Analysis of Successful vs. Failed Radiographic Outcomes following Cervical Deformity Surgery

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Study Design.

Prospective multi-center cohort study with consecutive enrollment


To evaluate pre-operative alignment and surgical factors associated with sub-optimal early post-operative radiographic outcomes following surgery for cervical deformity.

Summary of Background Data.

Recent studies have demonstrated correlation between cervical sagittal alignment and patient reported outcomes. Few studies have explored cervical deformity correction prospectively, and the factors that result in successful vs. failed cervical alignment corrections remain unclear.


Adult cervical deformity (ACD) patients included with either cervical kyphosis >10°, cSVA >4 cm, or CBVA >25°. Patients were categorized into failed outcomes group if cSVA >4 cm or TS-CL >20° at 6 months post-operatively.


71 ACD patients (mean age 62yrs, 56%Female, 41% revisions) were included. 45 had primary cervical deformities and 26 at the CT junction. 33 (46.4%) had failed radiographic outcomes by cSVA and 46 (64.7%) by TS-CL. Failure to restore cSVA was associated with worse preoperative C2 pelvic tilt angle (CPT: 64.4 vs 47.8°, p = 0.01), worse postoperative C2 Slope (35.0 vs 23.8°, p = .004), TS-CL (35.2 vs 24.9°, p = .01), CPT (47.9 vs 28.2°, p < .001), “+” Schwab modifiers (p = 0.007), revision surgery (p = 0.05) and failure to address the secondary, thoracolumbar driver of the deformity (p = .02). Failure to correct TS-CL was associated with worse preoperative cervical kyphosis (10.4 vs -2.1°, p = .03), CPT (52.6 vs 39.1°, p = .04), worse postoperative C2 Slope (30.2 vs 13.3°, p < .001), cervical lordosis (-3.6 vs -15.1°, p = .01), and CPT (37.7 vs 24.0°, p < .001). Multivariate analysis revealed post-operative DJK associated with sub-optimal outcomes by cSVA (OR- 0.06, CI- 0.01–0.4, p = .004) and TS-CL (OR-0.15, CI- 0.02–0.97, p = .05).


Factors associated with failure to correct the cSVA included revision surgery, worse preop CPT, and concurrent thoracolumbar deformity. Failure to correct the TS-CL mismatch was associated with worse preoperative cervical kyphosis and CPT. Occurrence of early post-operative DJK significantly affects post-operative radiographic outcomes.


Level of Evidence: 3

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