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Surgical outcomes in rigid versus flexible cervical deformities
Themistocles S Protopsaltis1, Nicholas Stekas1, Justin S Smith2
11Department of Orthopedic Surgery, New York University Langone Orthopedic Hospital, New York, New York.
Journal of Neurosurgery. Spine
|February 12, 2021
Summary
Patients with rigid cervical deformity (CD) have worse baseline alignment and require more invasive surgery than those with flexible CD. However, both groups achieve similar improvements in health-related quality of life after treatment.
Area of Science:
- Orthopedics
- Spine Surgery
- Radiology
Background:
- Cervical deformity (CD) significantly impacts patient disability and health.
- Limited understanding exists regarding the differences between rigid and flexible CD.
- This study aims to compare these two CD types.
Purpose of the Study:
- Assess baseline alignment in rigid vs. flexible CD.
- Determine if rigid CD necessitates more aggressive surgical correction.
- Compare postoperative outcomes between rigid and flexible CD patients.
Main Methods:
- Retrospective review of a prospective, multicenter CD database.
- Defined rigid CD as <10° cervical lordosis change (flexion-extension radiographs).
- Compared alignment, HRQOL, and surgical factors between rigid and flexible CD groups.
Main Results:
- Rigid CD showed worse preoperative alignment (T1 slope, cSVA, C2 slope).
- Rigid CD patients underwent more posterior fusions, greater blood loss, and more osteotomies.
- No significant differences in baseline HRQOL, DJK, or complication rates were observed.
- Both groups showed significant HRQOL improvements postoperatively, with no difference between groups.
Conclusions:
- Rigid CD presents with worse baseline malalignment but similar baseline disability compared to flexible CD.
- Rigid CD requires more invasive surgical correction, leading to increased operative time and blood loss.
- Despite more extensive surgery, rigid CD patients achieve comparable HRQOL improvements to flexible CD patients.
