{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:04:11Z","timestamp":1772827451022,"version":"3.50.1"},"reference-count":58,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"5","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,1]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>The objective was to assess the frequency, outcomes, and impact of high-risk procedures receiving preoperative multidisciplinary review in adult cervical deformity (ACD) patients.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>ACD patients were stratified by whether they underwent high-risk review (HRR). High-risk patients were defined as meeting \u2265 1 of the following criteria: anterior-posterior cervical deformity fusion \u2265 3 levels; planned 3-column osteotomy, vertebral column resection, and\/or anterior column refinement; deformity correction with severe baseline neurological deficit; severe baseline myelopathy (modified Japanese Orthopaedic Association score &lt; 11); and severe osteoporosis with fusion \u2265 4 levels. Differences in demographic characteristics, radiographic outcomes, and complication rates were assessed via means comparison. Adjusting for baseline age and modified ACD frailty index, follow-up univariate 1-way ANCOVA was performed to assess postoperative outcomes. Logistic regressions assessed the impact of committee review on prediction of complications or reoperation.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>\n                      Of 149 ACD patients (mean \u00b1 SD age 57.5 \u00b1 10.9 years, 58.2% female, BMI 28.5 \u00b1 7.8 kg\/m\n                      <jats:sup>2<\/jats:sup>\n                      ), 51.0% (n = 76) underwent committee review. At baseline, cohorts were comparable in terms of age, sex, and BMI, although patients undergoing HRR (HRR+) were frailer according to the modified ACD frailty index (p &lt; 0.001). HRR+ patients were also significantly more likely to have a history of myocardial infarction (p = 0.045). Radiographically, HRR+ patients were more likely to have more severe deformity in terms of T1 slope minus cervical lordosis (p = 0.031) and C2\u20137 sagittal vertical axis (p &lt; 0.001) compared to patients who did not undergo high-risk review (HRR\u2212). Perioperatively, HRR\u2013 patients had significantly greater mean operative time (p &lt; 0.001) and were more likely to undergo any osteotomy (p = 0.020) or 3-column osteotomy (p = 0.045), although total estimated blood loss, length of stay, surgical intensive care unit admissions, and discharge dispositions were comparable between groups (all p &gt; 0.05). Rates of any complications and mortality were also comparable between groups (all p &gt; 0.05). HRR+ patients demonstrated lower reoperation rates (p = 0.037). Yet, adjusted regression revealed that HRR was neither independently predictive of intraoperative major complications nor reoperation (all p &gt; 0.05).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Implementation of high-risk committees is associated with a lower frequency of high-risk procedures over time. However, the risk of complications is not necessarily diminished after the establishment of such committees.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.5.spine25311","type":"journal-article","created":{"date-parts":[[2025,9,12]],"date-time":"2025-09-12T14:34:36Z","timestamp":1757687676000},"page":"577-583","source":"Crossref","is-referenced-by-count":0,"title":["Assessing the impact of high-risk committees in adult cervical deformity corrective surgery: a retrospective review of outcomes, complications, and frequency of procedures receiving preoperative multidisciplinary evaluation"],"prefix":"10.3171","volume":"43","author":[{"given":"Kristen E.","family":"Jones","sequence":"first","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Anthony","family":"Yung","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"},{"name":"Rutgers Robert Wood Johnson Medical School, New Brunswick, New Jersey;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Alyssa M.","family":"Bartlett","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Oluwatobi O.","family":"Onafowokan","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter S.","family":"Tretiakov","sequence":"additional","affiliation":[{"name":"New York Medical College, Valhalla, New York; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Max R.","family":"Fisher","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ethan","family":"Cottrill","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Tyler K.","family":"Williamson","sequence":"additional","affiliation":[{"name":"University of Texas Health San Antonio, San Antonio, Texas"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Division of Spinal Surgery, Department of Orthopedic Surgery & Neurosurgery, Duke University Medical Center, Duke School of Medicine, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1","series-title":"J Clin Neurosci","first-page":"110869","article-title":"So close yet so far: the impact of undercorrection of cervical sagittal alignment during adult cervical deformity surgery - an incremental correction analysis","volume":"130","author":"Das A","year":"2024","unstructured":"Das A, Yung A, Onafowokan O,  So close yet so far: the impact of undercorrection of cervical sagittal alignment during adult cervical deformity surgery - an incremental correction analysis. J Clin Neurosci. 2024;130:110869."},{"issue":"1","key":"b2","series-title":"Acta Neurochir (Wien)","first-page":"471","article-title":"Frail patients require longer fusions for success following adult cervical deformity surgery","volume":"166","author":"Onafowokan OO","year":"2024","unstructured":"Onafowokan OO, Galetta M, Lorentz N,  Frail patients require longer fusions for success following adult cervical deformity surgery. Acta Neurochir (Wien). 2024;166(1):471."},{"issue":"1","key":"b3","series-title":"Spine Deform","first-page":"3","article-title":"Adult cervical spine deformity: a state-of-the-art review","volume":"12","author":"Jackson-Fowl B","year":"2024","unstructured":"Jackson-Fowl B, Hockley A, Naessig S,  Adult cervical spine deformity: a state-of-the-art review. Spine Deform. 2024;12(1):3\u201323."},{"issue":"5","key":"b4","series-title":"Eur Spine J","first-page":"1598","article-title":"Distal junctional kyphosis in adult cervical deformity patients: where does it occur?","volume":"32","author":"Ye J","year":"2023","unstructured":"Ye J, Rider SM, Lafage R,  Distal junctional kyphosis in adult cervical deformity patients: where does it occur?. Eur Spine J. 2023;32(5):1598\u20131606."},{"issue":"2","key":"b5","series-title":"J Neurosurg Spine","first-page":"141","article-title":"Cervical spine alignment, sagittal deformity, and clinical implications: a review","volume":"19","author":"Scheer JK","year":"2013","unstructured":"Scheer JK, Tang JA, Smith JS,  Cervical spine alignment, sagittal deformity, and clinical implications: a review. 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Neurospine. 2022;19(4):862\u2013867."},{"key":"b12","series-title":"J Clin Neurosci","first-page":"297","article-title":"Improvement in some Ames-ISSG cervical deformity classification modifier grades may correlate with clinical improvement","volume":"89","author":"Horn SR","year":"2021","unstructured":"Horn SR, Passias PG, Passfall L,  Improvement in some Ames-ISSG cervical deformity classification modifier grades may correlate with clinical improvement. J Clin Neurosci. 2021;89:297\u2013304."},{"issue":"2","key":"b13","series-title":"J Craniovertebr Junction Spine","first-page":"157","article-title":"Redefining cervical spine deformity classification through novel cutoffs: an assessment of the relationship between radiographic parameters and functional neurological outcomes","volume":"12","author":"Passias PG","year":"2021","unstructured":"Passias PG, Pierce KE, Brown AE,  Redefining cervical spine deformity classification through novel cutoffs: an assessment of the relationship between radiographic parameters and functional neurological outcomes. J Craniovertebr Junction Spine. 2021;12(2):157\u2013164."},{"issue":"5","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"515","article-title":"Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review","volume":"27","author":"Pietrobon R","year":"2002","unstructured":"Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review. Spine (Phila Pa 1976). 2002;27(5):515\u2013522."},{"issue":"1","key":"b15","series-title":"Arch Phys Med Rehabil","first-page":"69","article-title":"Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain","volume":"89","author":"Cleland JA","year":"2008","unstructured":"Cleland JA, Childs JD, Whitman JM. Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain. Arch Phys Med Rehabil. 2008;89(1):69\u201374."},{"issue":"3","key":"b16","series-title":"Neurospine","first-page":"628","article-title":"Impact of myelopathy severity and degree of deformity on postoperative outcomes in cervical spinal deformity patients","volume":"18","author":"Passias PG","year":"2021","unstructured":"Passias PG, Pierce KE, Kummer N,  Impact of myelopathy severity and degree of deformity on postoperative outcomes in cervical spinal deformity patients. 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Spine J. 2020;20(8):1248\u20131260."},{"issue":"15","key":"b23","series-title":"Spine (Phila Pa 1976)","first-page":"1268","article-title":"Incidence and mortality of perioperative cardiac events in cervical spine surgery","volume":"38","author":"Fineberg SJ","year":"2013","unstructured":"Fineberg SJ, Oglesby M, Patel AA, Singh K. Incidence and mortality of perioperative cardiac events in cervical spine surgery. Spine (Phila Pa 1976). 2013;38(15):1268\u20131274."},{"issue":"5","key":"b24","series-title":"J Neurosurg Spine","first-page":"588","article-title":"Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up","volume":"33","author":"Smith JS","year":"2020","unstructured":"Smith JS, Buell TJ, Shaffrey CI,  Prospective multicenter assessment of complication rates associated with adult cervical deformity surgery in 133 patients with minimum 1-year follow-up. 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Acta Neurochir (Wien). 2024;166(1):471."},{"issue":"1","key":"b3","series-title":"Spine Deform","first-page":"3","article-title":"Adult cervical spine deformity: a state-of-the-art review","volume":"12","author":"Jackson-Fowl B","year":"2024","unstructured":"Jackson-Fowl B, Hockley A, Naessig S,  Adult cervical spine deformity: a state-of-the-art review. Spine Deform. 2024;12(1):3\u201323."},{"issue":"5","key":"b4","series-title":"Eur Spine J","first-page":"1598","article-title":"Distal junctional kyphosis in adult cervical deformity patients: where does it occur?","volume":"32","author":"Ye J","year":"2023","unstructured":"Ye J, Rider SM, Lafage R,  Distal junctional kyphosis in adult cervical deformity patients: where does it occur?. Eur Spine J. 2023;32(5):1598\u20131606."},{"issue":"2","key":"b5","series-title":"J Neurosurg Spine","first-page":"141","article-title":"Cervical spine alignment, sagittal deformity, and clinical implications: a review","volume":"19","author":"Scheer JK","year":"2013","unstructured":"Scheer JK, Tang JA, Smith JS,  Cervical spine alignment, sagittal deformity, and clinical implications: a review. J Neurosurg Spine. 2013;19(2):141\u2013159."},{"issue":"6","key":"b6","series-title":"Spine (Phila Pa 1976)","first-page":"357","article-title":"Impact of enhanced recovery after surgery protocols on outcomes up to two years after adult structural spine disorder surgery","volume":"50","author":"Yung A","year":"2025","unstructured":"Yung A, Onafowokan OO, Das A,  Impact of enhanced recovery after surgery protocols on outcomes up to two years after adult structural spine disorder surgery. Spine (Phila Pa 1976). 2025;50(6):357\u2013367."},{"issue":"25","key":"b7","series-title":"Spine (Phila Pa 1976)","first-page":"2232","article-title":"Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol","volume":"35","author":"Halpin RJ","year":"2010","unstructured":"Halpin RJ, Sugrue PA, Gould RW,  Standardizing care for high-risk patients in spine surgery: the Northwestern high-risk spine protocol. Spine (Phila Pa 1976). 2010;35(25):2232\u20132238."},{"issue":"2","key":"b8","series-title":"Neurosurg Clin N Am","first-page":"219","article-title":"Treatment algorithms and protocol practice in high-risk spine surgery","volume":"24","author":"Sugrue PA","year":"2013","unstructured":"Sugrue PA, Halpin RJ, Koski TR. Treatment algorithms and protocol practice in high-risk spine surgery. Neurosurg Clin N Am. 2013;24(2):219\u2013230."},{"issue":"6","key":"b9","series-title":"Neurosurgery","first-page":"928","article-title":"Development of risk stratification predictive models for cervical deformity surgery","volume":"91","author":"Passias PG","year":"2022","unstructured":"Passias PG, Ahmad W, Oh C,  Development of risk stratification predictive models for cervical deformity surgery. Neurosurgery. 2022;91(6):928\u2013935."},{"issue":"21","key":"b10","series-title":"J Clin Med","first-page":"4826","article-title":"Surgical strategy for the management of cervical deformity is based on type of cervical deformity","volume":"10","author":"Kim HJ","year":"2021","unstructured":"Kim HJ, Virk S, Elysee J,  Surgical strategy for the management of cervical deformity is based on type of cervical deformity. J Clin Med. 2021;10(21):4826."},{"issue":"4","key":"b11","series-title":"Neurospine","first-page":"862","article-title":"Classification(s) of cervical deformity","volume":"19","author":"Kaidi AC","year":"2022","unstructured":"Kaidi AC, Kim HJ. Classification(s) of cervical deformity. Neurospine. 2022;19(4):862\u2013867."},{"key":"b12","series-title":"J Clin Neurosci","first-page":"297","article-title":"Improvement in some Ames-ISSG cervical deformity classification modifier grades may correlate with clinical improvement","volume":"89","author":"Horn SR","year":"2021","unstructured":"Horn SR, Passias PG, Passfall L,  Improvement in some Ames-ISSG cervical deformity classification modifier grades may correlate with clinical improvement. J Clin Neurosci. 2021;89:297\u2013304."},{"issue":"2","key":"b13","series-title":"J Craniovertebr Junction Spine","first-page":"157","article-title":"Redefining cervical spine deformity classification through novel cutoffs: an assessment of the relationship between radiographic parameters and functional neurological outcomes","volume":"12","author":"Passias PG","year":"2021","unstructured":"Passias PG, Pierce KE, Brown AE,  Redefining cervical spine deformity classification through novel cutoffs: an assessment of the relationship between radiographic parameters and functional neurological outcomes. J Craniovertebr Junction Spine. 2021;12(2):157\u2013164."},{"issue":"5","key":"b14","series-title":"Spine (Phila Pa 1976)","first-page":"515","article-title":"Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review","volume":"27","author":"Pietrobon R","year":"2002","unstructured":"Pietrobon R, Coeytaux RR, Carey TS, Richardson WJ, DeVellis RF. Standard scales for measurement of functional outcome for cervical pain or dysfunction: a systematic review. Spine (Phila Pa 1976). 2002;27(5):515\u2013522."},{"issue":"1","key":"b15","series-title":"Arch Phys Med Rehabil","first-page":"69","article-title":"Psychometric properties of the Neck Disability Index and Numeric Pain Rating Scale in patients with mechanical neck pain","volume":"89","author":"Cleland JA","year":"2008","unstructured":"Cleland JA, Childs JD, Whitman JM. 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Neurospine. 2021;18(3):628\u2013634."},{"issue":"16","key":"b17","series-title":"Spine (Phila Pa 1976)","first-page":"1063","article-title":"Inter-rater reliability of the modified Japanese Orthopedic Association score in degenerative cervical myelopathy: a cross-sectional study","volume":"46","author":"Martin AR","year":"2021","unstructured":"Martin AR, Jentzsch T, Wilson JRF,  Inter-rater reliability of the modified Japanese Orthopedic Association score in degenerative cervical myelopathy: a cross-sectional study. Spine (Phila Pa 1976). 2021;46(16):1063\u20131069."},{"issue":"5","key":"b18","series-title":"Neurosurgery","first-page":"716","article-title":"The health impact of adult cervical deformity in patients presenting for surgical treatment: comparison to United States population norms and chronic disease states based on the EuroQuol-5 Dimensions questionnaire","volume":"80","author":"Smith JS","year":"2017","unstructured":"Smith JS, Line B, Bess S,  The health impact of adult cervical deformity in patients presenting for surgical treatment: comparison to United States population norms and chronic disease states based on the EuroQuol-5 Dimensions questionnaire. 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