||BACKGROUND:Limited data are available to objectively define what constitutes a "good"
versus a "bad" recovery for operative cervical deformity (CD) patients. Furthermore,
the recovery patterns of primary versus revision procedures for CD is poorly understood.
OBJECTIVE:To define and compare the recovery profiles of CD patients undergoing primary
or revision procedures, utilizing a novel area-under-the-curve normalization methodology.
METHODS:CD patients undergoing primary or revision surgery with baseline to 1-yr health-related
quality of life (HRQL) scores were included. Clinical symptoms and HRQL were compared
among groups (primary/revision). Normalized HRQL scores at baseline and follow-up
intervals (3M, 6M, 1Y) were generated. Normalized HRQLs were plotted and area under
the curve was calculated, generating one number describing overall recovery (Integrated
Health State). Subanalysis identified recovery patterns through 2-yr follow-up. RESULTS:Eighty-three
patients were included (45 primary, 38 revision). Age (61.3 vs 61.9), gender (F: 66.7%
vs 63.2%), body mass index (27.7 vs 29.3), Charlson Comorbidity Index, frailty, and
osteoporosis (20% vs 13.2%) were similar between groups (P > .05). Primary patients
were more preoperatively neurologically symptomatic (55.6% vs 31.6%), less sagittally
malaligned (cervical sagittal vertical axis [cSVA]: 32.6 vs 46.6; T1 slope: 28.8 vs
36.8), underwent more anterior-only approaches (28.9% vs 7.9%), and less posterior-only
approaches (37.8% vs 60.5%), all P < .05. Combined approaches, decompressions, osteotomies,
and construct length were similar between groups (P > .05). Revisions had longer op-times
(438.0 vs 734.4 min, P = .008). Following surgery, complication rate was similar between
groups (66.6% vs 65.8%, P = .569). Revision patients remained more malaligned (cSVA,
TS-CL; P < .05) than primary patients until 1-yr follow-up (P > .05). Normalized HRQLs
determined primary patients to exhibit less neck pain (numeric rating scale [NRS])
and myelopathy (modified Japanese Orthopaedic Association) symptoms through 1-yr follow-up
compared to revision patients (P < .05). These differences subsided when following
patients through 2 yr (P > .05). Despite similar 2-yr HRQL outcomes, revision patients
exhibited worse neck pain (NRS) Integrated Health State recovery (P < .05). CONCLUSION:Despite
both primary and revision patients exhibiting similar HRQL outcomes at final follow-up,
revision patients were in a greater state of postoperative neck pain for a greater
amount of time.