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Journal of Craniovertebral Junction and Spine
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Year : 2021  |  Volume : 12  |  Issue : 3  |  Page : 263-268

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

1 Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
2 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
3 Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
4 Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, CO, USA
5 Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, USA
6 Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
7 Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA
8 Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
9 Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
10 Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
11 Department of Neurosurgery, Duke University Medical Center, Durham, NC, USA

Correspondence Address:
Peter Gust Passias
Departments of Orthopaedic and Neurosurgery, New York Spine Institute, NYU Langone Orthopedic Hospital, 301 East 17th St., New York, NY 10003
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/jcvjs.jcvjs_35_21

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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.

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