BACKGROUND CONTEXT Patients with both adult degenerative and myelopathic conditions of the upper spine, along with progressive symptoms, are often eligible for corrective surgery. The impact and prevalence of myelopathy due to spinal cord dysfunction in adult cervical deformity (CD) surgery remains understudied. PURPOSE To investigate the rates of neurological deficits and improvements among patients with severe deformity and by morphotype breakdown. STUDY DESIGN/SETTING Retrospective cohort study of a prospective adult cervical deformity (CD) database. PATIENT SAMPLE A total of 280 CD patients. OUTCOME MEASURES Neurological symptoms, neurological improvements. METHODS CD patients 18 years old with complete baseline (BL) and 3M postoperative HRQL and radiographic data. Patient baseline and post-operative myelopathy signs and symptoms were assessed. Mild myelopathy was defined as mJOA 15-17, Moderate 12-14, and Severe <12. Means comparison tests assessed baseline clinical, radiographic, and demographic factors between patients with severe and mild/moderate myelopathy. RESULTS A total of 170 CD patients met inclusion criteria. Of these, 24% had mild myelopathy, 39% had moderate myelopathy, and 30% had severe myelopathy. Patients with severe myelopathy had a greater degree of frailty (.2 vs .26), greater comorbidity burden (CCI: 1.2 vs .7), disability (NDI: 63 vs 54) with a substantially lower mJOA (9.8 vs 14.5, all p< .05). Severe myelopathy patients also had a longer LOS (6.6 vs 4.8 days) and developed DJF at greater rates (14% vs 5%). Overall, 113 (67%) patients had BL neuro symptoms: 10% bladder incontinence, 6% bowel incontinence, 27% gait instability, 37% hand clumsiness, 60% hand numbness, 7% Lhermitte's sign, 45% bilateral paresthesia and 56% weakness. After surgical intervention, 39% improved in degree of myelopathy. Postoperative myelopathy was 13% mild, 14% moderate and 10% severe. Patients with severe BL myelopathy showed improvements in NDI (63 to 51), mJOA (9.8 to 12.5) and NSR Neck (7.8 to 5.2, all p < .001). However, compared to mild/moderate myelopathy patients, severely myelopathic patients maintained a greater postoperative disability (51 vs 41), and worse degree of myelopathy (12.5 vs 14.3), when compared to mild/moderate patients p<.05. CONCLUSIONS Surgical correction shows substantial efficacy in resolution of myelopathy and improvements in functional status among adult cervical deformity patients. Severely myelopathic patients present with a greater degree of morbidity, frailty and disability, and despite improving post-operatively, maintained a substantially greater disability and neurological impairment postoperatively. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. Patients with both adult degenerative and myelopathic conditions of the upper spine, along with progressive symptoms, are often eligible for corrective surgery. The impact and prevalence of myelopathy due to spinal cord dysfunction in adult cervical deformity (CD) surgery remains understudied. To investigate the rates of neurological deficits and improvements among patients with severe deformity and by morphotype breakdown. Retrospective cohort study of a prospective adult cervical deformity (CD) database. A total of 280 CD patients. Neurological symptoms, neurological improvements. CD patients 18 years old with complete baseline (BL) and 3M postoperative HRQL and radiographic data. Patient baseline and post-operative myelopathy signs and symptoms were assessed. Mild myelopathy was defined as mJOA 15-17, Moderate 12-14, and Severe <12. Means comparison tests assessed baseline clinical, radiographic, and demographic factors between patients with severe and mild/moderate myelopathy. A total of 170 CD patients met inclusion criteria. Of these, 24% had mild myelopathy, 39% had moderate myelopathy, and 30% had severe myelopathy. Patients with severe myelopathy had a greater degree of frailty (.2 vs .26), greater comorbidity burden (CCI: 1.2 vs .7), disability (NDI: 63 vs 54) with a substantially lower mJOA (9.8 vs 14.5, all p< .05). Severe myelopathy patients also had a longer LOS (6.6 vs 4.8 days) and developed DJF at greater rates (14% vs 5%). Overall, 113 (67%) patients had BL neuro symptoms: 10% bladder incontinence, 6% bowel incontinence, 27% gait instability, 37% hand clumsiness, 60% hand numbness, 7% Lhermitte's sign, 45% bilateral paresthesia and 56% weakness. After surgical intervention, 39% improved in degree of myelopathy. Postoperative myelopathy was 13% mild, 14% moderate and 10% severe. Patients with severe BL myelopathy showed improvements in NDI (63 to 51), mJOA (9.8 to 12.5) and NSR Neck (7.8 to 5.2, all p < .001). However, compared to mild/moderate myelopathy patients, severely myelopathic patients maintained a greater postoperative disability (51 vs 41), and worse degree of myelopathy (12.5 vs 14.3), when compared to mild/moderate patients p<.05. Surgical correction shows substantial efficacy in resolution of myelopathy and improvements in functional status among adult cervical deformity patients. Severely myelopathic patients present with a greater degree of morbidity, frailty and disability, and despite improving post-operatively, maintained a substantially greater disability and neurological impairment postoperatively.
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