Impact of myelopathy severity and degree of deformity on postoperative outcomes in cervical spinal deformity patients

Peter G. Passias, Katherine E. Pierce, Nicholas Kummer, Oscar Krol, Lara Passfall, M. Burhan Janjua, Daniel Sciubba, Waleed Ahmad, Sara Naessig, Bassel Diebo

Research output: Contribution to journalArticlepeer-review


myelopathy diagnosis. Whether deformity or myelopathy severity is stronger predictors of surgical outcomes is understudied. Methods: Surgical cervical deformity (CD) patients with baseline (BL) and up to 1-year data were included. Modified Japanese Orthopaedic Association (mJOA) score categorized BL myelopathy (mJOA=18 excluded), with moderate myelopathy mJOA being 12 to 17 and severe myelopathy being less than 12. BL deformity severity was categorized using the mismatch between T1 slope and cervical lordosis (TS-CL), with CL being the angle between the lower endplates of C2 and C7. Moderate deformity was TS-CL less than or equal to 25° and severe deformity was greater than 25°. Categorizations were combined into 4 groups: group 1 (G1), severe myelopathy and severe deformity; group 2 (G2), severe myelopathy and moderate deformity; group 3 (G3), moderate myelopathy and moderate deformity; group 4 (G4), moderate myelopathy and severe deformity. Univariate analyses determined whether myelopathy or deformity had greater impact on outcomes. Results: One hundred twenty-eight CD patients were included (mean age, 56.5 years; 46% female; body mass index, 30.4 kg/m2) with a BL mJOA score of 12.8±2.7 and mean TS-CL of 25.9°±16.1°. G1 consisted of 11.1% of our CD population, with 21% in G2, 34.6% in G3, and 33.3% in G4. At BL, Neck Disability Index (NDI) was greatest in G2 (p=0.011). G4 had the lowest EuroQol-5D (EQ-5D) (p<0.001). Neurologic exam factors were greater in severe myelopathy (p<0.050). At 1-year, severe deformity met minimum clinically important differences (MCIDs) for NDI more than moderate deformity (p=0.002). G2 had significantly worse outcomes compared to G4 by 1-year NDI (p=0.004), EQ-5D (p=0.028), Numerical Rating Scale neck (p=0.046), and MCID for NDI (p=0.001). Conclusion: Addressing severe deformity had increased clinical weight in improving patient- reported outcomes compared to addressing severe myelopathy.

Original languageEnglish (US)
Pages (from-to)628-634
Number of pages7
Issue number3
StatePublished - 2021


  • Cervical
  • Correction
  • Deformity
  • Myelopathy
  • Outcomes

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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