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- Title
Risk-benefit assessment of major versus minor osteotomies for flexible and rigid cervical deformity correction.
- Authors
PASSIAS, PETER GUST; PASSFALL, LARA; HORN, SAMANTHA R.; PIERCE, KATHERINE E.; LAFAGE, VIRGINIE; LAFAGE, RENAUD; SMITH, JUSTIN S.; LINE, BRETON G.; MUNDIS, GREGORY M.; EASTLACK, ROBERT; DIEBO, BASSEL G.; PROTOPSALTIS, THEMISTOCLES S.; HAN JO KIM; SCHEER, JUSTIN; BURTON, DOUGLAS C.; HART, ROBERT A.; SCHWAB, FRANK J.; BESS, SHAY; AMES, CHRISTOPHER P.
- Abstract
Introduction: Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction. Methods: Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent t-tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL. Results: 137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications (P = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients (P = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, P = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, P = 0.027). Both groups had similar sagittal realignment at 1 year (all P > 0.05). Conclusions: Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.
- Subjects
3M Co.; PROPENSITY score matching; HUMAN abnormalities; TREATMENT effectiveness; CHI-squared test
- Publication
Journal of Craniovertebral Junction & Spine, 2021, Vol 12, Issue 3, p263
- ISSN
0974-8237
- Publication type
Article
- DOI
10.4103/jcvjs.jcvjs_35_21