title: The Health Impact of Adult Cervical Deformity in Patients Presenting for Surgical Treatment: Comparison to United States Population Norms and Chronic Disease States Based on the EuroQuol-5 Dimensions Questionnaire.
abstract: BACKGROUND
  Although adult cervical spine deformity (ACSD) is associated with pain and disability, its health impact has not been quantified in comparison to other chronic diseases.
  
  
  OBJECTIVE
  To perform a comparative analysis of the health impact of symptomatic ACSD to US normative and chronic disease values using EQ-5D (EuroQuol-5 Dimensions questionnaire) scores.
  
  
  METHODS
  ACSD patients presenting for surgical treatment were identified from a prospectively collected multicenter database. Baseline demographics and EQ-5D scores were collected and compared with US normative and disease state values.
  
  
  RESULTS
  Of 121 ACSD patients, 115 (95%) completed the EQ-5D (60% women, mean age 61 years, previous spine surgery in 44%). Diagnoses included kyphosis with mid-cervical (63.4%), cervico-thoracic (23.5%), or thoracic (8.7%) apex and primary coronal deformity (4.3%). The mean ACSD EQ-5D index was 0.511 (standard definition = 0.224), which is 34% below the bottom 25th percentile (0.780) for similar age- and gender-matched US normative populations. Mean ACSD EQ-5D index values were worse than the bottom 25th percentile for several other disease states, including chronic ischemic heart disease (0.708), malignant breast cancer (0.708), and malignant prostate cancer (0.708). ACSD mean index values were comparable to the bottom 25th percentile values for blindness/low vision (0.543), emphysema (0.508), renal failure (0.506), and stroke (0.463). EQ-5D scores did not significantly differ based on cervical deformity type ( P = .66).
  
  
  CONCLUSIONS
  The health impact of symptomatic ACSD is substantial, with negative impact across all EQ-5D domains. The mean ACSD EQ-5D index was comparable to the bottom 25th percentile values for blindness/low vision, emphysema, renal failure, and stroke.
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: International Spine Study Group Foundation, Brighton, Colorado.
authors.forename: Breton
authors.initials: B
authors.lastname: Line
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.affiliation: San Diego Center for Spinal Disorders, La Jolla, California.
authors.forename: Gregory
authors.initials: G
authors.lastname: Mundis
authors.affiliation: University of California San Diego, School of Medicine, San Diego, California.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California.
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.affiliation: Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas.
authors.forename: Michael
authors.initials: M
authors.lastname: O'Brien
authors.affiliation: Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas.
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.affiliation: Department of Orthopaedic Surgery, Washington University, St Louis, Missouri.
authors.forename: Munish
authors.initials: M
authors.lastname: Gupta
authors.affiliation: Department of Orthopaedic Surgery, Brown University, Providence, Rhode Island.
authors.forename: Alan
authors.initials: A
authors.lastname: Daniels
authors.affiliation: Department of Orthopaedic Surgery, Washington University, St Louis, Missouri.
authors.forename: Michael
authors.initials: M
authors.lastname: Kelly
authors.affiliation: Department of Orthopaedic Surgery, Leatherman Spine Center, Louisville, Kentucky.
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Gum
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
authors.forename: Renaud
authors.initials: R
authors.lastname: Lafage
authors.affiliation: Departments of Neurosurgery and Orthopaedic Surgery, University of British Columbia, Vancouver, British Columbia, Canada.
authors.forename: Tamir
authors.initials: T
authors.lastname: Ailon
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Peter
authors.initials: P
authors.lastname: Passias
authors.affiliation: Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, New York.
authors.forename: Themistocles
authors.initials: T
authors.lastname: Protopsaltis
authors.affiliation: Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, New York.
authors.forename: Todd J
authors.initials: TJ
authors.lastname: Albert
authors.affiliation: Department of Orthopedic Surgery, Columbia University, New York.
authors.forename: K Daniel
authors.initials: KD
authors.lastname: Riew
authors.affiliation: Department of Orthopaedic Surgery, Oregon Health and Science University, Portland, Oregon.
authors.forename: Robert
authors.initials: R
authors.lastname: Hart
authors.affiliation: Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas.
authors.forename: Doug
authors.initials: D
authors.lastname: Burton
authors.affiliation: Department of Orthopedic Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.affiliation: Department of Neurological Surgery, University of California, San Francisco, San Francisco, California.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: International Spine Study
authors.initials: ISS
authors.lastname: Group
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000002:abnormalities* / Q000000981:diagnostic imaging / Q000601:surgery*; D002908:Chronic Disease; D005060:Europe / Q000453:epidemiology; D005260:Female; D006305:Health Status Indicators; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000000981:diagnostic imaging / Q000601:surgery; D011159:Population Surveillance / Q000379:methods; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D014481:United States / Q000453:epidemiology
keywords: Adult; Cervical deformity; Cervical kyphosis; Disability; EQ-5D; EQ-5D-3L; Health impact; Spine