{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,6]],"date-time":"2026-03-06T20:03:01Z","timestamp":1772827381167,"version":"3.50.1"},"reference-count":84,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"2","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2025,11,14]]},"abstract":"<jats:sec>\n                    <jats:title>OBJECTIVE<\/jats:title>\n                    <jats:p>While health-related quality of life (HRQOL) measures have been extensively quantified in cervical deformity (CD), this clinical dimension has not yet been fully integrated into understanding CD radiographic subtypes prior to surgery. The aim of this study was to identify distinct patterns of HRQOL deficits among patients with CD by focusing on clinical scores and to examine the association of these patterns with radiographic morphotypes of CD.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>METHODS<\/jats:title>\n                    <jats:p>This was a retrospective analysis of a prospective multicenter database of patients with CD aged 18 years or older. Patient-reported outcome measures consisted of the Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scale, and Swallowing Quality of Life (SWAL-QOL) questionnaire. After performing a principal component analysis on the individual questions of the NDI, mJOA, and SWAL-QOL, 4 factors with eigenvalues &gt; 1 were retained and included in a cluster analysis to assign patients into homogeneous groups of outcomes. Moreover, a subgroup of patients with severe deformity was described and analyzed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>RESULTS<\/jats:title>\n                    <jats:p>Overall, 134 patients (59% female, mean age \u00b1 SD 60.9 \u00b1 10.8 years) were included in this analysis. The mean HRQOL scores were NDI, 49.1 \u00b1 17.6; mJOA, 13.5 \u00b1 2.7; and EQ-5D, 0.7 \u00b1 0.1). The factor analysis involving NDI, SWAL-QOL, and mJOA revealed 4 clusters. Cluster A represented patients with a predominant sleep problem. Cluster B was patients with the lowest neck disability. Cluster C represented the most disabled patients in terms of dysphagia and neck disability. Cluster D represented patients with myelopathy. Among the 71 patients with severe deformity, the distribution of cervical morphotypes significantly differed across the 4 clusters of disability (p = 0.009). Cluster C mainly consisted of patients with cervicothoracic deformity (66.7%, p = 0.002). Cluster D had a large proportion of patients (66.7%) with focal deformity (p = 0.007). In clusters A and B, 57.9% and 46.4% of patients, respectively, presented with \"flat neck\" deformity (p = 0.02).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>CONCLUSIONS<\/jats:title>\n                    <jats:p>Distinct patterns of HRQOL deficits were observed across a heterogeneous population of patients with CD, and these patterns were associated with specific radiographic morphotypes. These findings provide a framework for the next generation of CD classification, wherein HRQOL measures are combined with radiographic parameters.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.3171\/2025.7.spine241245","type":"journal-article","created":{"date-parts":[[2025,11,17]],"date-time":"2025-11-17T20:53:30Z","timestamp":1763412810000},"page":"242-252","source":"Crossref","is-referenced-by-count":0,"title":["Are there distinct patterns of clinical deficits in cervical deformity? A discriminant analysis of health-related quality of life measures"],"prefix":"10.3171","volume":"44","author":[{"given":"Mikael","family":"Finoco","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, H\u00f4pital Europ\u00e9en Georges Pompidou, Paris;"},{"name":"Universit\u00e9 Paris-Cit\u00e9, Paris, France;"},{"name":"Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ahilan","family":"Sivaganesan","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Peter G.","family":"Passias","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Eric O.","family":"Klineberg","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, UTHealth, Houston, Texas;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gregory M.","family":"Mundis","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Scripps Clinic Torrey Pines, La Jolla, California;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Themistocles S.","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Department of Orthopedics, Division of Spine, NYU Langone Health, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Christopher P.","family":"Ames","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of California School of Medicine, San Francisco, California; and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Frank J.","family":"Schwab","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Northwell Health, Lenox Hill Hospital, New York;"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"issue":"4","key":"b1","series-title":"Neurosurgery","first-page":"864","article-title":"Alignment, classification, clinical evaluation, and surgical treatment for adult cervical deformity: a complete guide","volume":"88","author":"Scheer JK","year":"2021","unstructured":"Scheer JK, Lau D, Smith JS,  Alignment, classification, clinical evaluation, and surgical treatment for adult cervical deformity: a complete guide. 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