• Peter G Passias, Alex Soroceanu, Justin Smith, Anthony Boniello, Sun Yang, Justin K Scheer, Frank Schwab, Christopher Shaffrey, Han Jo Kim, Themistocles Protopsaltis, Gregory Mundis, Munish Gupta, Eric Klineberg, Virginie Lafage, Christopher Ames, and International Spine Study Group.
• *Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY †Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA ‡Department of Neurological Surgery, Northwestern University, Feinberg School of Medicine, Chicago, IL §Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY ¶San Diego Center for Spinal Disorders, La Jolla, CA ∥Department of Orthopaedic Surgery, University of California Davis, Sacramento, CA **Department of Neurosurgery, University of California San Francisco, San Francisco, CA; and ††International Spine Study Group, Littleton, CO.
• Spine. 2015 Mar 1; 40 (5): 283-91.

Study DesignRetrospective review of prospective multicenter database.ObjectiveQuantify the incidence of new onset cervical deformity (CD) after adult spinal deformity surgery of the thoracolumbar spine, identify predictors of development, and determine the impact on outcomes.Summary Of Background DataHigh prevalence of residual CD has been identified after surgical treatment of adult spinal deformity. Development of new onset CD is less understood and its clinical impact unclear.MethodsA total of 215 patients with complete 2-year follow-up and full-length radiographs met inclusion criteria. CD was defined by T1 slope minus Cervical Lordosis (CL) more than 20°, C2-C7 sagittal vertical axis more than 40 mm, or C2-C7 kyphosis more than 10°. Univariate analysis was performed using t tests or tests of proportion. Multivariate logistic regression was used to determine independent predictors of new onset CD. The impact of CD on health-related quality of life and satisfaction was measured using repeated measures mixed models or logistic regression as appropriate, accounting for potential confounders.ResultsThe overall rate of CD at 2 years after surgery was 63%. Univariate analysis revealed that patients who developed new onset CD postoperatively had higher incidence of diabetes (7.35% vs. 1.28%, P = 0.05), increased preoperative C2-C7 sagittal vertical axis (P = 0.04) and C2 slope (P = 0.038), and smaller diameter rods used at surgery (P = 0.032). Independent predictors of new onset CD at 2 years included: diabetes (odds ratio, 10.49; P = 0.046) and increased preoperative T1 slope minus cervical lordosis (odds ratio, 1.08/º; P = 0.022). Ending instrumentation below T4 was a negative predictor (odds ratio, 0.31; P = 0.019). Patients with and without CD experienced improvements in 2-year 36-Item Short Form Health Survey (P = 0.0001), Oswestry Disability Index (P = 0.0001), and Scoliosis Research Society (P = 0.0001). Rates and overall improvement were similar. CD was not associated with decreased satisfaction (P = 0.28).ConclusionA total of 47.7% of patients without preoperative CD developed new onset postoperative CD after thoracolumbar surgery. Independent predictors of new onset CD at 2 years included diabetes, higher preoperative T1 slope minus cervical lordosis, and ending instrumentation above T4. Significant improvements in health-related quality of life scores occurred despite the development of postoperative CD.Level Of Evidence2.

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