1Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
2Presbyterian St. Luke's Medical Center, Denver, Colorado.
J Neurosurg Spine. 2022 Jul 22;37(6):855-864. doi: 10.3171/2022.6.SPINE22422. Print 2022 Dec 1.
Adult cervical deformity (ACD) has high complication rates due to surgical complexity and patient frailty. Very few studies have focused on longer-term outcomes of operative ACD treatment. The objective of this study was to assess minimum 2-year outcomes and complications of ACD surgery.
A multicenter, prospective observational study was performed at 13 centers across the United States to evaluate surgical outcomes for ACD. Demographics, complications, radiographic parameters, and patient-reported outcome measures (PROMs; Neck Disability Index, modified Japanese Orthopaedic Association, EuroQol-5D [EQ-5D], and numeric rating scale [NRS] for neck and back pain) were evaluated, and analyses focused on patients with ≥ 2-year follow-up.
Of 169 patients with ACD who were eligible for the study, 102 (60.4%) had a minimum 2-year follow-up (mean 3.4 years, range 2-8.1 years). The mean age at surgery was 62 years (SD 11 years). Surgical approaches included anterior-only (22.8%), posterior-only (39.6%), and combined (37.6%). PROMs significantly improved from baseline to last follow-up, including Neck Disability Index (from 47.3 to 33.0) and modified Japanese Orthopaedic Association score (from 12.0 to 12.8; for patients with baseline score ≤ 14), neck pain NRS (from 6.8 to 3.8), back pain NRS (from 5.5 to 4.8), EQ-5D score (from 0.74 to 0.78), and EQ-5D visual analog scale score (from 59.5 to 66.6) (all p ≤ 0.04). More than half of the patients (n = 58, 56.9%) had at least one complication, with the most common complications including dysphagia, distal junctional kyphosis, instrumentation failure, and cardiopulmonary events. The patients who did not achieve 2-year follow-up (n = 67) were similar to study patients based on baseline demographics, comorbidities, and PROMs. Over the course of follow-up, 23 of the total 169 enrolled patients were reported to have died. Notably, these represent all-cause mortalities during the course of follow-up.
This multicenter, prospective analysis demonstrates that operative treatment for ACD provides significant improvement of health-related quality of life at a mean 3.4-year follow-up, despite high complication rates and a high rate of all-cause mortality that is reflective of the overall frailty of this patient population. To the authors' knowledge, this study represents the largest and most comprehensive prospective effort to date designed to assess the intermediate-term outcomes and complications of operative treatment for ACD.
成人颈椎畸形（ACD）由于手术复杂性和患者脆弱性而导致高并发症发生率。很少有研究关注手术治疗 ACD 的长期结果。本研究的目的是评估 ACD 手术的至少 2 年结果和并发症。
在美国 13 个中心进行了一项多中心、前瞻性观察性研究，以评估 ACD 的手术结果。评估了人口统计学、并发症、影像学参数和患者报告的结果测量（PROM；颈部残疾指数、改良日本矫形协会、欧洲五维健康量表 [EQ-5D] 和颈部和背部疼痛的数字评定量表 [NRS]），并分析了至少有 2 年随访的患者。
在符合研究条件的 169 例 ACD 患者中，有 102 例（60.4%）具有至少 2 年的随访（平均 3.4 年，范围 2-8.1 年）。手术时的平均年龄为 62 岁（标准差 11 岁）。手术入路包括前路（22.8%）、后路（39.6%）和联合入路（37.6%）。PROM 从基线到最后一次随访显著改善，包括颈部残疾指数（从 47.3 到 33.0）和改良日本矫形协会评分（从 12.0 到 12.8；对于基线评分≤14 的患者）、颈部疼痛 NRS（从 6.8 到 3.8）、背部疼痛 NRS（从 5.5 到 4.8）、EQ-5D 评分（从 0.74 到 0.78）和 EQ-5D 视觉模拟评分（从 59.5 到 66.6）（均 p≤0.04）。超过一半的患者（n=58，56.9%）至少有一次并发症，最常见的并发症包括吞咽困难、远端交界性后凸、器械失败和心肺事件。未达到 2 年随访的患者（n=67）在基线人口统计学、合并症和 PROM 方面与研究患者相似。在随访过程中，总共 169 名入组患者中有 23 名报告死亡。值得注意的是，这些代表了整个随访期间的所有原因死亡率。
这项多中心、前瞻性分析表明，尽管并发症发生率高，且全因死亡率高，反映了该患者人群的整体脆弱性，但 ACD 的手术治疗在平均 3.4 年的随访中提供了显著改善的健康相关生活质量。据作者所知，这是迄今为止评估 ACD 手术治疗的中期结果和并发症的最大和最全面的前瞻性研究。
