Optimizing Modifiable Health Conditions Prior to Adult Cervical Deformity Surgery Associated with Fewer Complications

Introduction: While benefits to surgical outcomes from optimizing comorbidities prior to surgical ACD correction is hypothesized, this has not yet been studied.

Methods: ACD patients with available up to 2-year data were included. Preoperative optimization for osteoporosis was assessed by treatment with an FDA approved drug prior to surgery. Patients were divided into 2 groups: those who had preoperative rehabilitation [Prehab] and those who did not [no Prehab]. Prehab consisted of cognitive behavioral therapy and physical therapy with core, paraspinal and leg strengthening. Nutritional status assessed by ranking patients into quartiles (Q1-Q4) by baseline BMI. Q1 (low BMI) and Q4 (high BMI) were considered not optimized. Patients stratified by optimization in all three groups (Opt) or non-optimized. ANCOVA and logistic regression analyses assessed outcomes while accounting for surgical and demographic differences between groups.

Results: 347 patients (average 57.9±12.1 years, 48% female, 29.0±6.82 kg/m2) included. Optimized patients were significantly less female (43% vs. 52%, p=.038) and had fewer levels fused (4.14±3.50 vs. 5.21±4.15, p=.002), shorter length of stay (3.96±3.94 vs. 5.12±8.18 days, p=.044), less operative time (261.9±166.6 vs. 315.8±189.7 mins, p=.002), and lower EBL (502.8±950.6 vs. 679.0±965.5 mL, p=.039). Optimized patients trended towards being younger (p=.199) and having fewer osteotomies (p=.314) but this was not significant. When comparing means for perioperative outcomes and cost, optimized patients experienced fewer minor complications (9.12% vs. 16.5%, p=.010. However, optimized patients were similar to not optimized patients when comparing mean rate of reoperations and reaching MCID for mJOA at 2 years (all p>.05). A stepwise regression model was significant higher odds of reaching MCID for NDI for optimized patients when controlling for gender, levels fused, operative time, and EBL (OR: 1.406 [1.169-1.691], p<.001. Optimized patients had lower odds of overall complications at 2 years (OR:.45 [1.02, 1.89], p=.009) with lower rates of DJK and DJF development (p <.05).

Conclusion : Patients undergoing corrective cervical deformity surgery benefit from preoperative optimization, emphasizing its importance in surgical planning.