Effect of Obesity on Radiographic Alignment and Short-Term Complications After Surgical Treatment of Adult Cervical Deformity

Peter G Passias; Gregory W Poorman; Samantha R Horn; Cyrus M Jalai; Cole Bortz; Frank Segreto; Bassel M Diebo; Alan Daniels; D Kojo Hamilton; Daniel Sciubba; Justin Smith; Brian Neuman; Christopher I Shaffrey; Virginie LaFage; Renaud LaFage; Frank Schwab; Shay Bess; Christopher Ames; Robert Hart; Alexandra Soroceanu; Gregory Mundis; Robert Eastlack; International Spine Study Group

doi:10.1016/j.wneu.2019.01.248

Effect of Obesity on Radiographic Alignment and Short-Term Complications After Surgical Treatment of Adult Cervical Deformity

World Neurosurg. 2019 May:125:e1082-e1088. doi: 10.1016/j.wneu.2019.01.248. Epub 2019 Feb 18.

Authors

Peter G Passias¹, Gregory W Poorman², Samantha R Horn², Cyrus M Jalai², Cole Bortz², Frank Segreto², Bassel M Diebo³, Alan Daniels⁴, D Kojo Hamilton⁵, Daniel Sciubba⁶, Justin Smith⁷, Brian Neuman⁸, Christopher I Shaffrey⁷, Virginie LaFage⁹, Renaud LaFage⁹, Frank Schwab⁹, Shay Bess¹⁰, Christopher Ames¹¹, Robert Hart¹², Alexandra Soroceanu¹³, Gregory Mundis¹⁴, Robert Eastlack¹⁵; International Spine Study Group¹⁶

Affiliations

¹ Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA. Electronic address: Peter.Passias@nyumc.org.
² Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA.
³ Deparment of Orthopedic Surgery, SUNY Downstate Medical School, Brooklyn, New York, USA.
⁴ Department of Orthopedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, Rhode Island, USA.
⁵ Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA.
⁶ Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁷ Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia, USA.
⁸ Department of Orthopaedic Surgery, Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
⁹ Department of Orthopedics, Hospital for Special Surgery, New York, New York, USA.
¹⁰ Rocky Mountain Scoliosis and Spine, Denver, Colorado, USA.
¹¹ Department of Neurological Surgery, University of California, San Francisco, School of Medicine, San Francisco, California, USA.
¹² Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA.
¹³ Department of Orthopaedic Surgery, University of Calgary, Calgary, Alberta, Canada.
¹⁴ San Diego Center for Spinal Disorders, La Jolla, California, USA.
¹⁵ Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California, USA.
¹⁶ International Spine Study Group, Denver, Colorado, USA.

PMID: 30790725
DOI: 10.1016/j.wneu.2019.01.248

Abstract

Objective: We investigated the 30-day complication incidence and 1-year radiographic correction in obese patients undergoing surgical treatment of cervical deformity.

Methods: The patients were stratified according to World Health Organization's definition for obesity: obese, patients with a body mass index of ≥30 kg/m²; and nonobese, patients with a body mass index of <30 kg/m². The patients had undergone surgery for the treatment of cervical deformity. The patient baseline demographic, comorbidity, and radiographic data were compared between the 2 groups at baseline and 1 year postoperatively. The 30-day complication incidence was stratified according to complication severity (any, major, or minor), and type (cardiopulmonary, dysphagia, infection, neurological, and operative). Binary logistic regression models were used to assess the effect of obesity on developing those complications, with adjustment for patient age and levels fused.

Results: A total of 124 patients were included, 53 obese and 71 nonobese patients. The 2 groups had a similar T1 slope minus cervical lordosis (obese, 37.2° vs. nonobese, 36.9°; P = 0.932) and a similar C2-C7 (-5.9° vs. -7.3°; P = 0.718) and C2-C7 (50.1 mm vs. 44.1 mm; P = 0.184) sagittal vertical axis. At the 1-year follow-up examination, the T1 pelvic angle (1.0° vs. -3.1°; P = 0.021) and C2-S1 sagittal vertical axis (-5.9 mm vs. -35.0 mm; P = 0.036) were different, and the T1 spinopelvic inclination (-1.0° vs. -2.9°; P = 0.123) was similar. The obese patients had a greater risk of overall short-term complications (odds ratio, 2.5; 95% confidence interval, 1.1-6.1) and infectious complications (odds ratio, 5.0; 95% confidence interval, 1.0-25.6).

Conclusions: Obese patients had a 5 times greater odds of developing infections after surgery for adult cervical deformity. Obese patients also showed significantly greater pelvic anteversion after cervical correction.

Keywords: Alignment; Cervical deformity; Complications; Obese; Obesity; Surgery.

MeSH terms

Cervical Vertebrae / surgery*
Female
Humans
Male
Middle Aged
Obesity / complications
Obesity / epidemiology*
Postoperative Complications / epidemiology*
Postoperative Complications / etiology
Spinal Curvatures / complications
Spinal Curvatures / diagnostic imaging
Spinal Curvatures / epidemiology*
Spinal Curvatures / surgery*
Surgical Wound Infection / epidemiology
Surgical Wound Infection / etiology
Treatment Outcome