{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T22:20:56Z","timestamp":1791411656528,"version":"4.3.3"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,2]]},"abstract":"<jats:sec><jats:title>OBJECTIVE<\/jats:title><jats:p>Cervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery.<\/jats:p><\/jats:sec><jats:sec><jats:title>METHODS<\/jats:title><jats:p>The authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2\u20137 Cobb angle &gt; 10\u00b0), cervical scoliosis (coronal Cobb angle &gt; 10\u00b0), C2\u20137 sagittal vertical axis (cSVA) &gt; 4 cm, or chin-brow vertical angle (CBVA) &gt; 25\u00b0. Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope\u2013cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications\/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC).<\/jats:p><\/jats:sec><jats:sec><jats:title>RESULTS<\/jats:title><jats:p>In total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg\/m<jats:sup>2<\/jats:sup>). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients\u2019 conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0\u201311). For the complications\/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2\u201312 kyphosis, TS-CL, C2\u2013T3 SVA, C2\u2013T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9\u201339), worse baseline neurological status (OR 11.4, 95% CI 1.8\u201370.8), baseline pelvic tilt &gt; 20\u00b0 (OR 0.92, 95% CI 0.85\u20130.98), &gt; 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1\u20134.1), preoperative C2\u2013T3 SVA &gt; 5.4 cm (OR 1.01, 95% CI 0.9\u20131.1), and global SVA &gt; 4 cm (OR 3.2, 95% CI 0.09\u201310.3).<\/jats:p><\/jats:sec><jats:sec><jats:title>CONCLUSIONS<\/jats:title><jats:p>Of all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA &gt; 4 cm, and including more of the thoracic maximal kyphosis in the construct.<\/jats:p><\/jats:sec>","DOI":"10.3171\/2019.7.spine18651","type":"journal-article","created":{"date-parts":[[2019,11,1]],"date-time":"2019-11-01T22:56:41Z","timestamp":1572649001000},"page":"182-190","source":"Crossref","is-referenced-by-count":27,"title":["Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery"],"prefix":"10.3171","volume":"32","author":[{"given":"Samantha R.","family":"Horn","sequence":"first","affiliation":[{"name":"Department of Orthopaedics, NYU Langone Medical Center\u2013Orthopaedic Hospital, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, NYU Langone Medical 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