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Adult Cervical Deformity (ACD) Patients Have Higher Baseline Frailty, Disability, and Comorbidities Compared with Complex Adult Thoracolumbar Deformity Patients (ATLD)

Friday, May 3, 2024

Presenting Author(s)

Justin S. Smith, MD, PhD

Professor of Neurosurgery
Department of Neurosurgery, University of Virginia
Charlottesville, VA, US

Co-Author(s)

Christopher P. Ames, MD

Neurosurgeon
University of California, San Francisco
San Francisco, California, United States
SB

Shay Bess, MD

President of the ISSG/Orthopaedic Spine Surgeon
Denver International Spine Center, United States
Thomas Buell, MD (he/him/his)

Assistant Professor of Neurosurgery
University of Pittsburgh Medical Center
Pittsburgh, PA, US
DB

Douglas C. Burton, MD

Professor of Spine Surgery
University of Kansas Medical Center, United States
AD

Alan H. Daniels, MD

Associate Professor of Orthopaedic Surgery/Chief, Adult Spinal Deformity Service
Alpert Medical School of Brown University
Providence, Rhode Island, United States
BD

Bassel Diebo, MD

Assistant Professor of Orthoepdic Surgery
Brown University
New York, New York, United States
RE

Robert K. Eastlack, MD

Orthopaedic Spine Surgeon
Scripps Clinic, United States
Jeffrey L. Gum, MD

Orthopaedic Spine Surgeon
Leatherman Spine Center, Kentucky, United States
MG

Munish Gupta, MD

Professor of Orthopedic Surgery
Washington University
St. Louis, Missouri, United States
DH

D. Kojo Hamilton, M.D.

Professor of Neurosurgery
Univesity of Pittsburgh Medical Center, United States
MK

Michael P. Kelly, MD

Rady Children's Hospital
Saskatoon, Saskatchewan, Canada
Han Jo Kim, MD (he/him/his)

Professor of Orthopedic Surgery
Hospital for Special Surgery
New York, NY, US
Eric Klineberg, MD

Professor of Orthopedic Surgery
University of Texas Houston
Houston, Texas, United States
RL

Renaud Lafage, MS

Biomedical engineer
Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY
NYC, New York, United States
VL

Virginie Lafage, MD

Scientist
Lenox Hill Hospital
New York, New York, United States
LL

Lawrence G. Lenke, MD

Chief of spinal deformity surgery
Columbia University
New York, New York, United States
BL

Breton G. Line, BS

Clinical Research Assistant
Denver International Spine Center, United States
Gregory M. Mundis, Jr., MD (he/him/his)

Orthopaedic Spine Surgeon
San Diego Spine
Encinitas, California, United States
Peter G. Passias, MD

Assistant Clinical Professor of Orthopedic Surgery
New York University, Langone Medical Center
New Canaan, Connecticut, United States
TP

Themistocles Protopsaltis, MD

Professor of Orthopedic Surgery
New York University, United States
JS

Justin Scheer, MD

Attending Surgeon
UCSF
San Francisco, California, United States
FS

Frank J. Schwab, MD

Chair of Orthopaedic Surgery
Lenox Hill Hospital Department of Orthopaedic Surgery, New York, United States
Christopher I. Shaffrey, MD

Professor of Spine Surgery
Duke University Medical Center
Durham, NC, US
AS

Alex Soroceanu, MD, FRCS(C), MPH

Clinical Associate Professor
University of Calgary, United States

Introduction: Studies have shown markedly higher rates of complications and all-cause mortality following surgery for ACD compared with ATLD. Although the explanation is often based on a perceived worse health state of ACD patients, this has not been previously demonstrated. Our objectives were to compare baseline measures of frailty, disability, and comorbidities between ACD and complex ATLD patients undergoing surgery.

Methods: Two multicenter prospective adult spinal deformity registries were queried, one ATLD and one ACD. Baseline demographic and health status measures were compared between the cohorts.

Results: 616 patients were identified, including 107 ACD and 509 ATLD patients. These groups had similar mean age (64.6 vs 60.8 yrs, respectively, p=0.07). ACD patients were less likely to be women (51.9% vs 69.5%, p< 0.001) and had greater BMI (28.6 vs 27.1, p=0.017), Charlson Comorbidity Index (1.5 vs 0.9, p< 0.001), and ASA grade (2.7 vs 2.4, p< 0.001). ACD patients were more disabled based on the VR-12 Physical Component Score (PCS, 25.7 vs 29.9, p< 0.001) and PROMIS Physical Function Score (33.3 vs 35.3, p=0.031). All frailty measures were significantly worse for ACD patients, including hand dynamometer (44.6 vs 55.6 lbs, p< 0.001), CSHA Clinical Frailty Score (CFS, 4.0 vs 3.2, p< 0.001), and Edmonton Frailty Scale (EFS, 5.15 vs 3.21, p< 0.001). Greater proportions of ACD patients were frail (22.9% vs 5.7%) or vulnerable (15.6% vs 10.9%) based on EFS (p < 0.001). Time to walk 3M was significantly worse in ACD patients (13.5 vs 11.0 s, p< 0.001). In the combined ACD and ATLD groups, baseline disability (VR-12 PCS) significantly correlated with frailty measures, including CFS (r=-0.501, p< 0.001) and EFS (r=-0.506, p< 0.001).

Conclusion : Compared with ATLD patients, ACD patients have worse baseline characteristics on all measures assessed (comorbidities/disability/frailty). These differences may help account for greater risk of complications and all-cause mortality observed in ACD patients and facilitate strategies to provide better preoperative optimization.