Thank you. Next speaker is Dr. Janjua. Improvement in AIMS-ISSG cervical deformity classification modifier grades correlate to clinical improvement and likelihood of reaching MCID in multiple metrics. One-year follow-up study. Thank you. Thank you for the opportunity. We have nothing to disclose. So there has been recent advances that have led to improvement in short-term clinical outcomes for cervical deformity. The long-lasting effects of deformity correction are still pretty challenging. AIMS classification system has come up with cervical deformity. There have been previous studies with the first clinical application of AIMS classification system. However, there's a limited follow-up data and no postoperative outcome correlations. So our purpose was to use AIMS classification system to assess relationship of improvement in AIMS modifiers with clinical outcome. All patients more than the age of 18 years who met the radiographic criteria for cervical deformity, or at least met one of these following criteria with the C2 to C7, sagittal cob more than 10 degree, coronal cob more than 10 degree, or cervical SBA more than 4 centimeter, or CBVA more than 25 were essentially included in this study. Patients were also substratified based on AIMS deformity subtype into cervical, cervical thoracic, thoracic or coronal subtype. So cervical deformity patients were characterized by AIMS classification at baseline and one year follow-up. Alignment modifier changes, either improvement or deterioration or no changes were recorded. Comparison between modifiers, groups in AIMS classification deformity types were assessed by PSO correlation and ANOVA. So here are the cervical deformity descriptors in 73 cervical deformity patients. Forty-one with cervical deformities, cervical thoracic 18, nine patients with thoracic deformity, and in coronal deformity five patients. Here are the overall results for cohort demographics and surgical details. We can see average age of 61 years, BMI of around 30, 60 percent female, 7.6 average levels fused and anterior approaches were done in about 18 percent, posterior about 47 and combined approaches were done in about 35 percent of patients. Looking at baseline and one year improvement in radiographic parameters, we can see improvement in almost all cervical and global parameters was observed from preoperative to postoperative time points. Looking at AIMS modifier improvement by deformity descriptor subgroups, we can essentially see improvement in cervical SVA, T1 slope cervical lodosis and horizontal gaze modifier, which is CBVA, did not differ actually across deformity descriptor groups. However, patients with the apex of deformity in cervical spine had the most improvement in MJOA modifier grade. Looking at baseline and one year postoperative changes in modifier grades, we can see cervical deformity patient with cervical descriptors improved the most in cervical SVA and MJOA modifiers from baseline to one year follow-up. Here are the results comparing baseline and one year outcome measures, overall outcome measures. So improvement was seen in overall cohort in NDI, MJOA and European 5D quality of life measures. Interestingly, far less than 50 percent of patients met minimum clinically important difference for these outcome measures. Looking at results where comparing correlation between AIMS radiographic modifiers and critical outcome, we can see improvement in MJOA modifier was correlated with one year NDI, MCID in overall cohort. However, reaching one year NDI with MCID was correlated with cervical SVA improvement for cervical deformity descriptor subgroups. Improvement in multiple radiographic AIMS modifier correlated with one year MJOA, MCID and reaching MCID for multiple outcome metrics. So here's one of the examples of patients with cervical deformity, in fact cervical thoracic deformity descriptor. 68-year-old woman, we can see looking at preoperative and postoperative radiographic parameters, we can see statistically significant improvement was seen in cervical SVA and MJOA for grades change from 1 to 0 and 2 to 1 respectively. The patient reached MCID for NDI and European 5D quality of life. So in conclusion, AIMS cervical deformity classification system has been effectively applied to cervical deformity patients to assess deformity both in terms of spinal alignment and overall clinical outcomes. So we have showed an association between cervical and thoracolumbar alignment improvement and patient-reported clinical outcome differences. Improvement in multiple radiographic AIMS modifier correlated reaching one year MCID for MJOA. However, future work will be needed for the large cohort of cervical deformity patients with the long-term follow-up. Thank you.

Dr. Janjua

cervical deformity

AIMS-ISSG classification system

clinical outcomes

radiographic parameters