Prioritization of realignment associated with superior clinical outcomes for cervical deformity patients

Abstract

Objective: To prioritize the cervical parameter targets for alignment. Methods: Included: cervical deformity (CD) patients (C2-7 Cobb angle>10°, cervical lordosis> 10°, cervical sagittal vertical axis [cSVA]>4 cm, or chin-brow vertical angle>25°) with full baseline (BL) and 1-year (1Y) radiographic parameters and Neck Disability Index (NDI) scores; patients with cervical [C] or cervicothoracic [CT] Primary Driver Ames type. Patients with BL Ames classified as low CD for both parameters of cSVA (<4 cm) and T1 slope minus cervical lordosis (TS-CL) (<15°) were excluded. Patients assessed: meeting minimum clinically important differences (MCID) for NDI ( 0.050). Decision tree analysis determined cutoffs for radiographic change, prioritizing in the following order: =42.5° C2-T3 angle, >35.4° cervical lordosis, -30.8-mm C2-T3 SVA, and =-33.6° TS-CL. Conclusion: Certain ratios of correction of cervical parameters contribute to improving neck disability. Prioritizing these radiographic alignment parameters may help optimize patient- reported outcomes for patients undergoing CD surgery.