Complications in Treating Complex Cervical Deformities: Occurrence and Mitigation

Retrospective review.

Evaluate complication rates, their predictors, and functional outcomes in adults undergoing cervical deformity correction.

We conducted a retrospective review of 40 consecutive adult patients who underwent cervical deformity correction between 2019 and 2023. Eligible patients demonstrated at least one radiographic deformity criterion-C2-C7 Cobb angle >10 degrees, C2-C7 sagittal vertical axis (cSVA) >40 mm, or chin-brow vertical angle (CBVA) >25 degrees-with a minimum 2-year follow-up. Collected data included demographics, comorbidity burden, surgical details, and perioperative variables. We defined complications as any event that prolonged the initial hospital stay, necessitated readmission, or required reoperation within the 2-year follow-up. Neurological function was measured using the modified Japanese Orthopaedic Association (mJOA) score. Patients were compared with and without complications using univariate analyses, and then applied multivariate logistic regression to identify independent predictors of postoperative complications. A narrative review of complications associated with cervical deformity surgery was also conducted.

Mean age was 66.2±8.7 years; 70% female. Hypertension (67.5%) and diabetes (22.5%) were frequent comorbidities; 52.5% had prior cervical fusion. All cases used posterior pedicle-screw constructs; 20% included a T2 pedicle subtraction osteotomy (PSO). Mean instrumented levels=8.8±4.6; EBL=767±520 mL; LOS=8.7±5.9 days. Complications occurred in 42.5%-notably dysphagia (20%), infection/dehiscence (15%), C5 palsy (15%), radiculopathy (10%), CSF leak (7.5%), and mechanical failures (7.5%). Twenty-five percent were readmitted within 3 months; 2 nonsurgical mortality events occurred during follow-up. Mean mJOA improved from 13.2±3.3 to 15.1±2.1 at 2 years ( P =0.003). On univariate analysis, diabetes (41.2% vs. 8.6%, P =0.023), prior fusion (76.5% vs. 34.7%, P =0.009), and PSOs (35.3% vs. 8.6%, P =0.05) were more common in the complication group. Multivariate regression identified prior cervical fusion as an independent predictor of complications (OR 15.4, 95% CI: 1.78-133.7; P =0.013).

Complication rates remain high following cervical deformity correction, particularly in patients with prior fusion. Nevertheless, significant neurological function gains occur. Meticulous preoperative planning-alignment goals, modifiable risk-factor optimization, and judicious use of advanced instrumentation-is critical to mitigate complications and enhance long-term outcomes.