232. Importance of sagittal alignment in cervical spondylotic myelopathy: an observational study from the Canadian Spine Outcomes and Research Network

BACKGROUND CONTEXT Recent evidence suggests that sagittal alignment may play a role in the presentation and management of patients with cervical spondylotic myelopathy (CSM) but its importance has not been fully established. PURPOSE Our objectives were to evaluate the extent to which (1) preoperative sagittal alignment is associated with baseline function and symptoms, (2) surgery leads to changes in sagittal alignment, and (3) postoperative sagittal alignment is associated with function and symptoms at follow-up. STUDY DESIGN/SETTING We performed an observational cohort study using prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). PATIENT SAMPLE We included consecutive patients who were diagnosed with CSM by participating surgeons at seven centers between 2015 and 2017. OUTCOME MEASURES mJOA, NDI, VAS, SF12 and EQ5D. METHODS We measured sagittal alignment using two methods: surgeon classification and Ishihara's Cervical Curvature Index (ICCI). We measured function and symptoms with multiple Patient Reported Outcome Measures (PROMs), and we adjusted for age, gender, severity, and comorbidities using multiple linear regression. RESULTS Among 474 patients, baseline alignment was neutral in 196 (41%), lordotic in 190 (40%), and kyphotic in 88 (19%). In unadjusted analyses, baseline kyphosis was associated with significantly worse EuroQol 5D (p CONCLUSIONS In patients with CSM, baseline alignment is not associated with differences in impairment of health-related quality of life after adjusting for potential confounders. Surgery for CSM increases lordosis and improves symptoms and function regardless of baseline alignment, but postoperative sagittal alignment does not seem to be associated with final patient-reported outcomes. Our findings suggest that sagittal alignment restoration may not be critical for improving PROMs in the surgical management of patients with CSM, and that surgeons may prioritize the technical goals of neurological decompression and stabilization. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.