Abstract：
Cervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery.
The authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2-7 Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2-7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25°. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope-cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC).
In total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients\' conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0-11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2-12 kyphosis, TS-CL, C2-T3 SVA, C2-T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9-39), worse baseline neurological status (OR 11.4, 95% CI 1.8-70.8), baseline pelvic tilt > 20° (OR 0.92, 95% CI 0.85-0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1-4.1), preoperative C2-T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9-1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09-10.3).
Of all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct.
The authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2-7 Cobb angle > 10°), cervical scoliosis (coronal Cobb angle > 10°), C2-7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25°. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope-cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC).
In total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients\' conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0-11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2-12 kyphosis, TS-CL, C2-T3 SVA, C2-T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9-39), worse baseline neurological status (OR 11.4, 95% CI 1.8-70.8), baseline pelvic tilt > 20° (OR 0.92, 95% CI 0.85-0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1-4.1), preoperative C2-T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9-1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09-10.3).
Of all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct.
摘要：
颈椎畸形（CD）矫正在临床上具有挑战性。这些高度复杂的手术有发生并发症的高风险。这项研究的目的是使用基线人口统计学，临床,和手术因素来预测CD手术后的不良结果。
作者对多中心前瞻性CD数据库进行了回顾性回顾。CD被定义为以下至少一种：颈椎后凸畸形（C2-7Cobb角>10°），颈椎侧凸（冠状Cobb角>10°），C2-7矢状垂直轴（cSVA）>4厘米，或下巴-眉毛垂直角（CBVA）>25°。患者根据总体不良结果进行分类。与健康相关的生活质量测量包括颈部残疾指数(NDI)，EQ-5D,和改良的日本骨科协会(mJOA)量表评分。不良结局定义为满足以下所有3类：1）影像学不良结局：cSVA或T1斜率-宫颈曲度不匹配（TS-CL）术后1年恶化或严重的影像学异常；2）临床不良结局：未能满足NDI的最小临床重要差异（MCID）或具有严重的mJOAAmes修饰符；3）并发症/再手术结局不良：主要并发症，死亡,或因感染以外的并发症而再次手术。进行了单变量逻辑回归，然后进行了多变量回归模型，通过计算曲线下面积(AUC)进行内部验证.
总共，纳入89例CD患者(平均年龄61.9岁，女性65.2%,BMI29.2kg/m2)。术后1年,18例（20.2%）患者的总体预后较差。对于射线照相不良结果，TS-CL的患者病情恶化或仍然严重（73％的患者），CSVA（8%），水平凝视（34%），和全球SVA（28%）。对于临床不良结果，80%和60%的患者未达到EQ-5D和NDI的MCID，分别,24%的患者有严重症状（mJOA评分0-11）。对于并发症/再次手术效果不佳，28例患者出现严重并发症，11人接受了再次手术，1例并发症相关死亡.临床结果不佳的患者，75％的放射线照相结果不佳；35％的放射线照相不良患者和37％的临床结果不良患者有重大并发症。通过以下因素组合预测结果较差：骨质疏松症，基线神经状态，使用过渡杆，后减压的数量，基线骨盆倾斜,T2-12后凸畸形,TS-CL,C2-T3SVA,C2-T1骨盆角（C2坡度），全局SVA,和最大胸椎后凸的水平数。预测不良结局的最终模型（AUC86％）包括：骨质疏松症（OR5.9，95％CI0.9-39），基线神经状况较差(OR11.4，95%CI1.8-70.8)，基线骨盆倾斜>20°(OR0.92，95%CI0.85-0.98)，最大胸椎后凸>9水平（OR2.01，95％CI1.1-4.1），术前C2-T3SVA>5.4cm(OR1.01,95%CI0.9-1.1),全局SVA>4cm（OR3.2，95%CI0.09-10.3）。
在这项研究中的所有CD患者中，20.2%的人总体结果不佳，由放射学和临床结果恶化定义，和一个主要的并发症。此外,75％的临床结果不佳的患者也有不良的影像学结果。严重的基线神经功能缺损最强烈地预测了较差的总体结局。全局SVA>4厘米，结构中包括更多的胸部最大后凸。
作者对多中心前瞻性CD数据库进行了回顾性回顾。CD被定义为以下至少一种：颈椎后凸畸形（C2-7Cobb角>10°），颈椎侧凸（冠状Cobb角>10°），C2-7矢状垂直轴（cSVA）>4厘米，或下巴-眉毛垂直角（CBVA）>25°。患者根据总体不良结果进行分类。与健康相关的生活质量测量包括颈部残疾指数(NDI)，EQ-5D,和改良的日本骨科协会(mJOA)量表评分。不良结局定义为满足以下所有3类：1）影像学不良结局：cSVA或T1斜率-宫颈曲度不匹配（TS-CL）术后1年恶化或严重的影像学异常；2）临床不良结局：未能满足NDI的最小临床重要差异（MCID）或具有严重的mJOAAmes修饰符；3）并发症/再手术结局不良：主要并发症，死亡,或因感染以外的并发症而再次手术。进行了单变量逻辑回归，然后进行了多变量回归模型，通过计算曲线下面积(AUC)进行内部验证.
总共，纳入89例CD患者(平均年龄61.9岁，女性65.2%,BMI29.2kg/m2)。术后1年,18例（20.2%）患者的总体预后较差。对于射线照相不良结果，TS-CL的患者病情恶化或仍然严重（73％的患者），CSVA（8%），水平凝视（34%），和全球SVA（28%）。对于临床不良结果，80%和60%的患者未达到EQ-5D和NDI的MCID，分别,24%的患者有严重症状（mJOA评分0-11）。对于并发症/再次手术效果不佳，28例患者出现严重并发症，11人接受了再次手术，1例并发症相关死亡.临床结果不佳的患者，75％的放射线照相结果不佳；35％的放射线照相不良患者和37％的临床结果不良患者有重大并发症。通过以下因素组合预测结果较差：骨质疏松症，基线神经状态，使用过渡杆，后减压的数量，基线骨盆倾斜,T2-12后凸畸形,TS-CL,C2-T3SVA,C2-T1骨盆角（C2坡度），全局SVA,和最大胸椎后凸的水平数。预测不良结局的最终模型（AUC86％）包括：骨质疏松症（OR5.9，95％CI0.9-39），基线神经状况较差(OR11.4，95%CI1.8-70.8)，基线骨盆倾斜>20°(OR0.92，95%CI0.85-0.98)，最大胸椎后凸>9水平（OR2.01，95％CI1.1-4.1），术前C2-T3SVA>5.4cm(OR1.01,95%CI0.9-1.1),全局SVA>4cm（OR3.2，95%CI0.09-10.3）。
在这项研究中的所有CD患者中，20.2%的人总体结果不佳，由放射学和临床结果恶化定义，和一个主要的并发症。此外,75％的临床结果不佳的患者也有不良的影像学结果。严重的基线神经功能缺损最强烈地预测了较差的总体结局。全局SVA>4厘米，结构中包括更多的胸部最大后凸。
