Does the Presence of Cervical Deformity in Patients with Baseline Mild Myelopathy Increase Operative Urgency in Adult Cervical Spinal Surgery?: A Retrospective Analysis

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
PD

Pooja R. Dave

Miami, Florida, United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
EB

Emmanuel Budis

United States
OO

Oluwatobi Onafowokan

United Kingdom
PJ

Pawel Jankowski

United States
TL

Tomi Lanre-Amos

United States
AM

Angel Macagno

United States
NP

Nicholas Post

United States
TR

Timothy Roberts

Orthopaedic Spine Surgeon
Westbury, New York, United States
AD

Alexandre De Moura

United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Cervical deformity can result in cord compression, leading to pain, loss of function, and myelopathy. However, whether the presence of CD with concomitant mild myelopathy necessitates surgical management remains unanswered.

Purpose: To assess if delaying surgical management of CD with concomitant mild myelopathy increases risk of suboptimal outcomes.

Methods: Cervical deformity patients ≥18yrs that have a baseline diagnosis of mild myelopathy with pre-(BL) and up to two-years (2Y) of data were assessed. Patients were categorized as having cervical deformity (CD+) or not (CD-) at baseline. The time to surgery was calculated as the number of days between initial BL visit and date of surgery. Patients with symptoms of myelopathy for greater than 1Y prior to surgery were considered delayed. Clinical and radiographic data were assessed using means comparison analyses. Multivariate regression analysis assessed correlations between increasing time to surgery and peri- and post-operative outcomes adjusting for BL age and frailty score. Backstep logistic regression analysis assessed the risk of complication or reoperation, while controlling for baseline deformity severity per T1 Slope-Cervical Lordosis (TS-CL).

Results: 106 patients were included (58.11 ± 11.97 years, 48% female, 29.13 ± 6.89 kg/m2). Of the patients with baseline mild myelopathy, 22 (20.8%) were CD-, while 84 (79.2%) were CD+. While patients with a history of myelopathy, with or without CD, did not differ in terms of duration of symptoms, those that were CD+ were significantly more likely to present at BL with a history of renal disease (p=.045), or peripheral vascular disease (p=.024). Overall, 9.5% of patients were considered to have delayed surgery. Surgically delayed patients differed by the number of decompressions performed, with CD- patients being more likely to undergo decompression (p <.001). Linear regression revealed that both CD- and CD+ patients were more likely to require reoperation when there was more time between the initial visit and surgical admission (p <.001). Additionally, an adjusted logistic regression indicated that CD+ patients who had a greater length of time to surgery had a higher likelihood for major complications (p < 0.001). Conversely, CD+ patients who were operated on within 30 days of initial visit had significantly lower risk for major complication [OR: .901 [ .889 – 1.105), p=.022), and a lower risk for reoperation [OR: .954 [.877 – 1. 090, p=.043], while controlling for the severity of deformity based upon baseline TS-CL.

Conclusions: The presence of cervical deformity in the context of mild baseline myelopathy, presents a challenging clinical scenario for spine surgeons. There are limited data indicating whether early operative intervention in these patients was beneficial compared to nonoperative management. The findings of the present study demonstrate that delay in surgery after initial visit increases the risk for major complication and reoperation significantly in patients with CD with associated mild baseline myelopathy. As such, early operative treatment in this patient population may lower the risk of postoperative complications.