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Functional Outcomes following Anterior Cervical Discectomy and Fusion: Analysis of a Worker’s Compensation Population
Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S four-level fusion. NDI improved from 34.46 at baseline to 25.47 at two years. Neck pain improved from 7.04 at baseline to 3.95 and arm pain improved from 6.24 to 3.09 at two-year follow up. Sixteen patients (35%) returned to surgery within two years with 11 of these patients (24%) returning for nonunion. The average number of days to revision surgery was 750.6 6570.3 days. CONCLUSIONS: Patients undergoing three- and four-level ACDF for multilevel cervical disease demonstrate substantial improvement in outcomes. However, the two-year revision rate is relatively high at 35% with the majority of these patients returning due to nonunion. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.328
P93. Does Depression or Anxiety Affect Patient-Reported Outcomes and Satisfaction following Operative Treatment for Cervical Radiculopathy? Harrison F. Kay1, Silky Chotai, MD2, Joseph Wick, BA1, David Stonko2, Matthew J. McGirt, MD3, Clinton J. Devin, MD4; 1Nashville, TN, US; 2 Vanderbilt University School of Medicine, Nashville, TN, US; 3Carolina Neurosurgery & Spine Associates, Charlotte, NC, US; 4Vanderbilt University Medical Center, Nashville, TN, US BACKGROUND CONTEXT: Preoperative depression and anxiety are labels that often steer spine surgeons away from operative management for degenerative spine disease due to their association with worse outcomes. Better understanding of these factors as predictors for patient-reported outcomes (PROs) could improve selection of patients with the greatest opportunity for a successful outcome. PURPOSE: This study evaluates the differences in PROs and patient satisfaction following surgery for cervical radiculopathy in patients with depression or anxiety. STUDY DESIGN/SETTING: Analysis of prospective registry data at a single institution from 2010 to 2012. PATIENT SAMPLE: We evaluated consecutive patients undergoing operative management for cervical radiculopathy. Follow-up of at least 12 months was required. OUTCOME MEASURES: The Neck Disability Index (NDI), Short Form-12 (SF-12), Visual Analog Scale Neck and Arm Pain, and NASS patient satisfaction scale were utilized. METHODS: Patients undergoing surgery for cervical radiculopathy over a two-year period were enrolled into a prospective, web-based registry. 170 patients were included in the analysis. Baseline and 12month PRO values, Zung depression scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) were recorded prospectively. Patients with ZDSO33 were characterized as depressed, and patients with MSPQO12 as anxious. Mean absolute and change-score between groups were compared using Student’s t-test. Chi-square test was used to compare proportions between groups for patients who achieved MCID and patients who were satisfied (NASS patient satisfaction score). Multivariable linear regression was used to determine the effect of depression and anxiety on NDI controlling for 13 independent variables chosen a priori. RESULTS: 170 patients (103 depressed and 67 nondepressed, 36 anxious and 134 nonanxious) were evaluated. Mean 12-month absolute scores were significantly worse in depressed patients for all measures except VAS-AP: NDI% (P !0.001), SF-6D (P!0.001), VAS-NP (P50.008), VAS-AP (P 5 0.125). Mean 12-month absolute scores were also significantly worse in anxiety patients for all measures: NDI% (P!0.001), SF-6D (P!0.001), VAS-NP (P50.049), VAS-AP (P50.008). No difference in mean change scores was observed in depressed patients: NDI% (21.79 vs 18.03, P50.201), SF-6D (0.109 vs 0.102, P50.791), VAS-NP (3.11 vs 2.53, P50.260), VAS-AP (3.94 vs 3.03, P 5 0.134). No difference in mean
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change scores was observed in anxious patients: NDI% (21.89 vs 19.88, P50.568), SF-6D (0.108 vs 0.106, P50.936), VAS-NP (3.22 vs 2.79, P50.477), VAS-AP (4.00 vs 3.47, P50.468). No difference in proportion of patients achieving MCID was observed except for VAS-AP, in which depressed patients actually achieved MCID significantly more (P50.036). Multivariable linear regression demonstrated neither depression nor anxiety have a significant association with 12-month NDI% absolute or change score after controlling for 13 independent variables. Satisfaction with surgery was not significantly different for depression (P50.224) or anxiety (P50.162). CONCLUSIONS: Depressed and anxious patients have worse absolute pain and disability one year following surgery for cervical radiculopathy. However, 12-month change scores, achievement of MCID for patient-reported outcomes, and satisfaction with surgery are not dependent on preoperative depression or anxiety. These patients should not be dismissed as potential candidates for surgery because of their psychological distress alone as they stand to gain measurable clinical benefit. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.329
P94. Functional Outcomes following Anterior Cervical Discectomy and Fusion: Analysis of a Worker’s Compensation Population Kern Singh, MD1, Junyoung Ahn1, Blaine Manning, BS2, Spencer Leblang, BS3, Aamir Iqbal, BS3, Khaled A. Aboushaala4; 1Rush University Medical Center, Chicago, IL, US; 2Chicago, IL, US; 3Rush Medical College, Chicago, IL, US; 4Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: Ultimate patient work level is assessed via a functional capacity evaluation (FCE) that can significantly impact postoperative employment status. PURPOSE: To analyze clinical and functional outcomes following anterior cervical discectomy and fusion (ACDF) in worker’s compensation (WC) patients and to determine factors predictive of diminished postoperative function. STUDY DESIGN/SETTING: Retrospective cohort analysis of a prospectively maintained registry. PATIENT SAMPLE: Fifty-eight WC patients who underwent a primary 1- or 2-level ACDF with subsequent FCE between 2007 and 2013. OUTCOME MEASURES: Demographics, comorbidity, smoking status, length of hospitalization, 1-year arthrodesis, Visual Analog Scale (VAS) score. Peri- and postoperative variables. METHODS: Patients were stratified into cohorts based on ultimate work level (light/medium vs heavy). Subgroup analyses were performed stratifying patients by age, gender, smoking status, reoperation, fusion levels and preoperative glucose levels. Statistical analysis was performed with chi-squared test for categorical data, and Student’s T-test and one-way ANOVA for continuous variables. A p-value of !0.05 denoted statistical significance. RESULTS: Of the 58 patients included, 50 achieved light/medium and 8 demonstrated heavy work level. 24 patients met pre-injury job requirements. The 1-year arthrodesis rate overall was 84.5% and 13 patients required reoperation (range 99-1030 days postoperative). Reoperation was performed in 9 patients (69.2%) for pseudarthrosis, 2 patients (15.4%) with adjacent level disc degeneration (ALD), 1 patient (7.7%) with persistent stenosis (same level), and 1 patient (7.7%) with combined ALD and pseudarthrosis. Demographics, smoking status, VAS scores (pre- and postoperative), complications (in-hospital/6-month), and 1-year arthrodesis rates were similar between light/medium and heavy work level cohorts. Patients who underwent reoperation were more likely to have undergone an index 2-level ACDF. Patients who underwent re-operation at levels other than the
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
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Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
index were significantly less likely to achieve heavy work levels. Postoperative pain levels were significantly higher in patients with impaired glucose control, revision surgeries or 2-level fusions. Smokers, 2-level ACDFs and patients with impaired glucose control were more likely to have decreased functional levels following surgery. Males trended toward a greater postoperative level of functioning with no females achieving a heavy work-demand level. CONCLUSIONS: WC patients undergoing a 1- or 2-level ACDF appear likely to achieve at least a light or medium postoperative level of functioning. Impaired glucose control, smoking status and 2-level ACDFs were significant risk factors associated with a decreased likelihood of meeting preinjury occupational requirements. Patients with impaired glucose control, 2-level ACDFs, and revision cervical fusions were more likely to have an increased final postoperative VAS scores. Additionally, patients who underwent re-operation at levels other than the index were less likely to achieve a heavy physical demand level. Lastly, males were more likely to achieve greater postoperative functional demand levels. Understanding preoperative variables in order to predict postoperative functional outcomes is essential in order to educate patients regarding return-to-work expectations and to minimize indirect societal costs associated with longterm disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.330
P95. Prospective Multicenter Assessment of Early Complication Rates Associated with Adult Cervical Deformity Surgery in 78 Patients International Spine Study Group1, Justin S. Smith, MD, PhD2, Virginie Lafage, PhD3, Christopher I. Shaffrey, MD4, Themistocles S. Protopsaltis, MD3, Peter G. Passias, MD5, Frank J. Schwab, MD3, Munish C. Gupta, MD6, Michael F. O’Brien, MD7, Richard A. Hostin, Jr., MD8, Gregory M. Mundis, Jr., MD5, Robert K. Eastlack, MD9, Douglas C. Burton, MD10, Robert A. Hart, MD11, Alan Daniels, MD12, Han Jo Kim, MD13, Eric O. Klineberg, MD14, Shay Bess, MD15, Vedat Deviren, MD16, Todd J. Albert, MD13, K. Daniel Riew, MD17, Christopher P. Ames, MD16; 1 Brighton, CO, US; 2UVA Health System, Charlottesville, VA, US; 3New York University Hospital for Joint Diseases, New York, NY, US; 4University of Virginia, Charlottesville, VA, US; 5New York University School of Medicine, New York, NY, US; 6University of California Davis Orthopaedic Surgery, Sacramento, CA, US; 7Baylor Scoliosis Center, Plano, TX, US; 8 Southwest Scoliosis Institute, Plano, TX, US; 9Scripps Clinic, San Diego, CA, US; 10University of Kansas Medical Center, Kansas City, KS, US; 11 Oregon Health & Science University, Portland, OR, US; 12Warren Alpert Medical School of BU/RI Hospital, Providence, RI, US; 13Hospital for Special Surgery, New York, NY, US; 14University of California Davis School of Medicine, Sacramento, CA, US; 15Rocky Mountain Scoliosis and Spine, Denver, CO, US; 16University of California San Francisco, San Francisco, CA, US; 17Washington University School of Medicine, Saint Louis, MO, US BACKGROUND CONTEXT: Although adult cervical deformity (ACD) can have profound impact on function and health-related quality of life, few reports have focused on the treatment of these patients. We present early complication rates associated with surgical treatment for ACD based on a prospective multicenter cohort. Accurately defining the early complication rates is particularly important for patient counseling with regard to the risks and benefits of surgical treatment. PURPOSE: Assess early complication rates associated with the surgical treatment of ACD based on a prospective multicenter cohort. STUDY DESIGN/SETTING: Prospective multicenter cohort. PATIENT SAMPLE: ACD patients treated surgically.
OUTCOME MEASURES: Occurrence of early (within 30 days from surgery) minor and major complications. METHODS: Prospective multicenter database of operative ACD patients from 2013-2014 were reviewed for early (!30 days from surgery) complications. Database enrollment required at least one of the following: cervical kyphosis O10 , cervical scoliosis O10 , C2-7 sagittal vertical axis O4cm or chin-brown vertical angle O25 . Patients with ACD due to neoplasm or acute infection were excluded. RESULTS: 78 patients (59% women) underwent surgical treatment for ACD and had a mean age of 60.7 years (range 37-81 years), mean Charlson Comorbidity Index of 0.6 (range 0-6) and previous surgery in 52%. Surgical approaches included anterior-only (A, 14%), posterior-only (P, 49%), anterior-posterior (AP, 35%) and posterior-anterior-posterior (PAP, 3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major for an overall complication rate of 66.7%. 22 (28.2%) patients had at least one minor complication, and 19 (24.4%) had at least one major complication. Overall, 34 (43.6%) patients had one or more complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), respiratory failure (5.1%), new nerve root (not C5) motor deficit (3.8%), new nerve sensory deficit (3.8%), and superficial wound infection (3.8%). Less common complications included pulmonary embolism, cardiac arrest, arterial injury, instrumentation malposition, and mortality (respiratory arrest 1 week postop), excessive (O4L) bleeding (each occurring in 1.3%). Overall early complication rates were significantly different based on approach: A (27.3%), P (68.4%), AP/PAP (79.3%) (p50.007). CONCLUSIONS: Among 78 patients treated for ACD and prospectively followed, a total of 52 complications were reported (26 minor and 26 major), including 1 mortality. Overall, 34 (43.6%) patients had one or more complication and 24.4% of patients had one or more major complication. Significantly higher rates of complications were associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning and patient counseling. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.331
P96. Does Obesity Correlate with Poor Patient-Reported Outcomes following Cervical Surgery for Degenerative Conditions? John A. Sielatycki, MD1, Silky Chotai, MD2, Joseph Wick, BA2, David Stonko3, Harrison F. Kay2, Kevin O’Neill, MD4, Clinton J. Devin, MD1; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US; 3Vanderbilt University School of Medicine, Nashville, TN, US; 4Vanderbilt University Medical Center Department of Orthopaedics, Nashville, TN, US BACKGROUND CONTEXT: Obesity is associated with numerous disease states and is thought to exacerbate spinal pathology. Several studies have investigated the impact of obesity in thoracolumbar surgery. However, the effect of obesity on outcomes in cervical surgery has not been established. The direct effect of obesity on patient-reported outcomes (PROs) following degenerative cervical surgery is unknown. PURPOSE: To investigate the possible correlation between obesity and patient-reported outcomes following surgery for degenerative cervical conditions at a high-volume center. STUDY DESIGN/SETTING: Analysis of prospective registry data at a single institution from 2010 to 2013. PATIENT SAMPLE: All patients undergoing elective anterior cervical discectomy and fusion (ACDF) for stenosis, disc herniation and cervical
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
P93. Does Depression or Anxiety Affect Patient-Reported Outcomes and Satisfaction following Operative Treatment for Cervical Radiculopathy? Harrison F. Kay1, Silky Chotai, MD2, Joseph Wick, BA1, David Stonko2, Matthew J. McGirt, MD3, Clinton J. Devin, MD4; 1Nashville, TN, US; 2 Vanderbilt University School of Medicine, Nashville, TN, US; 3Carolina Neurosurgery & Spine Associates, Charlotte, NC, US; 4Vanderbilt University Medical Center, Nashville, TN, US BACKGROUND CONTEXT: Preoperative depression and anxiety are labels that often steer spine surgeons away from operative management for degenerative spine disease due to their association with worse outcomes. Better understanding of these factors as predictors for patient-reported outcomes (PROs) could improve selection of patients with the greatest opportunity for a successful outcome. PURPOSE: This study evaluates the differences in PROs and patient satisfaction following surgery for cervical radiculopathy in patients with depression or anxiety. STUDY DESIGN/SETTING: Analysis of prospective registry data at a single institution from 2010 to 2012. PATIENT SAMPLE: We evaluated consecutive patients undergoing operative management for cervical radiculopathy. Follow-up of at least 12 months was required. OUTCOME MEASURES: The Neck Disability Index (NDI), Short Form-12 (SF-12), Visual Analog Scale Neck and Arm Pain, and NASS patient satisfaction scale were utilized. METHODS: Patients undergoing surgery for cervical radiculopathy over a two-year period were enrolled into a prospective, web-based registry. 170 patients were included in the analysis. Baseline and 12month PRO values, Zung depression scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ) were recorded prospectively. Patients with ZDSO33 were characterized as depressed, and patients with MSPQO12 as anxious. Mean absolute and change-score between groups were compared using Student’s t-test. Chi-square test was used to compare proportions between groups for patients who achieved MCID and patients who were satisfied (NASS patient satisfaction score). Multivariable linear regression was used to determine the effect of depression and anxiety on NDI controlling for 13 independent variables chosen a priori. RESULTS: 170 patients (103 depressed and 67 nondepressed, 36 anxious and 134 nonanxious) were evaluated. Mean 12-month absolute scores were significantly worse in depressed patients for all measures except VAS-AP: NDI% (P !0.001), SF-6D (P!0.001), VAS-NP (P50.008), VAS-AP (P 5 0.125). Mean 12-month absolute scores were also significantly worse in anxiety patients for all measures: NDI% (P!0.001), SF-6D (P!0.001), VAS-NP (P50.049), VAS-AP (P50.008). No difference in mean change scores was observed in depressed patients: NDI% (21.79 vs 18.03, P50.201), SF-6D (0.109 vs 0.102, P50.791), VAS-NP (3.11 vs 2.53, P50.260), VAS-AP (3.94 vs 3.03, P 5 0.134). No difference in mean
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change scores was observed in anxious patients: NDI% (21.89 vs 19.88, P50.568), SF-6D (0.108 vs 0.106, P50.936), VAS-NP (3.22 vs 2.79, P50.477), VAS-AP (4.00 vs 3.47, P50.468). No difference in proportion of patients achieving MCID was observed except for VAS-AP, in which depressed patients actually achieved MCID significantly more (P50.036). Multivariable linear regression demonstrated neither depression nor anxiety have a significant association with 12-month NDI% absolute or change score after controlling for 13 independent variables. Satisfaction with surgery was not significantly different for depression (P50.224) or anxiety (P50.162). CONCLUSIONS: Depressed and anxious patients have worse absolute pain and disability one year following surgery for cervical radiculopathy. However, 12-month change scores, achievement of MCID for patient-reported outcomes, and satisfaction with surgery are not dependent on preoperative depression or anxiety. These patients should not be dismissed as potential candidates for surgery because of their psychological distress alone as they stand to gain measurable clinical benefit. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.329
P94. Functional Outcomes following Anterior Cervical Discectomy and Fusion: Analysis of a Worker’s Compensation Population Kern Singh, MD1, Junyoung Ahn1, Blaine Manning, BS2, Spencer Leblang, BS3, Aamir Iqbal, BS3, Khaled A. Aboushaala4; 1Rush University Medical Center, Chicago, IL, US; 2Chicago, IL, US; 3Rush Medical College, Chicago, IL, US; 4Midwest Orthopaedics at Rush, Chicago, IL, US BACKGROUND CONTEXT: Ultimate patient work level is assessed via a functional capacity evaluation (FCE) that can significantly impact postoperative employment status. PURPOSE: To analyze clinical and functional outcomes following anterior cervical discectomy and fusion (ACDF) in worker’s compensation (WC) patients and to determine factors predictive of diminished postoperative function. STUDY DESIGN/SETTING: Retrospective cohort analysis of a prospectively maintained registry. PATIENT SAMPLE: Fifty-eight WC patients who underwent a primary 1- or 2-level ACDF with subsequent FCE between 2007 and 2013. OUTCOME MEASURES: Demographics, comorbidity, smoking status, length of hospitalization, 1-year arthrodesis, Visual Analog Scale (VAS) score. Peri- and postoperative variables. METHODS: Patients were stratified into cohorts based on ultimate work level (light/medium vs heavy). Subgroup analyses were performed stratifying patients by age, gender, smoking status, reoperation, fusion levels and preoperative glucose levels. Statistical analysis was performed with chi-squared test for categorical data, and Student’s T-test and one-way ANOVA for continuous variables. A p-value of !0.05 denoted statistical significance. RESULTS: Of the 58 patients included, 50 achieved light/medium and 8 demonstrated heavy work level. 24 patients met pre-injury job requirements. The 1-year arthrodesis rate overall was 84.5% and 13 patients required reoperation (range 99-1030 days postoperative). Reoperation was performed in 9 patients (69.2%) for pseudarthrosis, 2 patients (15.4%) with adjacent level disc degeneration (ALD), 1 patient (7.7%) with persistent stenosis (same level), and 1 patient (7.7%) with combined ALD and pseudarthrosis. Demographics, smoking status, VAS scores (pre- and postoperative), complications (in-hospital/6-month), and 1-year arthrodesis rates were similar between light/medium and heavy work level cohorts. Patients who underwent reoperation were more likely to have undergone an index 2-level ACDF. Patients who underwent re-operation at levels other than the
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.
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Proceedings of the NASS 30th Annual Meeting / The Spine Journal 15 (2015) 87S–267S
index were significantly less likely to achieve heavy work levels. Postoperative pain levels were significantly higher in patients with impaired glucose control, revision surgeries or 2-level fusions. Smokers, 2-level ACDFs and patients with impaired glucose control were more likely to have decreased functional levels following surgery. Males trended toward a greater postoperative level of functioning with no females achieving a heavy work-demand level. CONCLUSIONS: WC patients undergoing a 1- or 2-level ACDF appear likely to achieve at least a light or medium postoperative level of functioning. Impaired glucose control, smoking status and 2-level ACDFs were significant risk factors associated with a decreased likelihood of meeting preinjury occupational requirements. Patients with impaired glucose control, 2-level ACDFs, and revision cervical fusions were more likely to have an increased final postoperative VAS scores. Additionally, patients who underwent re-operation at levels other than the index were less likely to achieve a heavy physical demand level. Lastly, males were more likely to achieve greater postoperative functional demand levels. Understanding preoperative variables in order to predict postoperative functional outcomes is essential in order to educate patients regarding return-to-work expectations and to minimize indirect societal costs associated with longterm disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.330
P95. Prospective Multicenter Assessment of Early Complication Rates Associated with Adult Cervical Deformity Surgery in 78 Patients International Spine Study Group1, Justin S. Smith, MD, PhD2, Virginie Lafage, PhD3, Christopher I. Shaffrey, MD4, Themistocles S. Protopsaltis, MD3, Peter G. Passias, MD5, Frank J. Schwab, MD3, Munish C. Gupta, MD6, Michael F. O’Brien, MD7, Richard A. Hostin, Jr., MD8, Gregory M. Mundis, Jr., MD5, Robert K. Eastlack, MD9, Douglas C. Burton, MD10, Robert A. Hart, MD11, Alan Daniels, MD12, Han Jo Kim, MD13, Eric O. Klineberg, MD14, Shay Bess, MD15, Vedat Deviren, MD16, Todd J. Albert, MD13, K. Daniel Riew, MD17, Christopher P. Ames, MD16; 1 Brighton, CO, US; 2UVA Health System, Charlottesville, VA, US; 3New York University Hospital for Joint Diseases, New York, NY, US; 4University of Virginia, Charlottesville, VA, US; 5New York University School of Medicine, New York, NY, US; 6University of California Davis Orthopaedic Surgery, Sacramento, CA, US; 7Baylor Scoliosis Center, Plano, TX, US; 8 Southwest Scoliosis Institute, Plano, TX, US; 9Scripps Clinic, San Diego, CA, US; 10University of Kansas Medical Center, Kansas City, KS, US; 11 Oregon Health & Science University, Portland, OR, US; 12Warren Alpert Medical School of BU/RI Hospital, Providence, RI, US; 13Hospital for Special Surgery, New York, NY, US; 14University of California Davis School of Medicine, Sacramento, CA, US; 15Rocky Mountain Scoliosis and Spine, Denver, CO, US; 16University of California San Francisco, San Francisco, CA, US; 17Washington University School of Medicine, Saint Louis, MO, US BACKGROUND CONTEXT: Although adult cervical deformity (ACD) can have profound impact on function and health-related quality of life, few reports have focused on the treatment of these patients. We present early complication rates associated with surgical treatment for ACD based on a prospective multicenter cohort. Accurately defining the early complication rates is particularly important for patient counseling with regard to the risks and benefits of surgical treatment. PURPOSE: Assess early complication rates associated with the surgical treatment of ACD based on a prospective multicenter cohort. STUDY DESIGN/SETTING: Prospective multicenter cohort. PATIENT SAMPLE: ACD patients treated surgically.
OUTCOME MEASURES: Occurrence of early (within 30 days from surgery) minor and major complications. METHODS: Prospective multicenter database of operative ACD patients from 2013-2014 were reviewed for early (!30 days from surgery) complications. Database enrollment required at least one of the following: cervical kyphosis O10 , cervical scoliosis O10 , C2-7 sagittal vertical axis O4cm or chin-brown vertical angle O25 . Patients with ACD due to neoplasm or acute infection were excluded. RESULTS: 78 patients (59% women) underwent surgical treatment for ACD and had a mean age of 60.7 years (range 37-81 years), mean Charlson Comorbidity Index of 0.6 (range 0-6) and previous surgery in 52%. Surgical approaches included anterior-only (A, 14%), posterior-only (P, 49%), anterior-posterior (AP, 35%) and posterior-anterior-posterior (PAP, 3%). Mean numbers of fused anterior and posterior vertebral levels were 4.7 and 9.4, respectively. A total of 52 early complications were reported, including 26 minor and 26 major for an overall complication rate of 66.7%. 22 (28.2%) patients had at least one minor complication, and 19 (24.4%) had at least one major complication. Overall, 34 (43.6%) patients had one or more complication. The most common complications included dysphagia (11.5%), deep wound infection (6.4%), new C5 motor deficit (6.4%), respiratory failure (5.1%), new nerve root (not C5) motor deficit (3.8%), new nerve sensory deficit (3.8%), and superficial wound infection (3.8%). Less common complications included pulmonary embolism, cardiac arrest, arterial injury, instrumentation malposition, and mortality (respiratory arrest 1 week postop), excessive (O4L) bleeding (each occurring in 1.3%). Overall early complication rates were significantly different based on approach: A (27.3%), P (68.4%), AP/PAP (79.3%) (p50.007). CONCLUSIONS: Among 78 patients treated for ACD and prospectively followed, a total of 52 complications were reported (26 minor and 26 major), including 1 mortality. Overall, 34 (43.6%) patients had one or more complication and 24.4% of patients had one or more major complication. Significantly higher rates of complications were associated with combined and posterior-only approaches compared with anterior-only approaches. These findings may prove useful in treatment planning and patient counseling. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. http://dx.doi.org/10.1016/j.spinee.2015.07.331
P96. Does Obesity Correlate with Poor Patient-Reported Outcomes following Cervical Surgery for Degenerative Conditions? John A. Sielatycki, MD1, Silky Chotai, MD2, Joseph Wick, BA2, David Stonko3, Harrison F. Kay2, Kevin O’Neill, MD4, Clinton J. Devin, MD1; 1Vanderbilt University Medical Center, Nashville, TN, US; 2Nashville, TN, US; 3Vanderbilt University School of Medicine, Nashville, TN, US; 4Vanderbilt University Medical Center Department of Orthopaedics, Nashville, TN, US BACKGROUND CONTEXT: Obesity is associated with numerous disease states and is thought to exacerbate spinal pathology. Several studies have investigated the impact of obesity in thoracolumbar surgery. However, the effect of obesity on outcomes in cervical surgery has not been established. The direct effect of obesity on patient-reported outcomes (PROs) following degenerative cervical surgery is unknown. PURPOSE: To investigate the possible correlation between obesity and patient-reported outcomes following surgery for degenerative cervical conditions at a high-volume center. STUDY DESIGN/SETTING: Analysis of prospective registry data at a single institution from 2010 to 2013. PATIENT SAMPLE: All patients undergoing elective anterior cervical discectomy and fusion (ACDF) for stenosis, disc herniation and cervical
Refer to onsite Annual Meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosures and FDA device/drug status at time of abstract submission.