• Tamir Ailon, Justin S Smith, Christopher I Shaffrey, Han Jo Kim, Gregory Mundis, Munish Gupta, Eric Klineberg, Frank Schwab, Virginie Lafage, Renaud Lafage, Peter Passias, Themistocles Protopsaltis, Brian Neuman, Alan Daniels, Justin K Scheer, Alex Soroceanu, Robert Hart, Rick Hostin, Douglas Burton, Vedat Deviren, Todd J Albert, K Daniel Riew, Shay Bess, Christopher P Ames, and International Spine Study Group.
• Department of Orthopaedics, University of British Columbia, Vancouver, British Columbia, Canada.
• Neurosurgery. 2018 Nov 1; 83 (5): 1031-1039.

BackgroundDespite the potential for profound impact of adult cervical deformity (ACD) on function and health-related quality of life (HRQOL), there are few high-quality studies that assess outcomes of surgical treatment for these patients.ObjectiveTo determine the impact of surgical treatment for ACD on HRQOL.MethodsWe conducted a prospective cohort study of surgically treated ACD patients eligible for 1-yr follow-up. Baseline deformity characteristics, surgical parameters, and 1-yr HRQOL outcomes were assessed.ResultsOf 77 ACD patients, 55 (71%) had 1-yr follow-up (64% women, mean age of 62 yr, mean Charlson Comorbidity Index of 0.6, previous cervical surgery in 47%). Diagnoses included cervical sagittal imbalance (56%), cervical kyphosis (55%), proximal junctional kyphosis (7%) and coronal deformity (9%). Posterior fusion was performed in 85% (mean levels = 10), and anterior fusion was performed in 53% (mean levels = 5). Three-column osteotomy was performed in 24% of patients. One year following surgery, ACD patients had significant improvement in Neck Disability Index (50.5 to 38.0, P < .001), neck pain numeric rating scale score (6.9 to 4.3, P < .001), EuroQol 5 dimension (EQ-5D) index (0.51 to 0.66, P < .001), and EQ-5D subscores: mobility (1.9 to 1.7, P = .019), usual activities (2.2 to 1.9, P = .007), pain/discomfort (2.4 to 2.1, P < .001), anxiety/depression (1.8 to 1.5, P = .014).ConclusionBased on a prospective multicenter series of ACD patients, surgical treatment provided significant improvement in multiple measures of pain and function, including Neck Disability Index, neck pain numeric rating scale score, and EQ-5D. Further follow-up will be necessary to assess the long-term durability of these improved outcomes.

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