• Darryl Lau, Rushikesh S Joshi, Alexander F Haddad, Vedat Deviren, and Christopher P Ames.
• Department of Neurological Surgery, New York University, New York, New York, USA.
• Neurosurgery. 2022 Feb 1; 90 (2): 207214207-214.

BackgroundRigid cervical deformity (CD) requires multilevel and/or high-grade osteotomies and long-construct fusions to achieve adequate correction. The incidence of mechanical complications (MCs) remains incompletely studied.ObjectiveTo define the incidence and risk factors for MC.MethodsA retrospective review of consecutive patients with CD who underwent correction from 2010 to 2018 was performed. Inclusion criteria were cervical kyphosis >20° and/or cervical sagittal vertical axis (cSVA) >4 cm. MCs (junctional kyphosis/failure, pseudarthrosis, and implant failure) and reoperation at 1 and 2 yr were examined.ResultsEighty-three patients were included. The mean age was 63.4 yr, and 61.0% were female. Fifty-three percent underwent 3-column osteotomies. After surgery, cervical parameters were significantly improved: cSVA (6.2 vs 3.8 cm, P < .001), cervical lordosis (6.3 vs -8.3°, P < .001), cervical scoliosis (CS) (6.5 vs 2.2°, P < .001), and T1 slope (41.7 vs 36.3°, P = .007). The MC rate was 28.9%: junctional (18.1%), implant (16.9%), and pseudarthrosis (10.8%). MC rates at 1 and 2 yr were 14.5% and 25.5%, respectively: junctional (9.6% and 17.6%), implant (9.6% and 17.6%), and pseudarthrosis (2.4% and 7.8%). The overall reoperation rate was 24.1%: 14.5% at 1 yr and 19.6% at 2 yr. Body mass index (BMI) (P = .015) and preoperative CS (P = .040) were independently associated with higher odds of MC. Receiver operating characteristic curves defined CS >5° to be the threshold of risk for MCs and reoperation.ConclusionCorrection of CD is effective by posterior-based osteotomes, but MCs are relatively high at 1 and 2 yr. BMI >30 and preoperative CS >5° predispose patients for MC and reoperation.Copyright © Congress of Neurological Surgeons 2021. All rights reserved.

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