Professor Duke University Duke University Heath System New Canaan, CT, US
Introduction: Potentially modifiable patient-related factors have not been well studied in complex adult cervical deformity (ACD) surgery, especially in the context of distal junctional kyphosis (DJK).
Methods: Complex ACD patients with baseline (BL) data were included. BL static and flexion/extension radiographs were assessed and classified per Kim-ISSG adult cervical deformity morphological grading: 1) Flat Neck (FN) 2) Focal (F), Cervicothoracic (CT), and Coronal (C) based upon mean radiographic parameters described in by Louie et al. ANOVA was then used to compare baseline demographic, frailty, and patient-reported measures between each deformity subtype. Chi-Square then assessed BL disability per NDI tertiles (I – III) across morphotypes. Logistic regression and CIT assessed thresholds of disability within each tertile and morphotype.
Results: 72 patients were included (63.3±12.3yrs, BMI: 28.6±5.8kg/m2). By morphological subtype, 19.7% of patients were classified as FN, 28.2% were classified as F, 28.2% were classified as CT, and 23.9% were classified as C. Disability assessment by NDI quartiles revealed significant differences between morphological subtypes (χ2(9)= 18.936, p=.026), with a greater proportion of F and CT patients presenting in the highest tertiles NDI. At BL, tertile distribution in FN patients were as follows: 42.9% (I), 28.6% (II), 28.6% (III); in F patients: 25.0% (I), 41.2% (II), 29.4% (III); in CT patients: 36.8% (I), 26.3% (II), 36.8% (III); in C patients: 17.6% (I), 47.1% (II), 35.3% (III).
Conclusion : Predictive analysis quantifying radiographic parameters based on increased baselined disability results in significantly greater probability of a patient being classified as having Focal, or Cervicothoracic deformity, but not Flat Neck nor Coronal, and that patients assigned said subtypes are more likely to present in the upper 66thth percentile of disability by the Neck Disability Index (NDI).
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