{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,11,4]],"date-time":"2026-11-04T21:13:28Z","timestamp":1793826808294,"version":"4.6.1"},"reference-count":26,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,11,1]]},"abstract":"\nOBJECTIVE<\/jats:title>\nThe aim of this study was to investigate whether surgery for high-risk patients is being optimized over time and if poor outcomes are being minimized.<\/jats:p>\n<\/jats:sec>\n\nMETHODS<\/jats:title>\nPatients who underwent surgery for cervical deformity (CD) and were \u2265 18 years with baseline and 2-year data were stratified by year of surgery from 2013 to 2018. The cohort was divided into two groups based on when the surgery was performed. Patients in the early cohort underwent surgery between 2013 and 2015 and those in the recent cohort underwent surgery between 2016 and 2018. High-risk patients met at least 2 of the following criteria: 1) baseline C2\u20137 Cobb angle > 15\u00b0, mismatch between T1 slope and cervical lordosis \u2265 35\u00b0, C2\u20137 sagittal vertical axis > 4 cm, or chin-brow vertical angle > 25\u00b0; 2) age \u2265 70 years; 3) severe baseline frailty (Miller index); 4) Charlson Comorbidity Index (CCI) \u2265 1 SD above the mean; 5) three-column osteotomy as treatment; and 6) fusion > 10 levels or > 7 levels for elderly patients. The mean comparison analysis assessed differences between groups. Stepwise multivariable linear regression described associations between increasing year of surgery and complications.<\/jats:p>\n<\/jats:sec>\n\nRESULTS<\/jats:title>\nEighty-two CD patients met high-risk criteria (mean age 62.11 \u00b1 10.87 years, 63.7% female, mean BMI 29.70 \u00b1 8.16 kg\/m2<\/jats:sup>, and mean CCI 1.07 \u00b1 1.45). The proportion of high-risk patients increased with time, with 41.8% of patients in the early cohort classified as high risk compared with 47.6% of patients in the recent cohort (p > 0.05). Recent high-risk patients were more likely to be female (p = 0.008), have a lower BMI (p = 0.038), and have a higher baseline CCI (p = 0.013). Surgically, high-risk patients in the recent cohort were more likely to undergo low-grade osteotomy (p = 0.003). By postoperative complications, recent high-risk patients were less likely to experience any postoperative adverse events overall (p = 0.020) or complications such as dysphagia (p = 0.045) at 2 years. Regression analysis revealed increasing year of surgery to be correlated with decreasing minor complication rates (p = 0.030), as well as lowered rates of distal junctional kyphosis by 2 years (p = 0.048).<\/jats:p>\n<\/jats:sec>\n\nCONCLUSIONS<\/jats:title>\nOver time, high-risk CD patients have an increase in frequency and comorbidity rates but have demonstrated improved postoperative outcomes. These findings suggest that spine surgeons have improved over time in optimizing selection and reducing potential adverse events in high-risk patients.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine23457","type":"journal-article","created":{"date-parts":[[2023,7,29]],"date-time":"2023-07-29T17:19:46Z","timestamp":1690651186000},"page":"628-635","source":"Crossref","is-referenced-by-count":7,"title":["Are we improving in the optimization of surgery for high-risk adult cervical spine deformity patients over time?"],"prefix":"10.3171","volume":"39","author":[{"given":"Peter G.","family":"Passias","sequence":"first","affiliation":[{"name":"Departments of Orthopedic and Neurological Surgery, Division of Spine Surgery, NYU Langone Orthopedic Hospital, New York, New York;"},{"name":"New York Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Tretiakov","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic and Neurological Surgery, Division of Spine Surgery, NYU Langone Orthopedic Hospital, New York, New York;"},{"name":"New York Spine Institute, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel","family":"Diebo","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin K.","family":"Scheer","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert K.","family":"Eastlack","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alan H.","family":"Daniels","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of California, Davis, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khaled M.","family":"Khabeish","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, Maryland;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay D.","family":"Turner","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, Barrow Neurological Institute, Phoenix, Arizona;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Munish C.","family":"Gupta","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University in St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Frank","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, University of California, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"3","key":"b1","series-title":"Neurospine","first-page":"533","article-title":"Association of spinal alignment correction with patient-reported outcomes in adult cervical deformity: review of the literature","volume":"18","author":"Massaad E","year":"2021","unstructured":"Massaad E, Hadzipasic M, Kiapour A, Association of spinal alignment correction with patient-reported outcomes in adult cervical deformity: review of the literature. 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