Risk-benefit assessment of major versus minor osteotomies for flexible and rigid cervical deformity correction

• Published in: Journal of craniovertebral junction and spine 2021-07, Vol.12 (3), p.263-268
• Main Authors: Passias, Peter, Passfall, Lara, Horn, Samantha, Pierce, Katherine, Lafage, Virginie, Lafage, Renaud, Smith, Justin, Line, Breton, Mundis, Gregory, Eastlack, Robert, Diebo, Bassel, Protopsaltis, Themistocles, Kim, Han, Scheer, Justin, Burton, Douglas, Hart, Robert, Schwab, Frank, Bess, Shay, Ames, Christopher, Shaffrey, Christopher
• Format: Article
• Language: English
• Subjects: Abnormalities; Back surgery; Complications; Complications and side effects; Deformities; fixed deformity; flexible deformity; Health aspects; Health risk assessment; Methods; Original; Osteotomy; pedicle subtraction osteotomy; rigid deformity; Spine; Surgery; Vertebrae, Cervical; vertebral column resection
• ISSN: 0974-8237; 0976-9285
• DOI: 10.4103/jcvjs.jcvjs_35_21

Introduction: Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction. Methods: Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent t-tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL. Results: 137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications (P = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients (P = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, P = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, P = 0.027). Both groups had similar sagittal realignment at 1 year (all P > 0.05). Conclusions: Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.