Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery


Study Design: Retrospective cohort study. Objective: Factors that predict outcomes for adult cervical spine deformity (ACSD) have not been well defined. To compare ACSD patients with best versus worst outcomes. Methods: This study was based on a prospective, multicenter observational ACSD cohort. Best versus worst outcomes were compared based on Neck Disability Index (NDI), Neck Pain Numeric Rating Scale (NP-NRS), and modified Japanese Orthopaedic Association (mJOA) scores. Results: Of 111 patients, 80 (72%) had minimum 1-year follow-up. For NDI, compared with best outcome patients (n = 28), worst outcome patients (n = 32) were more likely to have had a major complication (P =.004) and to have undergone a posterior-only procedure (P =.039), had greater Charlson Comorbidity Index (P =.009), and had worse postoperative C7-S1 sagittal vertical axis (SVA; P =.027). For NP-NRS, compared with best outcome patients (n = 26), worst outcome patients (n = 18) were younger (P =.045), had worse baseline NP-NRS (P =.034), and were more likely to have had a minor complication (P =.030). For the mJOA, compared with best outcome patients (n = 16), worst outcome patients (n = 18) were more likely to have had a major complication (P =.007) and to have a better baseline mJOA (P =.030). Multivariate models for NDI included posterior-only surgery (P =.006), major complication (P =.002), and postoperative C7-S1 SVA (P =.012); models for NP-NRS included baseline NP-NRS (P =.009), age (P =.017), and posterior-only surgery (P =.038); and models for mJOA included major complication (P =.008). Conclusions: Factors distinguishing best and worst ACSD surgery outcomes included patient, surgical, and radiographic factors. These findings suggest areas that may warrant greater awareness to optimize patient counseling and outcomes.






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Publication Info

Smith, JS, CI Shaffrey, HJ Kim, P Passias, T Protopsaltis, R Lafage, GM Mundis, E Klineberg, et al. (2019). Comparison of Best Versus Worst Clinical Outcomes for Adult Cervical Deformity Surgery. Global Spine Journal, 9(3). pp. 303–314. 10.1177/2192568218794164 Retrieved from

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Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

Peter Passias

Instructor in the Department of Orthopaedic Surgery

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