKGROUND CONTEXT Computer adaptive testing is becoming increasingly common in assessing patient outcomes. The Patient Reported Outcome Measurement Information System (PROMIS) instruments of Physical Function, Pain Intensity and Pain Interference have been shown to correlate with established patient outcome metrics. There is a lack of studies investigating the relationship between PROMIS physical health domain metrics and established Ames cervical deformity (CD) radiographic classification. PURPOSE To evaluate the association of available cervical alignment components via the Ames cervical deformity classification parameters with PROMIS physical domains. STUDY DESIGN/SETTING Retrospective review of a single-center stereoradiographic database. PATIENT SAMPLE A total of 208 CD patients with complete baseline radiographic and PROMIS data. OUTCOME MEASURES PROMIS metrics [Pain Intensity (PI), Physical Function (PF), Pain Interference] and Ames CD modifiers [cSVA, TS-CL]. METHODS Surgical CD patients (C2-C7 Cobb angle >10° or C2-C7 sagittal vertical axis >4cm or TS-CL>15°) ≥18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the Spine Quality Database (Quality). Patients were classified according to Ames CD modifiers for cSVA and TS-CL (non-deformed [Non], moderate deformity [Mod], severe deformity [Sev]). Descriptives and univariate analyses compared population-weighted PROMIS scores for PI, PF, and Interference across CD deformity modifiers. Conditional Tree Analysis with logistic regression sampling were performed to determine a possible threshold of PROMIS scores for which the correlation with Ames radiographic cut-offs was most significant. Reported cut off values for Mod (cSVA: 4-8cm; TS-CL: 15-20°) and Sev (cSVA: >8cm; TS-CL: >20°) disability were used. RESULTS A total of 208 pts (58.8yrs, 51%F, 29.6kg/m2, mean Charlson Comorbidity score: 1.19) met inclusion criteria. By surgical approach: 79.3% posterior, 5.7% anterior, 14.9% combined; mean levels fused: 3.7±4.2. Baseline cervical cSVA modifier by severity: 83.2% Non, 16.8% Mod. No patients met criteria for severe cSVA modifier. Baseline TS-CL modifier by severity: 18.8% Non, 22.1% Mod, 59.1% Sev. Mean PI score: 89.6±15.4, mean PF score: 11.9±13.1, mean Int score: 56.9±6.8. PI did not differ between cSVA or TS-CL modifier severity. Mod cSVA patients and Mod/Sev TS-CL modifier groups both trended towards lower PF scores and higher pain interference scores though this was not significant (P>0.05). Conditional tree analysis determined thresholds for PROMIS scores that were independent predictors of modifier severity. A PI score>96(OR: 0.658[0.303-1.430]), a PF score 57.4 (OR: 1.712[0.811-3.616]) were predictors of Mod cSVA. A PI score of >87(OR: 1.428[0.767-2.659]), a PF score 56.3 (OR:1.656[0.946-2.897]) were predictors of Sev TS-CL. CONCLUSIONS PROMIS physical health domain metrics of Pain Intensity, Physical Function, and Pain Interference were related to cervical malalignment parameters of the Ames cervical deformity classifications system. Certain baseline PROMIS thresholds can be connected to severity of cervical deformity. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

38. Prioritization of realignment associated with superior clinical outcomes for surgical cervical deformity patients

BACKGROUND CONTEXT Many patients are unable to undergo a major cervical deformity corrective surgery due to deformity severity, age, comorbidities, and overall frailty status. In order to optimize quality of life in patients with cervical deformity, there may be alignment targets to be prioritized. PURPOSE To prioritize the cervical parameter targets for alignment. STUDY DESIGN/SETTING Retrospective review of a multicenter prospective cervical deformity database. PATIENT SAMPLE Seventy-seven patients undergoing cervical deformity (CD) corrective surgery. OUTCOME MEASURES Cervical regional alignment parameters: cervical sagittal vertical axis(cSVA), cervical lordosis(CL), T1 Slope minus CL(TS-CL), chin brow vertical angle(CBVA), McGregor's slope(MGS), C2-T3 plumb line(C2-T3 SVA), C2-T3 angle, C2 Slope. Health-related quality of life measures: NDI. METHODS Included:CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4cm, or CBVA>25°) with full baseline (BL) and 1-year (1Y) radiographic parameters and NDI scores; patients with cervical or cervicothoracic Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA( RESULTS Seventy-seven CD patients included (62.1yrs, 64%F, 28.8kg/m2). Average CCI: 0.94, 7% current smokers. By approach, anterior: 19.4%, posterior: 41.6%, combined approach: 39%. Mean anterior levels fused: 3.5, posterior: 8.3, total: 7.5. Average op time: 553.1min; mean EBL: 1128.1ccs. 41.6% met MCID for NDI. A backwards linear regression model including radiographic differences as predictors from BL to 1 year for meeting MCID for NDI demonstrated an R2 of 0.820 (p=0.032) included TS-CL, cSVA, MGS, C2SS, C2-T3 angle, C2-T3 SVA, CL. By primary Ames driver, 67.5% of patients were categorized as C, and 32.5% as CT. Ratios of change in predictors for MCID NDI patients (BL -1Y) for C driver patients: 260.8% MGS, 140.3% CL, 121.2% C2-T3 angle, 49.6% C2 slope, 41.1% cSVA, 20.5% TS-CL, 3.1%C2-T3 SVA. While correction in CT driver patients included: 168.7% CL, 93% MGS, 70.8% C2-T3 angle, 31.1% cSVA, 27.5% C2 slope, 24.9% TS-CL, 13.7% C2-T3 SVA. The ratios were not significant between the two groups(p>0.050). Decision tree analysis determined cut-offs for radiographic change, prioritizing in the following order (based upon ordinal regression values): a correction ≤42.5°C2-T3 angle (OR: 5.667[1.074-29.891], p=0.041), -31.76°C2 slope (OR: 3.2 [0.852-12.026], p=0.085), >-11.57mm cSVA (OR: 3.185[1.137-8.917], p=0.027), >-2.16° MGS (OR: 2.724[0.971-7.636], p=0.057). CONCLUSIONS Certain ratios of correction of cervical parameters contribute to improving neck disability. Specific cut-offs of radiographic differences from baseline to 1 year were found prioritizing C2-T3 angle, followed by cervical lordosis, C2 slope, C2-C7 plumb line, and McGregor's slope, all strongly associated with meeting the minimal clinically important difference for the neck disability index score. Prioritizing these radiographic alignment parameters will optimize patient-reported outcomes for patients undergoing cervical deformity surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

298. Predicting the magnitude of distal junctional kyphosis following cervical deformity correction

BACKGROUND CONTEXT Severe cervical deformity (CD) can be a source of severe disability. Surgical correction of the deformity can markedly improve a patient's quality of life and functional status. However, high rates of complications have been reported, one of the most serious being distal junctional kyphosis (DJK). Although researchers have identified risk factors for DJK, no model has been proposed that predicts the magnitude of DJK. PURPOSE To develop a model that can accurately predict the DJ angle following CD correction using radiographic measurements that can be obtained pre- and intraoperatively. STUDY DESIGN/SETTING Retrospective review of a prospectively-collected CD database. PATIENT SAMPLE A total of 131 preoperative patients with cervical deformity. OUTCOME MEASURES DJK angle, reoperation for DJK METHODS A prospective database of operative CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4cm or CBVA>25°) with clinical and radiographic data at preoperative and any postoperative interval (3m, 6m, 1y, 2y). Patients with a history of fusion below L4 were excluded. DJK angle was defined as the Cobb from LIV to LIV-2, traditional DJK (tDJK) was a DJK angle change >10°; a change >20° was defined as severe DJK (sDJK) was a DJK angle change >20°.Models were developed using a randomly selected 66.6% of patients. Pre- and intraoperative radiographic parameters significantly associated with DJK were identified and ranked in order of importance via a conditional variable importance table that used a nonreplacement sampling set of 4,000 conditional inference trees. Linear regression models were developed using the factors most strongly associated with postoperative DJK angle. The models were then validated in the remaining 33.3% of patients. RESULTS A total of 131 patients were included (60 ±10y, 62% female). Mean follow-up was 14±8 months. The most common LIV was T2 (20.6%) with an LIV below T2 in 44%. The mean postoperative DJK angle was 14.6° ±14°. 35% of patients developed DJK (11% sDJK). Five patients underwent a subsequent revision surgery due to DJK. The model development subset included 84 patients and did not differ significantly from the validation subset in terms of radiographic or clinical parameters. The variables identified as being most significant were: Intraoperative change of CL (ΔCL) and C2-LIV Tilt (ΔC2-LIV), and preoperative DJK angle (DJK­Apre). The initial model including ΔCL and ΔC2-LIV accounted for 19.6% of the variability in postoperative DJKA (r=.470, p CONCLUSIONS DJK is a serious, but fairly common complication following correction of CD and can lead to pain and disability necessitating revision surgery. Through the use of pre- and intraoperative measurements, surgeons can reliably predict the magnitude of DJK following correction. In order of importance, the variables that increased the DJK angle were, preoperative DJK angle, the magnitude of the correction within the construct and the change in CL. The models developed in this study, which reliably predict postoperative DJK angle and severe DJK, can be easily applied in a clinical setting when planning postoperative alignment for CD correction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

175. Intraoperative alignment goals for severe cervical deformity to achieve optimal improvements in health-related quality of life measures

BACKGROUND CONTEXT Patients with severe cervical deformity (CD) often have profound deficits in numerous activities of daily living. Association between health status and postoperative radiographic goals is difficult to quantify. PURPOSE Investigate the radiographic characteristics of patients who achieved optimal HRQOLs following surgery for CD. STUDY DESIGN/SETTING Retrospective review of prospective CD database. PATIENT SAMPLE Forty adult CD patients (C2-C7 Cobb>10°, CL>10°, cSVA>4cm, or CBVA>25°). OUTCOME MEASURES Health-related-quality of life (HRQL) scores, radiographic alignment. METHODS Surgical patients with severe CD were isolated based upon a previously presented combination of preop cSVA, T1 slope, maximum focal kyphosis in extension, C2 slope in extension, and number of kyphotic levels in extension. Those with available preop and 1-year postop HRQL data were included. Based on previous study, patients were grouped into 3 distinct patterns of CD: focal deformity (FD), flatneck (FN=large TS-CL and lack of compensation), or cervicothoracic (CT). Postoperative outcomes were defined as “good” if a patient had >2 of the 3 following criteria (1) NDI 2 points from baseline. Within each distinct deformity group, patients with good outcomes were compared to those with poor outcomes (ie, not meeting the criteria for good) for differences in demographics, HRQL scores, and alignment, via chi-squared or student's t-tests. RESULTS Overall, 83/153 patients met the criteria of severe CD and 40 patients had complete 1-year follow-up of clinical/radiographic data. Patient breakdown by deformity pattern was as follows: CT (N=13), FN (N=17), and FD (N=17), with 7 patients meeting criteria for both FD and FN deformities. Within the FD cohort, maximal focal kyphosis (ie, kyphosis at one level) was better corrected in patients with a “good” outcome (p = 0.03). In the FN cohort, patients who went on to have “good” outcomes presented with worse horizontal gaze (McGregor slope 21° vs 6°, p=0.061) and cSVA (72 mm vs 60 mm, p=0.030). “Good” outcome FN patients showed significantly greater postop correction of horizontal gaze (−25° vs −5°, p = 0.031). In the CT cohort, patients with “good” outcomes had superior global alignment both pre- (SVA: −17 mm vs 108 mm, p 0.050). CONCLUSIONS The results of this study highlight intraoperative goals for three distinct sagittal morphotypes of severe CD: cervicothoracic, flat neck, and focal deformity. Distinct deformity specific intraoperative goals include obtaining proper sagittal global/cervical alignment for cervicothoracic patients, correcting maximal focal kyphosis in focal deformity patients, and correcting horizontal gaze for flat neck patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

208. Predictors of superior recovery kinetics in adult cervical deformity correction: an analysis using a novel area under the curve methodology

BACKGROUND CONTEXT Novel analyses of clinical outcomes following cervical deformity (CD) corrective surgery use an area-under-the-curve (AUC) method to assess health-related quality of life (HRQL) metrics throughout the surgical recovery process. It remains unclear how demographics, preop parameters, and surgical decisions are associated with superior recovery. PURPOSE Identify demographic, surgical and radiographic factors that predict superior recovery kinetics. STUDY DESIGN/SETTING Retrospective review of a prospective CD database. PATIENT SAMPLE A total of 98 CD patients. OUTCOME MEASURES Baseline (BL) to 1-year (1Y) HRQL Instruments: Neck Disability Index (NDI). METHODS CD database criteria:C2-7 Cobb angle>10°, coronal Cobb angle >10°, cSVA>4cm or TS-CL>10°, or CBVA>25°. Following univariate analyses, the AUC normalization method was utilized by dividing all reported BL and postoperative(3M, 1Y) outcome measures by the BL score. Normalized scores(y-axis) were plotted against follow-up time interval(x-axis). Total area was calculated for all follow-up, divided by cumulative follow-up length, determining overall, time-adjusted HRQL recovery (Integrated Health State[IHS]). IHS NDI scores were stratified by quartile, the uppermost 25% were categorized as having “superior” recovery kinetics (SRK) vs “normal” recovery kinetics (NRK). BL demographic, clinical and surgical information were used to predict SRK using generalized linear modeling. RESULTS A total of 98 patients included(62±10yrs, 28±6kg/m2, 65%F). Mean CCI: 0.95, 6% smokers, and 31% history of smoking. Surgical approach: combined(33%), posterior(49%), anterior(18%). Average posterior levels fused: 8.7, anterior levels fused: 3.6, EBL: 915.9ccs, op time: 495min. According to the Ames CD classification at BL: cSVA (53.2% minor deformity and 46.8% moderate), TS-CL (9.8% minor, 4.3% moderate, 85.9% marked), and horizontal gaze (27.4% minor, 46.6% moderate, 26% marked). Relative to BL NDI scores (mean: 47), normalized postop NDI scores showed decrease in disability at 3M(0.9±0.5, p=0.260) and a further decrease at 1Y (0.78±0.41, p CONCLUSIONS Superior recovery kinetics following cervical deformity surgery was predicted with high accuracy using a combination of baseline patient reported factors(VAS EQ5D, swallow sleep, and mJOA scores) and radiographic factors(TK, T10-T12, T12-S1, L1-S1). Patients and health care providers should be aware of these factors in order to improve surgical decision-making, in an effort to reduce postop neck disability. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

Predicting extended operative time and length of inpatient stay in cervical deformity corrective surgery

It’s increasingly common for surgeons to operate on more challenging cases and higher risk patients, resulting in longer op-time and inpatient LOS. Factors predicting extended op-time and LOS for cervical deformity (CD) patients are understudied. This study identified predictors of extended op-time and length of stay (LOS) after CD-corrective surgery. CD patients with baseline (BL) radiographic data were included. Patients were stratified by extended LOS (ELOS; >75th percentile) and normal LOS (N-LOS; <75th percentile). Op-time analysis excluded staged cases, cases >12 h. A Conditional Variable Importance Table used non-replacement sampling set of Conditional Inference trees to identify influential factors. Mean comparison tests compared LOS and op-time for top factors. 142 surgical CD patients (61 yrs, 62%F, 8.2 levels fused). Op-time and LOS were 358 min and 7.2 days; 30% of patients experienced E-LOS (14 ± 13 days). Overlapping predictors of E-LOS and op-time included levels fused (>7 increased LOS 2.7 days; >5 increased op-time 96 min, P < 0.001), approach (anterior reduced LOS 3.0 days; combined increased op-time 69 min, P < 0.01), BMI (>38 kg/m2 increased LOS 8.1 days; >39 kg/m2 increased op-time 17 min), and osteotomy (LOS 2.0 days, op-time 62 min, P < 0.005). BL cervical parameters increased LOS and op-time: cSVA (>42 mm increased LOS; >50 mm increased op-time, P < 0.030), C0 slope (>@−0.9° increased LOS, >0.3° increased op-time, P < 0.003.) Additional op-time predictors: prior cervical surgery (p = 0.004) and comorbidities (P = 0.015). Other predictors of E-LOS: EBL (P < 0.001), change in mental status (P = 0.001). Baseline cervical malalignment, levels fused, and osteotomy predicted both increased op-time and LOS. These results can be used to better optimize patient care, hospital efficiency, and resource allocation.

Limited morbidity and possible radiographic benefit of C2 vs. subaxial cervical upper-most instrumented vertebrae.

The study aims to evaluate differences in alignment and clinical outcomes between surgical cervical deformity (CD) patients with a subaxial upper-most instrumented vertebra (UIV) and patients with a UIV at C2. Use of CD-corrective instrumentation in the subaxial cervical spine is considered risky due to narrow subaxial pedicles and vertebral artery anatomy. While C2 fixation provides increased stability, the literature lacks guidelines indicating extension of CD-corrective fusion from the subaxial spine to C2. Included: operative CD patients with baseline (BL) and 1-year postop (1Y) radiographic data, cervical UIV ≥ C2. Patients were grouped by UIV: C2 or subaxial (C3-C7) and propensity score matched (PSM) for BL cSVA. Mean comparison tests assessed differences in BL and 1Y patient-related, radiographic, and surgical data between UIV groups, and BL-1Y changes in alignment and clinical outcomes. Following PSM, 31 C2 UIV and 31 subaxial UIV patients undergoing CD-corrective surgery were included. Groups did not differ in BL comorbidity burden (P=0.175) or cSVA (P=0.401). C2 patients were older (64 vs. 58 yrs, P=0.010) and had longer fusions (9 vs. 6 levels, P=0.002). Overall, patients showed BL-1Y improvements in TS-CL (P<0.001), cSVA (P=0.005), McGS (P=0.004). Cervical flexibility was maintained at 1Y regardless of UIV, assessed by CL flexion (-0.2° vs. 6.0°, P=0.115) and extension (13.9° vs. 9.9°, P=0.366). While both subaxial and C2 patients showed BL-1Y improvements in McGS (both P<0.030), C2 patients improved to a larger degree (7.3° vs. 6.2°). Between UIV groups, there were no differences in BL-1Y changes in HRQLs, overall complication rates, or operative complication rates (all P>0.05). C2 UIV patients showed similar cervical range of motion and baseline to 1-year functional outcomes as patients with a subaxial UIV. C2 UIV patients also showed greater baseline to 1-year horizontal gaze improvement and had complication profiles similar to subaxial UIV patients, demonstrating the radiographic benefit and minimal functional loss associated with extending fusion constructs to C2. In the treatment of adult cervical deformities, extension of the reconstruction construct to the axis may allow for certain clinical benefits with less morbidity than previously acknowledged.

Recovery kinetics following spinal deformity correction: a comparison of isolated cervical, thoracolumbar, and combined deformity morphometries

The postoperative recovery patterns of cervical deformity patients, thoracolumbar deformity patients, and patients with combined cervical and thoracolumbar deformities, all relative to one another, is not well understood. Clear objective benchmarks are needed to quantitatively define a "good" versus a "bad" postoperative recovery across multiple follow-up visits, varying deformity types, and guide expectations. To objectively define and compare the complete 2-year postoperative recovery process among operative cervical only, thoracolumbar only, and combined deformity patients using area-under-the-curve (AUC) methodology. Retrospective review of 2 prospective, multicenter adult cervical and spinal deformity databases. One hundred seventy spinal deformity patients. Common health-related quality of life (HRQOL) assessments across both databases included the EuroQol 5-Dimension Questionnaire and Numeric Rating Scale (NRS) back pain assessment. In order to compare disability improvements, the Neck Disability Index (NDI) and the Oswestry Disability Index (ODI) were merged into one outcome variable, the ODI-NDI. Both assessments are gauged on the same scale, with minimal question deviation. Sagittal Radiographic Alignment was also assessed at pre- and all postoperative time points. Operative deformity patients >18 years old with baseline (BL) to 2-year HRQOLs were included. Patients were stratified by cervical only (C), thoracolumbar only (T), and combined deformities (CT). HRQOL and radiographic outcomes were compared within and between deformity groups. AUC normalization generated normalized HRQOL scores at BL and all follow-up intervals (6 weeks, 3 months, 1 year, and 2 year). Normalized scores were plotted against follow-up time interval. AUC was calculated for each follow-up interval, and total area was divided by cumulative follow-up length, determining overall, time-adjusted HRQOL recovery (Integrated Health State, IHS). Multiple linear regression models determined significant predictors of HRQOL discrepancies among deformity groups. One hundred seventy patients were included (27 C, 27 T, and 116 CT). Age, BMI, sex, smoking status, osteoporosis, depression, and BL HRQOL scores were similar among groups (p >. 05). T and CT patients had higher comorbidity severities (CCI: C 0.696, T 1.815, CT 1.699, p= .020). Posterior surgical approaches were most common (62.9%) followed by combined (28.8%) and anterior (6.5%). Standard HRQOL analysis found no significant differences among groups until 1-year follow-up, where C patients exhibited comparatively greater NRS back pain (4.88 vs. 3.65 vs. 3.28, p= .028). NRS Back pain differences between groups subsided by 2-years (p>.05). Despite C patients exhibiting significantly faster ODI-NDI minimal clinically important difference (MCID) achievement (33.3% vs. 0% vs. 23.0%, p< .001), all deformity groups exhibited similar ODI-NDI MCID achievement by 2-years (51.9% vs. 59.3% vs. 62.9%, p= 0.563). After HRQOL normalization, similar results were observed relative to the standard analysis (1-year NRS Back: C 1.17 vs. T 0.50 vs. CT 0.51, p< .001; 2-year NRS Back: 1.20 vs. 0.51 vs. 0.69, p= .060). C patients exhibited a worse NRS back normalized IHS (C 1.18 vs. T 0.58 vs. CT 0.63, p= .004), indicating C patients were in a greater state of postoperative back pain for a longer amount of time. Linear regression models determined postoperative distal junctional kyphosis (adjusted beta: 0.207, p= .039) and osteoporosis (adjusted beta: 0.269, p= .007) as the strongest predictors of a poor NRS back IHS (model summary: R2= 0.177, p= .039). Despite C patients exhibiting a quicker rate of MCID disability (ODI-NDI) improvement, they exhibited a poorer overall recovery of back pain with worse NRS back scores compared with BL status and other deformity groups. Postoperative distal junctional kyphosis and osteoporosis were identified as primary drivers of a poor postoperative NRS back IHS. Utilization of the IHS, a single number adjusting for all postoperative HRQOL visits, in conjunction with predictive modelling may pose as an improved method of gauging the effect of surgical details and complications on a patient's entire recovery process.

Grading of Complications After Cervical Deformity-corrective Surgery: Are Existing Classification Systems Applicable?

This is a retrospective review of prospective multicenter cervical deformity (CD) database. Assess the impact of complication type and Clavien complication (Cc) grade on clinical outcomes of surgical CD patients BACKGROUND:: Validated for general surgery, the Clavien-Dindo complication classification system allows for broad comparison of postoperative complications; however, the applicability of this system is unclear in CD-specific populations. Surgical CD patients above 18 years with baseline and postoperative clinical data were included. Primary outcomes were complication type (renal, infection, cardiac, pulmonary, gastrointestinal, neurological, musculoskeletal, implant-related, radiographic, operative, wound) and Cc grade (I, II, III, IV, V). Secondary outcomes were estimated blood loss (EBL), length of stay (LOS), reoperation, and health-related quality of life (HRQL) score. The univariate analysis assessed the impact of complication type and Cc grade on improvement markers and 1-year postoperative HRQL outcomes. In total, 153 patients (61±10 y, 61% female) underwent surgery for CD (8.1±4.6 levels fused; surgical approach included 48% posterior, 18% anterior, 34% combined). Overall, 63% of patients suffered at least 1 complication. Complication breakdown by type: renal (2.0%), infection (5.2%), cardiac (7.2%), pulmonary (3.9%), gastrointestinal (2.0%), neurological (26.1%), musculoskeletal (0.0%), implant-related (3.9%), radiographic (16.3%), operative (7.8%), and wound (5.2%). Of complication types, only operative complications were associated with increased EBL (P=0.004), whereas renal, cardiac, pulmonary, gastrointestinal, neurological, radiographic, and wound infections were associated with increased LOS (P<0.050). Patients were also assessed by Cc grade: I (28%), II (14.3%), III (16.3%), IV (6.5%), and V (0.7%). Grades I and V were associated with increased EBL (both P<0.050); Cc grade V was the only complication not associated with increased LOS (P=0.610). Increasing complication severity was correlated with increased risk of reoperation (r=0.512; P<0.001), but not inferior 1-year HRQL outcomes (all P>0.05). Increasing complication severity, assessed by the Clavien-Dindo classification system, was not associated with increased EBL, inpatient LOS, or inferior 1-year postoperative HRQL outcomes. Only operative complications were associated with increased EBL. These results suggest a need for modification of the Clavien system to increase applicability and utility in CD-specific populations.

The impact of osteotomy grade and location on regional and global alignment following cervical deformity surgery.

Introduction:Correction of cervical deformity (CD) often involves different types of osteotomies to address sagittal malalignment. This study assessed the relationship between osteotomy grade and vertebral level on alignment and clinical outcomes.Methods:Retrospective review of a multi-center prospectively collected CD database. CD was defined as at least one of the following: C2–C7 Cobb >10°, cervical lordosis (CL) >10°, C2–C7 sagittal vertical axis (cSVA) >4 cm, and chin-brow vertical angle > 25°. Patients were evaluated for level and type of cervical osteotomy.Results:86 CD patients were included (61.4 ± 10.6 years, 66.3% female, body mass index 29.1 kg/m2). 141 osteotomies were in the cervical spine and 79 were in the thoracic spine. There were 19 major osteotomies performed, with 47% at T1. Patients with an osteotomy in the cervical spine improved in T1 slope minus CL (TS − CL), CL, and C2 slope (all P < 0.05). Patients with upper thoracic osteotomies improved in TS − CL, cSVA, C2–T3, C2–T3 sagittal vertical axis (SVA), and C2 slope (all P < 0.05). Minor osteotomies in the upper thoracic spine showed improvement in cSVA (63 mm to 49 mm, P = 0.022), C2–T3 (P = 0.007), and SVA (−16 mm to 27 mm, P < 0.001). The greatest amount of C2–T3 angular change occurred for patients with a major osteotomy at T2 (39.1° change), then T3 (15.7°), C7 (16.9°°), and T1 (13.5°°). Patients with a major osteotomy in the upper thoracic spine showed similar radiographic changes from pre- to post-operative as patients with three or more minor osteotomies, although C2–T3 SVA trended toward greater improvement with a major osteotomy (−22.5 mm vs. +5.9 mm, P = 0.058) due to lever arm effect.Conclusions:CD patients undergoing osteotomies in the cervical and upper thoracic spine experienced improvement in TS–−CL and C2 slope. In the upper thoracic spine, multiple minor osteotomies achieved similar alignment changes to major osteotomies at a single level, while a major osteotomy focused at T2 had the greatest overall impact in cervicothoracic and global alignment in CD patients.

PROMIS physical health domain scores are related to cervical deformity severity

Introduction:The aim of this study was to evaluate the association of available cervical alignment components through the Ames cervical deformity (CD) classification parameters with the Patient-Reported Outcomes Measurement Information System (PROMIS) physical health domain metrics.Methods:Surgical CD patients (C2–C7 Cobb >10° or C2–C7 sagittal vertical axis [cSVA] >4 cm or T1 slope minus cervical lordosis (TS-CL) >15°) ≥18 years with available baseline (BL) radiographic and PROMIS were isolated in a single-center spine database. Patients were classified according to the Ames CD modifiers for cSVA and TS-CL (low deformity [Low], moderate deformity [Mod], and severe deformity [Sev]). Descriptives and univariate analyses compared population-weighted PROMIS scores for Pain Intensity (PI), Physical Function (PF), and Pain Interference (Int) across CD modifiers. Conditional tree analysis with logistic regression sampling determined the threshold of PROMIS scores for which the correlation with Ames radiographic cutoffs was most significant. Reported cutoff values for Mod (cSVA: 4–8 cm; TS-CL: 15–20°) and Sev (cSVA: >8 cm; TS-CL: >20°) disabilities were used.Results:Two hundred and eight patients (58.8 years, female: 51%, 29.6 kg/m2, Charlson Comorbidity Index: 1.19). BL cSVA modifier by severity: 83.2% Low, 16.8% Mod. No patients met criteria for severe cSVA. BL TS-CL modifier by severity: 18.8% Low, 22.1% Mod, 59.1% Sev. Mean baseline PROMIS scores were as follows: PI score: 89.6 ± 15.4, PF score: 11.9 ± 13.1, Int score: 56.9 ± 6.8. PI did not differ between cSVA and TS-CL severity. Mod cSVA patients and Mod/Sev TS-CL modifier groups trended toward lower PF scores and higher Int scores. A PI score of >96 (odds ratio [OR]: 0.658 [0.303–1.430]), a PF score of <14 (OR: 1.864 [0.767–4.531]), and an Int score of > 57.4 (OR: 1.878 [0.889–3.967]) were predictors of Mod cSVA. A PI score of >87 (OR: 1.428 [0.767–2.659]), a PF score of <14 (OR: 1.551 [0.851–2.827]), and an Int score of >56.5 (OR: 1.689 [0.967–2.949]) were predictors of Sev TS-CL.Conclusions:PROMIS physical health domains were related to the Ames CD classification. Certain BL PROMIS thresholds can be connected to the severity of CD.

Fatty Infiltration of Cervical Spine Extensor Musculature: Is there a Relationship With Cervical Sagittal Balance?

This is a retrospective review of a single surgeon cervical deformity (CD) database. Quantitatively describe the cervical extensor musculature in a CD population, and delineate associations between posterior musculature atrophy and progressive sagittal deformity. While fatty infiltration (FI; ie, posterior musculature atrophy) of lumbar extensor musculature has been associated with pain and deformity, little is known of the relationship between FI, CD, cervical sagittal alignment, and functionality. CD patients [TS-CL>20 degrees, C2-C7 Cobb>10 degrees, CL>10 degrees, cervical sagittal vertical axis (cSVA)>4 cm, or chin-brow vertical angle>25 degrees] 18 years old and above, undergoing spinal fusion, with baseline T2-weighted magnetic resonance images were included. FI was assessed using dedicated imaging software at each intervertebral level from C2-C7. FI was gauged as a ratio of fat-free muscle cross-sectional area over total muscle cross-sectional area, with lower values indicating increasing FI. Influence of BL C2-C7 FI on patient-reported outcome measures (PROMs) and alignment was investigated. Multiple linear regression analysis (covariates: age, sex, body mass index, C2-C7 FI ratio) determined predictors of postoperative sagittal alignment and PROMs. Thirty-eight patients were included (age: 56.6, sex: 73.7% female, body mass index: 30.1, Charlson Comorbidity Index 0.61). BL deformity presentation: TS-CL 27.4 degrees, CL 2.1 degrees, cSVA: 27.2 mm. Mean baseline C2-C7 FI ratio was 0.65±0.11. Worsening FI was associated with malaligned baseline cSVA (rs=0.389, P=0.019), T1SS (rs=0.340, P=0.062), and impaired gait (rs=0.358, P=0.078). FI was not associated with BL PROMs (P>0.05). Following surgical intervention, regression models determined BL C2-C7 FI ratio as the strongest predictor of 1-year postoperative cSVA (β=-0.482, P=0.007, R=0.317). No associations between BL FI and postoperative PROMS or alignment parameters were observed (P>0.05). Patients with significant CD demonstrate alterations in the posterior extensor musculature of the cervical spine. Atrophic changes with FI of these muscle groups is associated with worsening CD and is an important predictor of postoperative sagittal alignment. Level III.

Cost-utility of revisions for cervical deformity correction warrants minimization of reoperations.

Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction. Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin-brow vertical angle (CBVA) >25°. Quality-adjusted life year (QALY) were calculated by EuroQol Five-Dimensions questionnaire (EQ-5D) and Neck Disability Index (NDI) mapped to SF-6D index and utilized a 3% discount rate to account for residual decline to life expectancy (men: 76.9 years, women: 81.6 years). Medicare reimbursement at 30 days assigned costs for index procedures (9+ level posterior fusion, 4-8 level posterior fusion with anterior fusion, 2-3 level posterior fusion with anterior fusion, 4-8 level anterior fusion) and revision fusions (2-3 level, 4-8 level, or 9+ level posterior refusion). Cost per QALY gained was calculated. Eighty-nine CD patients were included (61.6 years, 65.2% female). CD correction for these patients involved a mean 7.7±3.7 levels fused, with 34% combined approach surgeries, 49% posterior-only and 17% anterior-only, 19.1% three-column osteotomy. Costs for index surgeries ranged from $20,001-55,205, with the average cost for this cohort of $44,318 and cost per QALY of $27,267. Eleven revision surgeries (mean levels fused 10.3) occurred up to 1-year, with an average cost of $41,510. Indications for revisions were DJK (5/11), neurologic impairment [4], infection [1], prominent/painful instrumentation [1]. Average QALYs gained was 1.62 per revision patient. Cost was $28,138 per QALY for reoperations. CD revisions had a cost of $28,138 per QALY, in addition to the $27,267 per QALY for primary CD surgeries. For primary CD patients, CD surgery has the potential to be cost effective, with the caveats that a patient livelihood extends long enough to have the benefits and durability of the surgery is maintained. Efforts in research and surgical technique development should emphasize minimization of reoperation causes just as DJK that significantly affect cost utility of these surgeries to bring cost-utility to an acceptable range.

Development of New-Onset Cervical Deformity in Nonoperative Adult Spinal Deformity Patients With 2-Year Follow-Up.

Evaluate the presence of new-onset cervical deformity (CD) in nonoperative adult spinal deformity (ASD) patients with extended follow-up, with consideration for predictors, prevalence, and impact on patient-reported outcomes. Retrospective review of a prospective nonoperative ASD cohort. New onset CD patients at 1- (CD-1Y) and 2-year (CD-2Y) follow-up were defined as displaying baseline cervical alignment. Univariate analyses determined differences in radiographic parameters and outcome scores of CD and maintained-cervical-alignment patients. Multivariate binary logistic regression models determined new-onset CD predictors. A total of 143 patients were included (mean age 54 years, mean body mass index 25.6 kg/m2, 86% female). Cervical deformity rate was 38.5% at baseline. New-onset CD incidence at 1- and 2-year follow-up was 30.0% and 41.7%, respectively. Global sagittal profile comparison of CD-1Y/CD-2Y versus maintained cervical alignment cases revealed no differences (P > .05) at any interval. Baseline C2-C7 sagittal vertical axis (SVA) was associated with increased new-onset CD risk at 1 (odds ratio [OR] 1.14, P = .025) and 2 years (OR 1.04, P = .032); prior spine surgical history was associated with CD risk at 1-year follow-up (OR 6.75, P = .047); baseline C2 slope was associated with increased CD risk at 2-year follow-up (OR 1.12, P = .041). CD development did not significantly impact health-related quality of life (P > .05). Cervical deformity can manifest in nonoperative ASD patients: 30.0% at 1-year follow-up, and 41.7% at 2-year follow-up. Progressive CD manifested independently of thoracolumbar profile changes. Increased baseline C2-C7 SVA, C2 slope, and prior surgical history increased new-onset CD odds at 1 and 2 years.

Cervical Deformity Patients Have Baseline Swallowing Dysfunction but Surgery Does Not Increase Dysphagia at 3 Months: Results From a Prospective Cohort Study.

Study Design:Prospective cohort study.Objectives:Most studies of dysphagia in the cervical spine have focused on a degenerative patient population; the rate of dysphagia following surgery for cervical deformity (CD) is unknown. This study aims to investigate if surgery for cervical deformity results in postoperative dysphagia.Methods:Patients with CD undergoing surgery from 2013 to 2015 were prospectively enrolled to evaluate dysphagia. Demographic, operative, and radiographic variables were analyzed. The Quality of Life in Swallowing Disorders (SWAL-QoL) was used to measure dysphagia. Paired t test, independent t tests, and bivariate Pearson correlations were performed.Results:A total of 88 CD patients, aged 61.52 ± 10.52 years, were enrolled. All patients (100%) had 3-month SWAL-QoL for analysis. The baseline preoperative SWAL-QoL was 78.35. This is roughly the same level of dysphagia as an anterior cervical discectomy patient that is 3 weeks removed from surgery. Increasing body mass index (BMI) was correlated with decreased SWAL-QoL score (r = −0.30, P = .001). Age, gender, smoking, and Charlson Comorbidity Index (CCI) showed no significant correlations with preoperative SWAL-QoL. Patients with prior cervical surgery had a lower preoperative SWAL-QoL (P = .04). While 11 patients had acute postoperative dysphagia, CD surgery did not result in lower SWAL-QoL at 3 months (77.26 vs 78.35, P = .53). Surgical variables, including estimated blood loss (EBL), anterior or posterior fusion levels, steroid use, preoperative traction, staged surgery, surgical approach, anterior corpectomy, posterior osteotomy, and UIV (upper instrumented vertebrae) location, showed no impact on postoperative SWAL-QoL. Correction of cervical kyphosis was not correlated to 3-month SWAL-QoL scores or the change in SWAL-QoL scores.Conclusions:While patients undergoing surgery for cervical deformity had swallowing dysfunction at baseline, we did not observe a significant decline in SWAL-QoL scores at 3 months. Patients with prior cervical surgery and higher BMI had a lower baseline SWAL-QoL. There were no surgical or radiographic variables correlated to a change in SWAL-QOL score.