Faculty Bibliography

BACKGROUND CONTEXT: Much research has focused on the etiology of PJK and with the evolution of our knowledge, there have been modifications to surgical techniques and radiographic aims in an attempt to minimize the risk for PJK development. PURPOSE: To examine if rates of PJK are lower today compared to a historical cohort. STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: Multicenter adult spinal deformity database. OUTCOME MEASURES: PJK incidence, radiographic outcomes, revision rates.
METHOD(S): A multicenter database of Adult Spinal Deformity patients was analyzed for the following inclusion criteria: fusions >5 levels, LIV S1/Ilium with at least 6 weeks follow up (f/u) for the assessment of PJK. A historical cohort of patients from 2009-2011 (Group P) were compared to those from 2016-2018 (Group T) for the rates of PJK. Patient demographics, operative details, radiographic and clinical outcomes were compared between groups. Unpaired T-Tests were utilized followed by a multivariate analysis to eliminate confounding variables.
RESULT(S): A total of 504 patients were included for analysis (Group P, n=210 vs. Group T, n=294). Group T were older patients (65 vs. 62, p<0.01), with a higher CCI and ASA compared to Group P (p<0.01) with a larger PI-LL mismatch (24 vs. 20, p=0.02) and TPA (28 vs. 26, p=0.03) at baseline. Statistically significant differences in the surgical strategies were noted between cohorts, with a higher number of ALIFs, LLIFs, Allograft and BMP usage in the T group versus P (all p<0.05) and a lower prevalence of 3CO utilization (17.7% vs. 29.5%, p<0.01). There were no differences in the rates of PJK or in the PJK angle between groups (P 38% vs. T 34%, p=0.43; P 13.8 deg+/-9.8 vs. T 14.5 deg+/-9.0, p=0.39). No differences were noted in the radiographic outcomes post-operatively. When controlling for confounding variables (age, CCI and ASA, surgical strategies and 3CO), there were no significant differences in PJK rates between the cohorts (p=0.2). The prevalence of revision cases for PJK was also similar between time points (25 vs 23)
CONCLUSION(S): In a study of over 500 patients comparing PJK rates from 2009-2011 versus 2016-2018, no differences were noted in the rate of PJK or in the PJK angles through time (38% vs 34%, 13.8 deg+/-9.8 vs 14.5 deg+/-9.0, respectively). While there were differences in operative techniques and strategies evidenced by the utilization of different interbody techniques, osteotomies and bone graft products through time, PJK incidence has stayed the same. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Flattening of the thoracic spine is a common biomechanical compensatory mechanism for adult spinal deformity (ASD). The literature shows that younger ASD patients recruit more thoracic flattening than older patients. It is hypothesized that differences in muscle quality between younger and older ASD patients explains this difference in the recruitment of thoracic compensation. PURPOSE: Investigate the relationship between paraspinal muscle degeneration and recruitment of thoracic compensation. STUDY DESIGN/SETTING: Retrospective review of a prospective database. PATIENT SAMPLE: ASD patients from a prospective database. OUTCOME MEASURES: Posterior paraspinal muscle fat infiltration, thoracic kyphosis between T4 and T12 (TK) and pelvic retroversion (PT).
METHOD(S): ASD patients with spino-pelvic deformity (defined as SRS-Schwab PI-LL modifier of + or ++) and available pre-op CT imaging were identified from a retrospective database. Patients with previous fusion of the thoracic spine were excluded. Erector spinae and multifidus measurements were manually contoured on CT imagesat three vertebral levels (T2, T10, and L3), at three locations per level: immediately inferior to the superior end plate, in the middle of the vertebral body, and superior to the inferior end plate. Fat infiltration (Fat) within each muscle was defined as the number of voxels with a Hounsfield unit (HU) corresponding to fat (-190 to 0) divided by the total number of voxels. The maximum fat infiltration (MaxFat) was determined by taking the muscle with the highest percentage of Fat. After a Pearson correlation analysis, the cohort was separated into 2 groups: high Fat (HFat) and Low Fat (LFat) based on MaxFat threshold of 35%. Demographics and radiographic parameters including TK and PT were compared between groups.
RESULT(S): Of the 57 patients (mean age 61 yrs, 75% F, BMI 28) that met inclusion, 26% had a fused lumbar spine. Assessed by +/++ SRS-Schwab modifiers, 90% of patients had severe PT malalignment and 75% a severe SVA malalignment. Breakdown of Fat and area by vertebral level was: T2 (35% and 1332mm2), T10 (30% and 1910mm2), L3 (38% and 3915mm2). TK correlated significantly with Fat at all levels from T2 to L3 (r=-0.498, r=-0.519, r=-0.472), FatMax (r=-0.470) and area at T10 (r=-0.341). PT correlated significantly with FatMax (r=0.333) and T10 Fat(r=0.548). After grouping, 31 pts were HFat, and 25 pts were LFat. HFat pts were older (64.2 vs 56.3, p=0.047) and had a greater BMI (30.1 vs 25, p=0.002). The groups did not differ in sex or rates of lumbar fusion. In terms of spinal alignment, HFat pts had a higher T1 pelvic angle (30.7degree vs 23.7degree), a higher TK (-34.6degree vs -22.9degree), and a higher PT (30.1degree vs 25.2degree), without difference in lumbar deformity or other sagittal parameters.
CONCLUSION(S): Patients with higher fat infiltration in paraspinal muscles show less compensation with the thoracic spine than patients with leaner musculature, despite having similar lumbar deformities. Consequently, patients with degenerative paraspinal musculature have more pelvic retroversion, causing greater gait disruption due to limitation in hip extension. The assessment of fatty infiltration in posterior paraspinal muscles could help identify patient compensatory profile and aid in surgical planning. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Numerous advances have been made in the field of spine fusion, such as minimally invasive (MIS) or robotic assisted spine surgery. However, it is unknown how these advances have impacted the cost of care. PURPOSE: Compare the economic outcomes of lumbar spine fusion between open, MIS and robotic assisted surgery patients. STUDY DESIGN/SETTING: Retrospective review of a single center spine surgery database. PATIENT SAMPLE: A total of 360 propensity matched patients. OUTCOME MEASURES: Costs, EuroQol-5D (EQ5D), Cost per quality adjusted life years (QALY).
METHOD(S): Inclusion criteria: surgical patients >18 years undergoing lumbar fusion surgery. Patients were categorized into 3 groups based on procedure type: open, MIS or robotic. Open patients undergoing poster spinal fusion were considered as the control group. MIS patients included those undergoing transforaminal or lateral lumbar interbody fusion with percutaneous screws. Robotic patients were those undergoing robot assisted fusion. Propensity score matching was performed between all groups for the number of levels fused. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims for ICD-9 codes. For robot cases, costs were reflective of operational fees and initial purchase cost. Complications and comorbidities (CC) and major complications and comorbidities (MCC) were assessed according to CMS.gov manual definitions. QALYs and cost per QALY were calculated using a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs per QALY were calculated for both 1 year and life expectancy, assuming no loss of benefit.
RESULT(S): A total of 360 propensity matched patients (120 open, 120 MIS, 120 robot) met inclusion. Descriptive statistics for the cohort were: age 58.8+/-13.5, 50% women, BMI 29.4+/-6.3, op time 294.4+/-119.0, LOS 4.56+/-3.31 days, EBL 515.9+/-670.0 cc, and 2.3+/-2.2 average levels fused. Rates of postop complications were significantly higher in robotic cases versus open and MIS (43% vs. 21% and 22% for open and MIS, p<0.05). However, revision rates were comparable between all groups (3% open, 3% MIS, 5% robotic, p>0.05). After factoring in complications, revisions, and purchasing and operating fees, the costs of robotic cases was significantly higher than both open and MIS surgery ($60,047.01 vs. $42,538.98 open and $41,471.21 MIS). In a sub analysis of 42 patients with BL and 1Y EQ5D data, the cost per QALY at 1Y for open, MIS, and robot assisted cases was $296,624.48, $115,911.69, and $592,734.30. If utility gained was sustained to life expectancy, the cost per QALY was $14,905.75, $5,824.71, $29,785.64 for open, MIS, and robot assisted cases.
CONCLUSION(S): Numerous advances have been made in the field of spine surgery, however, there has been limited discussion of the effect these advances have on economic outcomes. When matched for levels fused, robot assisted surgery patients had significantly higher rates of complications and 30% higher costs of surgery compared to minimally invasive and open spine surgery patients. While 1 year economic outcomes weren't optimal for robotic surgery cases, the projected costs per quality adjusted life years at life expectancy were well below established acceptable thresholds. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Psychiatric diagnoses (PD) present a significant burden on elective surgery patients and may have potentially dramatic impacts on outcomes. As ailments of the spine can be particularly debilitating, the effect of PD on outcomes was compared between elective spine surgery patients and other common elective orthopedic surgery procedures. PURPOSE: Investigate the rates of PD in elective orthopedic procedures. STUDY DESIGN/SETTING: Retrospective review of the National Inpatient Database 2007-2013. PATIENT SAMPLE: A total of 15,434,393 weighted hospital discharges. OUTCOME MEASURES: Rates of PD, post-operative complications, length of stay (LOS), cost to charge (CCR), discharge location, and death.
METHOD(S): Inclusion criteria: elective orthopedic surgery procedures from 2007-2013 as defined by ICD-9-CM codes. Exclusion criteria: emergency, trauma, or non-elective surgery. Patients were grouped as shoulder, elbow, hand, spine, hip, knee, or foot/ankle. Descriptive statistics assessed demographics. Rates of DSM-IV PD, as classified by single-level C

BACKGROUND CONTEXT: Although epidural steroid injection (ESI) has been shown to provide adequate pain relief for degenerative spondylolisthesis patients in treatment regimens up to months, it remains unclear whether the use of ESI affects the rate of crossover from nonoperative to operative management. PURPOSE: Investigate the relationship between epidural steroid injections and rates of surgical crossover for degenerative spondylolisthesis patients. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data from 13 spine centers. PATIENT SAMPLE: Degenerative spondylolisthesis patients from both the randomized and concurrent observational cohorts of the Spine Patient Outcomes Research Trial (SPORT). OUTCOME MEASURES: Primary: Surgical crossover rates. Secondary: health related quality of life outcome (HRQL) measures (SF-36, ODI, Sciatica and Leg Pain Bothersomeness Indices), self-reported improvement METHODS: Included: surgical candidates >18yrs with degenerative spondylolisthesis. Excluded: patients receiving ESI before enrollment. Those who received ESI within 3 months of enrollment (ESI) and those who did not (no-ESI) were compared for differences in baseline characteristics. Outcomes at 1-year, 2-year, 3-year, and 4-year intervals following enrollment were assessed within operative and nonoperative groups using longitudinal mixed-effect models with random subject intercept term to account for correlations between repeated measurements. Treatment comparisons were performed at follow-up intervals. Area under the curve analysis for all time points assessed global significance of treatment.
RESULT(S): Included: 266 patients (192 no-ESI, 74 ESI). Patient groups did not differ in age, sex, BMI, or comorbidity burden (all p>0.05). No-ESI had greater baseline SF-36 body-pain scores (38+/-20 vs 30+/-16, p=0.002) and self-reported surgical preference (38% vs 11%, p<0.001). There were no differences in surgical rates within 4-years of enrollment between no-ESI and ESI patients (61% vs 62%, p=0.97). Surgical ESI and no-ESI patients did not differ in op-time, blood loss, rates of decompression, multilevel fusion or levels decompressed (all p>0.05). Surgical ESI and no-ESI patients showed no differences in postoperative HRQL changes at any follow-up interval, or in 4-year average HRQL outcomes. Non-operative no-ESI patients showed greater 4-year average improvement in SF-36 body pain (no-ESI: 17.8, ESI: 7.8, p=0.004) and physical function (no-ESI: 13.1, ESI: 4.3, p=0.005) than non-operative ESI patients. These improvements in SF-36 body pain were greater for non-operative no-ESI patients at 1-year (p=0.002) and 3-years (p=0.005); improvements in SF-36 physical function were greater for non-operative no-ESI patients at 1-year (p=0.030) and 2-years (p=0.002). Of patients that were initially non-operative, there was no difference between ESI and no-ESI groups in surgical crossover rates (ESI: 52%, no-ESI: 39%, p=0.15). For operative patients, crossover rates to non-operative treatment did not differ between ESI and no-ESI groups (ESI: 23%, no-ESI: 16%, p=0.38).
CONCLUSION(S): For surgical degenerative spondylolisthesis patients, there was no relationship between ESI and improved clinical outcomes over a 4-year study. For nonoperative patients, ESI was associated with inferior pain reduction through 3 years of follow-up; however, this was confounded by higher levels of baseline pain. ESI showed little relationship with surgical crossover. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication.
Copyright

BACKGROUND CONTEXT: Recent studies suggest that for patients with neck pain, both psychological and physical symptoms need to be addressed. Psychological distress risk factors are associated with poor outcomes in the fear avoidance model, where individuals passively cope through avoidance behaviors and disuse. Cognitive behavioral therapy (CBT) works to address risk factors through education about pain, modification of maladaptive beliefs, and increasing patient's self-efficacy. PURPOSE: Determine the effectiveness of brief psychological intervention on outcomes in cervical spine surgery. STUDY DESIGN/SETTING: Prospective, blind, and placebo-controlled trial. PATIENT SAMPLE: A total of 35 symptomatic Cervical Degenerative Disorders patients. OUTCOME MEASURES: Distress and Risk Assessment Method (DRAM), Fear Avoidance Beliefs Questionnaire (FABQ), Pain Catastrophizing Scale (PCS), Outcome Expectation Question (OEQ). Neck Disability Index (NDI), modified Japanese Orthopedic Association (mJOA), Visual Analog Scale (VAS), EuroQol Five Dimensions (EQ5D).
METHOD(S): Thirty-five patients age >18 with symptomatic cervical degenerative disease have been enrolled in the study. If patients met psychological distress criteria, they were in the treatment group: DRAM >17 and <33, FABQ >49/66, PCS >30/52 or OEQ <=2 (randomized to CBT or placebo). CBT and sham treatment groups had 6 sessions prior to surgery. The control group had no intervention prior to surgery. Baseline and 3M changes were assessed for all outcome measures.
RESULT(S): A total of 35 patients were enrolled (age 53.9 years, BMI 28.7 kg/m2). Twenty-two patients met psychological distress criteria and were randomized into a treatment group (13 CBT vs. 9 placebo). Thirteen patients were in the control group, with 5 having too high of DRAM scores to be CBT candidates. At enrollment, the average DRAM score was 34.55 +/- 13.87, with the DRAM observational group, Placebo, and CBT groups all having higher scores than control patients (45.6 vs 13.4, P<0.001). Treatment patients had higher baseline FABQ scores than controls (45.9 vs 20.4, P=0.004). The overall OEQ score was 3.78+/-1.18, with all control patients scoring a 5 and CBT and Placebo patients answering 3-4 out of 5 on the scale. At 3M post op, all groups showed improved outcomes in all measurements. Between CBT, placebo, and control patients, CBT patients exhibited greater postop improvement in all psychological questionnaires compared to non treatment groups (DRAM: 34.9 a30.8 CBT, 35.2 a22.4 placebo, 11 a10 no risk controls, FABQ: 40.8 a35.2 CBT, 38.3 a37.8 placebo, 19 a21 no risk controls, PCS: 31.8 a17.4 CBT, 32.8 a11.6 placebo, 15 a6 no risk controls, OEQ: Disagree aStrongly Agree CBT, Disagree aAgree placebo, Strongly Agree aStrongly Agree, no risk controls).
CONCLUSION(S): Preliminary results of this randomized controlled study on cervical degenerative surgery patients showed that patients who received cognitive behavioral treatment before surgery had better improvement in all psychological related questionnaires compared to non treatment patients. Long-term follow up will assess the changes in psychological and pain related outcomes in these groups to assess the impact of psychological intervention for at risk patients. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: For surgical adult spinal deformity (ASD) patients, incorporating restoration of appropriate Roussouly Classificaion shape into surgical planning may improve outcomes. With the introduction and use of the SRS-Schwab ASD classification system, it is important to compare the utility of both classification frameworks as they relate to surgical outcomes. PURPOSE: Compare outcomes of surgical ASD patients classified by both Roussouly and Schwab systems. STUDY DESIGN/SETTING: Retrospective review of prospective ASD database. PATIENT SAMPLE: A total of 515 ASD patients. OUTCOME MEASURES: Complications; Health-related quality of life (HRQL): ODI, SF-36 PCS, SRS-22r.
METHOD(S): ASD patients with pre- and 2-year postop (2Y) radiographic/HRQL data were grouped by "theoretical" Roussouly type (Type 1: PI<45degree, LL apex below L4; Type 2: PI<45degree, LL apex above L4-L5 space; Type 3: 45degree60degree) and "current" Roussouly type (1: SS<35degree, LL apex below L4; 2: PI<35degree, LL apex above L4-L5 space; 3: 35degree45degree), as published. Means comparison tests assessed outcomes of those that mismatched "theoretical" and "current" types at both pre- and 2Y intervals (mismatched) to those of preoperative mismatched patients that matched at 2-years (matched). Subanalysis assessed outcomes of patients that improved in Schwab modifiers, and patients that both improved in both Schwab modifiers and matched Roussouly type by 2Y.
RESULT(S): Included 515 ASD patients (59+/-14yrs, 80%F). The overall cohort showed moderate preoperative global and lumbo-pelvic deformity: SVA(64mm+/-73), PT(25degree+/-11), PI-LL(16degree+/-21). Preoperative breakdown of "current" Roussouly types: Type 1 (10%), Type 2 (54%), Type 3 (24%), Type 4 (12%). Preoperative mismatch between "current" and "theoretical" types was 60%. By 2Y, 16% of patients matched Roussouly types. Matched and Mismatched groups did not differ in rates of reaching MCID for any HRQL metrics by 2Y(all p>0.1). Reop, PJK and complications did not differ between matched and mismatched(all p>0.1), though mismatched patients showed a trend of increased instrumentation failure(17% vs 26%, p=0.080). By 2Y, 28% of patients improved in PT Schwab modifier, 37% in SVA, and 46% in PI-LL. Patients that improved in PT modifier had lower instrumentation failure rates (16% vs 24%) and higher rates of reaching 2Y MCID for ODI (58% vs 48%) and SRS Activity (75% vs 64%) than patients that did not improve. Patients that both Matched Roussouly at 2Y and improved in all Schwab modifiers met MCID for ODI and SRS Activity at higher rates than patients that did not. Roussouly Match patients that improved in Schwab PT met SRS Activity MCID at a higher rate, and had less renal, infection, and neurologic complications than patients that did not. Roussouly Match patients that improved in Schwab SVA also had superior SF-36 scores and fewer cardiopulmonary complications(all p<0.05).
CONCLUSION(S): For surgical ASD patients, isolated restoration of sagittal spinal shape per the Roussouly system was not associated with superior clinical outcomes or complications by 2 years. In contrast, improvement in PT, per the SRS-Schwab system, was associated with substantial improvement in low-back disability by 2 years. Collectively, patients that both matched Roussouly sagittal type and improved in Schwab modifiers had superior complication and patient-reported outcomes by 2 years. These results suggest that concurrent consideration of both existing systems may offer utility in establishing optimal realignment targets. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: MHD prevalence in patients with substance abuse history has been well-described. However, the impact of current or historical substance abuse/dependence in adolescent idiopathic scoliosis (AIS) patients on risk of subsequent development of new-onset mental health disorders (MHDs) is unknown. PURPOSE: This study evaluated the: (1) demographics and (2) new-onset diagnosis of MHD among AIS patients with baseline substance abuse/dependence. The goal of this study was to determine whether substance abuse among AIS patients increases the odds of subsequent new-onset development of a MHD. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data. PATIENT SAMPLE: Using the NYS Statewide Planning and Research Cooperative System (SPARCS), we identified age, gender, race, and Charlson/Deyo-index propensity-score matched cohorts of AIS patients with or without prior/current substance abuse. AIS patients with comorbid substance abuse were included from 2009-11, with minimum 2-year follow-up. A total of 386 AIS patients (n=193 in each group) were included. OUTCOME MEASURES: Demographic information, length of stay, hospital charges, new-onset MHD diagnosis at 2-year follow-up METHODS: The NYS Statewide Planning and Research Cooperative System was reviewed to identify all 10-25 year-old AIS patients with prior or concurrent substance abuse (AIS-Sub: alcohol, tobacco, cannabis, amphetamine, opioid or polysubstance) from 2009-11 to ensure two-year follow-up. Patients with prior or concurrent MHD(s) were excluded. AIS-Sub were 1:1 propensity score-matched by age, sex, race and Charlson/Deyo index to AIS patients without substance abuse (AIS-NoSub). Cohorts were compared for subsequent incidence/development of individual and overall MHDs (depressive, anxiety, stress, sleep and/or eating disorder). Binary stepwise logistic regressions were utilized to calculate odds ratios (OR) of developing individual or any MHDs based on baseline substance abuse.
RESULT(S): A total of 386 AIS patients were included (n=193 each in AIS-Sub and AIS-NoSub). AIS-Sub and AIS-NoSub patients had comparable age (both 20.8 years), sex (62.2 vs 62.7% male), race (54.9 vs 52.8% white), insurance (55.4 v 45.6% Medicaid), and Charlson-Deyo (0.29 vs 0.37) respectively. AIS-Sub patients had higher rates of new-onset subsequent overall MHDs (16.1% vs 3.6%), with only depressive disorder higher among individual MHDs (10.9% vs 0.5%), both p<0.001. Baseline substance abuse independently predicted subsequent diagnosis of overall MHD (OR=6.8). Among individual MHDs, baseline substance abuse predicted development of new-onset depressive disorder (OR=47.0), all p<=0.002; it did not predict development of anxiety, stress, sleep, or eating disorders.
CONCLUSION(S): AIS patients with prior or current substance abuse/dependence were at increased two-year risk of developing any new-onset MHD, specifically depressive disorders. This data may guide preoperative screening and optimization efforts for scoliosis surgeons, as MHDs have been associated with poor outcomes following spine surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: The shared decision-making (SDM) process is an opportunity to deliver answers to frequently asked questions (FAQs) in adult spinal deformity (ASD) surgery. PURPOSE: Our goal was to present a concise list of answers to these FAQs to aid in SDM counseling. STUDY DESIGN/SETTING: Retrospective analysis of a prospective multi-center ASD database. PATIENT SAMPLE: Adult spinal deformity patients undergoing surgical correction enrolled into a prospective, multicenter surgical database from 2008-2016. OUTCOME MEASURES: Health related quality of life (HRQOL) outcome measures were collected such as Oswestry Disability Index (ODI), SF-36 PCS, and SF-36 MCS.
METHOD(S): Adult patients undergoing >= 5 level fusion with minimum 2-year follow up were included. We purposely included all deformity types (heterogeneity) to provide general applicability. We compiled a list of FAQs by patients undergoing ASD surgery and utilized a retrospective analysis to provide answers. All responses are reported as either means or reaching minimal clinically important difference (MCID) at the 2-year follow-up interval.
RESULT(S): Out of 689 ASD patients eligible for 2-year follow-up, 521 (76%) had complete follow-up. The majority were female (77%) with mean age of 58.5 years and BMI of 27.5. Mean levels fused were 11.3 with 52% being primary vs 48% revision surgeries. Will my pain improve? Back (7.2 to 3.6) and leg (4.7 to 2.6) pain were both reduced by ~50%. Will my activity level improve? A total of 63.9% reached MCID for SRS-22r activity. Will I feel better about myself? A total of 71.2% reached MCID for SRS-22r appearance. Is there a chance I'm worse? A total of 4.1% of patients were worse (ODI). What is the likelihood I have a complication? A total of 52.9% of patients have at least 1 complication and 29.6% have a major complication. Will I need another surgery? A total of 29.6% of patients have a reoperation within 2 years. Will I regret having surgery? A total of 32% would not choose the same treatment. Will I get a blood transfusion? A total of 79.1% of patients receive a blood transfusion. How long will I stay in the hospital? Study showed 9.9 days. Will I have to go to the ICU? A total of 79.1% of patients require an ICU stay. Will I be able to return to work? A total of 71% returned to full-time work at 2 years. Will I be taller after surgery? Yes, 1.4cm was the average
CONCLUSION(S): The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Novel analyses of clinical outcomes following cervical deformity (CD) corrective surgery use an area-under-the-curve (AUC) method to assess health-related quality of life (HRQL) metrics throughout the surgical recovery process. It remains unclear how demographics, preop parameters, and surgical decisions are associated with superior recovery. PURPOSE: Identify demographic, surgical and radiographic factors that predict superior recovery kinetics. STUDY DESIGN/SETTING: Retrospective review of a prospective CD database. PATIENT SAMPLE: A total of 98 CD patients. OUTCOME MEASURES: Baseline (BL) to 1-year (1Y) HRQL Instruments: Neck Disability Index (NDI).
METHOD(S): CD database criteria:C2-7 Cobb angle>10degree, coronal Cobb angle >10degree, cSVA>4cm or TS-CL>10degree, or CBVA>25degree. Following univariate analyses, the AUC normalization method was utilized by dividing all reported BL and postoperative(3M, 1Y) outcome measures by the BL score. Normalized scores(y-axis) were plotted against follow-up time interval(x-axis). Total area was calculated for all follow-up, divided by cumulative follow-up length, determining overall, time-adjusted HRQL recovery (Integrated Health State[IHS]). IHS NDI scores were stratified by quartile, the uppermost 25% were categorized as having "superior" recovery kinetics (SRK) vs "normal" recovery kinetics (NRK). BL demographic, clinical and surgical information were used to predict SRK using generalized linear modeling.
RESULT(S): A total of 98 patients included(62+/-10yrs, 28+/-6kg/m2, 65%F). Mean CCI: 0.95, 6% smokers, and 31% history of smoking. Surgical approach: combined(33%), posterior(49%), anterior(18%). Average posterior levels fused: 8.7, anterior levels fused: 3.6, EBL: 915.9ccs, op time: 495min. According to the Ames CD classification at BL: cSVA (53.2% minor deformity and 46.8% moderate), TS-CL (9.8% minor, 4.3% moderate, 85.9% marked), and horizontal gaze (27.4% minor, 46.6% moderate, 26% marked). Relative to BL NDI scores (mean: 47), normalized postop NDI scores showed decrease in disability at 3M(0.9+/-0.5, p=0.260) and a further decrease at 1Y (0.78+/-0.41, p<0.001). As assessed with normalized NDI scores, patients showed significant improvement in neck disability from BL to 1Y postoperative (p<0.001). NDI IHS scores demonstrated correlation with age (p=0.011), gender (p=0.042), anterior approach only (p=0.042), posterior approach (p=0.042). After grouping by quartile, patients with greater BL PT (SRK:25.6degree, NRK:17degree, p=0.002), PI-LL (SRK:8.4degree, NRK:-2.8degree, p=0.009), and anterior approach (SRK:34.8%, NRK:13.3%; p=0.020) correlated strongly with SRK. A total of 69.4% of patients met MCID for NDI (CONCLUSION(S): Superior recovery kinetics following cervical deformity surgery was predicted with high accuracy using a combination of baseline patient reported factors(VAS EQ5D, swallow sleep, and mJOA scores) and radiographic factors(TK, T10-T12, T12-S1, L1-S1). Patients and health care providers should be aware of these factors in order to improve surgical decision-making, in an effort to reduce postop neck disability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright