Faculty Bibliography

BACKGROUND CONTEXT: Many patients are unable to undergo a major adult spinal deformity (ASD) corrective surgery due to deformity severity, age, comorbidities, and overall frailty status. In order to optimize quality of life in patients with ASD there may be alignment ratios to be prioritized across different presentations of spinal shape. PURPOSE: To prioritize radiographic alignment ratios for alignment. STUDY DESIGN/SETTING: Retrospective review of a single surgeon adult spinal deformity database. PATIENT SAMPLE: A total of 165 patients undergoing ASD corrective surgery OUTCOME MEASURES: Minimal clinically important difference (MCID) for SRS-22r and Oswestry Disability Index (ODI); proximal junctional kyphosis (PJK).
METHOD(S): Included: patients >18yrs undergoing surgery for ASD (scoliosis >=20degree, SVA >=5cm, PT >=25degree, or TK >=60degree) with full baseline (BL) and 2-year (2Y) radiographic parameters and HRQL scores. Patients were stratified by baseline pelvic incidence: low PI (<45), high PI (>=45). Ratios of SRS-Schwab radiographic parameters (PI-LL, SVA, PT) were assessed for quartiles of correction: minimal (<0%), 0-25%, 25-50%, 50-75%, and 75-100%. Target quartiles of correction were assessed within the PI severity groups for achievement of 2Y best clinical outcome as defined by Smith et al: SRS-22 scores >=4.5 and ODI <=15 [BCO] through correlations and stepwise linear regression analysis.
RESULT(S): A total of 165 ASD patients included (56.7+/-16.3yrs, 80.3% female, 25.8+/-5.3kg/m2). By approach, anterior: 0.6%, posterior: 91.2%, and combined approach: 8.2%. Average levels fused: 11.3+/-4.1, operative time: 332 min, estimated blood loss: 1,968 ccs. By baseline PI: 24.3% low PI, 75.7% high PI. (47 patients) of patients met the criteria for BCO, which was evenly distributed among the Roussouly types (p=0.115). For low PI patients, a combination of correcting the PI-LL from 0-25%, SVA 75-100%, and PT 0-25% significantly predicting acquiring the BCO (R2 =0.622, p=0.002). For BCO in high PI patients, a 25-50% correction in PI-LL, SVA minimal, and PT 75-100% (R2 =0.297, p=0.021). Low PI patents who met the three ratios of correction (PI-LL, SVA and PT) had less major complications (11.1% vs 23.1%) compared to other low PI patients. High PI patients who were corrected to the Schwab quartile of ratios underwent less reoperations (6.1% vs 23.3%) and had less PJK occurrence by 2-years postop (20.4% vs 40%), all p<0.05.
CONCLUSION(S): Certain ratios of correction of the SRS-Schwab modifiers contribute to improving clinical outcomes and vary by preoperative spinal shape. Prioritization of global realignment relative lumbo-pelvic mismatch depends on the theoretical contour of the individual patient. Importantly, certain subgroups experience the most clinical benefit from the initial percentages of realignment, which may obviate more aggressive corrections on an individual basis. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: The impact of neuromuscular disorders such as multiple sclerosis (MS) on outcomes following anterior cervical discectomy and fusion (ACDF) is underreported. PURPOSE: Identify the impact of MS on two-year (2Y) postoperative complications and revisions following 2-3-level ACDF for cervical radiculopathy (CR) or myelopathy (CM). STUDY DESIGN/SETTING: Retrospective review of the New York State Statewide Planning and Research Cooperative System (SPARCS) database. PATIENT SAMPLE: Patients undergoing 2-3 level ACDF for CR/CM. OUTCOME MEASURES: Two-year postoperative complications and reoperations.
METHOD(S): Patients undergoing 2-3 level ACDF for CR/CM were identified from SPARCS. Patients with a baseline diagnosis of MS were also identified. Patients with infectious/traumatic/neoplastic were excluded. The remaining patients were 1:1 propensity score-matched (MS to no-MS) for age, sex, race, Deyo index and compared for rates of 2Y postoperative complications and reoperations. Logistic regression models were utilized to determine significant predictors of these outcomes.
RESULT(S): A total of 302 total patients were identified (MS, n=151; non-MS, n=151). MS patients were more frequently female (72.8% vs 27.2%, p<0.001). Age was comparable (50.1 vs 50.1 years, p=0.225). MS patients incurred higher charges for their surgical visit ($41,029 vs $31,654) and higher LOS (2.8 vs 2.2 days), both p<=0.016. They experienced higher rates of deep vein thrombosis (DVT) (3.3% vs 0%, p=0.02), with similar overall medical (19.2% vs 21.2%), surgical (7.9% vs 10.6%), and total complications (21.9% vs 25.8%), all p>0.05. MS patients had similar rates of 2Y revisions (6.6% vs 5.3%, p=0.627). MS was not associated with medical, surgical, or overall complications or revisions at minimum 2Y follow-up.
CONCLUSION(S): Despite differences in demographics and higher rates of postoperative DVT, MS patients experienced comparable postoperative course with respect to other individual and overall complications and revisions following 2-3-level CF for degenerative spinal pathologies. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Navigation assisted and robotics systems are becoming more widespread in their utilization and can be invaluable intraoperative adjuncts during spine surgery. These systems are utilized in hopes of improving surgical accuracy and clinical outcomes. However, there is a lack in specificity of which type of procedures benefit the most from use of navigation versus robotics. PURPOSE: Identify Trends of Navigation and Robotic assisted elective spine surgeries from the onset of inception. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Elective spine patients from (2007-2016). OUTCOME MEASURES: Complications, procedures, levels fused.
METHOD(S): Patients(pts) between 2007-2016 in Nationwide Inpatient Sample (NIS) were isolated by ICD9 codes for Navigation [Nav] or Robotic [Rob]-Assisted surgery. Basic demographics and surgical variables were identified between each group via chi-squared and t-tests. Each system was analyzed from 2009-2015 for trends in usage with specific procedures and specific diagnoses.
RESULT(S): Included 3,759,751 elective spine patients (56.9 yrs, 52.7% F) with 100,488 Nav and 4,724 Rob pts. Nav pts were younger (56.7 vs 62.7) and had a lower comorbidity index (1.8 vs 6.2; all p<0.05). Nav pts also had more decompressions (65% vs 42%), fusions (71% vs 50.5%), anterior (17% vs 16.7%), posterior (58.3% vs 36.8%), and combined approach (7.1%vs 5%) than Rob pts. Overall, complication rates increased for Nav (5.8%-21.7%) and Rob pts (3.3%-18.4%) as well as for 2-3 level fusions (50.4%-52.5%) and (1.3%-3.2%); respectively. Concomitantly, Rob and Nav systems have been used on increasingly invasive spinal procedures (Rob:1.7-2.2; Nav: 3.7-4.6). During this time, the rate of posterior approaches (27.4%-41.3%) increased as well as osteotomies (4%-7%) and spinal fusions (40.9%-54.2%) for Rob pts. However, the rates for anterior approach for Rob procedures has since decreased (14.9%-14.4%). Nav increased for posterior (51.5%-63.9%) and anterior approaches (16.4%-19.2%) despite the decrease rate of osteotomies (2.1%-2.1%) and decompressions (73.6%-63.2%).
CONCLUSION(S): From 2007 to 2016 Robotic and Nav systems have been performed on increasing invasive spine procedures. Robotic systems have shifted from anterior to posterior approaches especially for spinal fusions. While, Navigation computer-assisted procedures have been increasingly used for different approaches, but have decreased in rates of usage for decompression procedures. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: The age-adjusted alignment ideal alignment was proposed in order reduce the occurrence of proximal junctional kyphosis (PJK) in an adult spinal deformity (ASD) population. The normative postoperative age ideal value for the mismatch between pelvic incidence and lumbar lordosis (PI-LL) has yet to be related to the global alignment and proportion (GAP) score postop proportionality. PURPOSE: To assess the impact of normative age-adjusted PI-LL and proportionality via GAP score on postoperative patient-reported outcomes. STUDY DESIGN/SETTING: Retrospective review of single-surgeon adult spinal deformity (ASD) database PATIENT SAMPLE: 140 ASD patients. OUTCOME MEASURES: Health-related quality-of-life (HRQLs); SRS-22r; PJK.
METHOD(S): ASD patients with baseline (BL) and 2-year postoperative (2Y) radiographic and HRQL data were included. Age-adjusted correction groups generated at postoperative follow-up for actual alignment compared to age-adjusted values for PI-LL-adjusted ideal values (matched, overcorrected, undercorrected). GAP Score in the literature includes the four parameters, and an age factor to formulate a sagittal plane score out of 13 (proportional, moderately disproportional [MD], severely disproportional [SD]). GAP improvement scores were noted as less at 2Y compared to BL. Patients were grouped by age-adjusted and 2Y GAP results: Match PI-LL/Proportional GAP, Match PI-LL/Disproportional GAP, Unmatch PI-LL/Proportional GAP, Unmatch PI-LL/Disproportional GAP. Means comparison and chi-squared ANOVA analyses assessed the outcomes between age-adjusted and GAP groups.
RESULT(S): Included: 140 ASD patients (55.5+/-16.4 years, 81% female, 25.2+/-4.7kg/m2). At BL, mean sacral slope: 30.7degree, pelvic tilt: 23degree, pelvic incidence: 53.5degree, PI-LL: 13.3degree, SVA: 61.6 mm, and L1-S1: 40.4degree. BL GAP proportionality: 17.8% proportional, 27.1% MD, 55% SD. PI-LL by baseline GAP proportionality groups: -6.4degree Proportional, -4.6degree MD, 26.8degree SD, p<0.001. Baseline ODI increased significantly with GAP proportionality: 27.3 Proportional, 32.3 MD, 37.4 SD, p=0.050. Assessment of 2Y age-adjusted PI-LL alignment found that 20.3% of patients Matched, 45.1% Overcorrected, and 34.6% Undercorrected. By 2Y GAP results, 32.3% were proportional, 38.5% MD, 29.5% SD (40.5% of patients improved, while 48.5% remained the same, and 11.1% deteriorated in their GAP proportionality). Categorized by the PI-LL age-adjusted/GAP groups: 2.3% Match PI-LL/Proportional GAP, 13.1% Match PI-LL/Disproportional GAP, 30% Unmatch PI-LL/Proportional GAP, 54.6% Unmatch PI-LL/Disproportional GAP. Patients who Unmatched PI-LL/Disproportional in GAP had significantly worse postoperative SRS-Pain scores (1.80 vs 3.53-3.86), SRS-Appearance (3.30 vs 3.69-4.29) and SRS-22 Total scores (2.84 vs 3.80-4.12), all p<0.050. Unmatch PI-LL/Disproportional patients developed PJK at a significantly higher rate by 6-months (66.7% vs 11.8-15.4%), p<0.050. Outcomes were not different between Match PI-LL/Disproportional GAP and Unmatch PI-LL/Proportional GAP groups.
CONCLUSION(S): Collectively over or undercorrecting in age-adjusted mismatch pelvic incidence and lumbar lordosis and becoming disproportional in spinal shape at 2 years led to increased postoperative proximal junctional kyphosis and significantly worse patient-reported outcomes. Surgeons should be wary of the double mal-correction when utilizing these complex realignment schemas. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: The Miller et al. adult spinal deformity frailty index (ASD-FI) correlates with increased complication risk after surgery; however, its development is rooted in health related quality of life metrics (HRQLs) that may be subjective, and the 40 factors needed for its calculation limit the index's utility in a clinical setting. PURPOSE: Develop a simplified, modified frailty index for ASD patients STUDY DESIGN/SETTING: Retrospective cohort study PATIENT SAMPLE: A total of 531 ASD patients OUTCOME MEASURES: HRQLs, length of stay (LOS) METHODS: ASD patients (scoliosis>=20degree, SVA>=5cm, PT>=25degree, or TK >=60degree) with baseline (BL) and 2-year HRQL follow up. HRQL components were removed from the FI and top contributors to the ASD-FI score of the remaining were assessed via Pearson correlation, and included in forward multiple stepwise regressions. Factors with the largest R2 value were including in the modified, ASD-FI (clin-ASD-FI). Factors included in the clin-ASD-FI were regressed against mortality, extended length of hospital stay (>8 days), revisions, major complications and weights for the clin-ASD-FI were calculated via Beta/Sullivan. Total clin-ASD-FI score was created with a score from 0 to 1. Linear regression correlated the clin-ASD-FI with ASD-FI scores and published cut-offs for the ASD-FI were used to create the new frailty cutoffs: not frail (NF: < 0.11), frail (F: 0.11-0.21) and severely frail (SF: >0.21). Binary logistic regression assessed odds of complication or reop for frail patients. Logistic regressions were run to determine whether the clin-ASD-FI is superior to previously utilized measures predicting risk (age, ASA, previous FI, and CCI) for complications and reop.
RESULT(S): A total of 531 ASD patients (59.5yrs, 79.5%F). The final stepwise regression model R2 of 0.681: <18.5 or >20 BMI (weight: 0.0625 out of 1), cardiac disease (0.125), disability employment status (0.3125), diabetes mellitus (0.0625), hypertension (0.0625), osteoporosis (0.125), blood clot (0.1875), and bowel incontinence (0.0625). These factors calculated the score from 0 to 1, with a mean cohort score of 0.13+/-0.14. Breakdown by clin-ASD-FI score: 51.8% NF, 28.1% F, 20.2% SF. Increasing frailty severity was associated with longer LOS (NF: 7.0, F: 8.3, SF: 9.2 days; p<0.001). When assessing BL HRQL status between the new clin-ASD-FI groups, ODI, EQ5D, SRS, PCS, MCS, NRS-Back, and NRS-Neck were worse with increasing categorical frailty (all p<0.001). Frailty independently predicted occurrence of any complication (9.357[2.20-39.76], p=0.002) and reop (2.79[0.662-11.72], p=0.162). Specific complications predicted included infection, neurologic, operative, radiographic, and wound complications (OR: 1.69-5, all p<0.001). Chi-square and p-values for the historical risk predictors of complications are as follows: Age(complication: 1.01[1-1.03] p=0.052; reop: 0.999[0.984-1.01] p=0.866), ASA(complication: 1.102[1.20-2.18], p=0.002; reop: 1.31[0.927-1.84], p=0.177), previous frailty index(complication: 8.57[1.66-44.17], p=0.010; reop=2.629[0.498-16.06], p=0.241), CCI(complication: 1.24[1.10-1.40], p<0.001; reop: 1.06[0.943-1.20], p=0.320).
CONCLUSION(S): Utilizing an existing ASD frailty index, we proposed a modified version eliminating the patient-reported components. This index is a true assessment of physiologic status, and represents a superior risk factor to other risk assessment tools for baseline and revision spinal deformity surgery as a result of its immutability with surgery, lack of subjectivity, and ease of use. Future studies should explore external validation of the proposed frailty index. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Metabolic (Met) syndrome is an amalgamation of medical disorders that ultimately increase patient complications. Factors such as obesity, hypertension, dyslipidemia and hyperglycemic are associated with this disease complex (two or more factors). PURPOSE: Assess the incremental value of improving Met syndrome in relation to clinical outcomes. STUDY DESIGN/SETTING: Retrospective cohort study of patients with metabolic syndrome through the use of the Nationwide Inpatient Sample (NIS) years 2007-16. PATIENT SAMPLE: Elective spine surgery patients with >2 metabolic syndrome criteria. OUTCOME MEASURES: Complications.
METHOD(S): Pts undergoing elective spine surgery were isolated in NIS 2007-2016. Spine patients were then separated into two groups: metabolic syndrome patients (>2 metabolic variables: hypertension, diabetes, obesity, and triglycerides) and non-metabolic patients (<2 metabolic variables). T-tests and chi-squared tests compared differences in pts demographics. Resolution of metabolic factors were incrementally analyzed for their effect on perioperative complications through utilization of logistic regressions.
RESULT(S): A total of 2,855,517 elective spine pts were included and 20.1% had metabolic syndrome (81.4% 2 factors, 18.4% 3 factors, 0.2% 4 factors). Met pts were older, less female, and more comorbid (p<0.001). Among the metabolic patients, the most common metabolic variable was hypertension (95.9%), blood sugar (72.4%), obesity (48.9%), and triglycerides/HDL (1.8%). A total of 28.8% Met pts developed more complications such as anemia (9.8% vs 5.9%), device-related (3.5% vs 2.9%), neurologic (2.3% vs 1.4%), and bowel issues (9.7% vs 6.8%; p<0.05). Controlling for age and invasiveness, having 3 Met factors increased a PT's likelihood (0.89x) of developing a perioperative complication (p<0.05) whereas 2 factors had lower odds (0.82). More specifically, pts that were hyperglycemic, obese, and had hypertension had the greatest odds at developing a complication (0.58 [0.58-0.57]) followed by those that had concomitant hypertension, high triglycerides, and were obese (0.55[0.63-0.48]; all p<0.001). Met pts with 2 factors, being obese and having hypertension produced the lowest odds at developing a complication (0.5[0.61-0.43;p<0.001). These Met pts also had a lower length of stay than those with 3 and 4 (p<0.001).
CONCLUSION(S): Metabolic patients improved in perioperative complications incrementally, demonstrating the utility of efforts to mitigate burden of metabolic syndrome even if not completed abolished. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Circumferentially minimally invasive (cMIS) correction techniques of adult scoliosis have advanced, but it is unclear how outcomes compare to open correction. PURPOSE: To compare health related quality of life (HRQL) measures and surgical parameters between the two modalities. STUDY DESIGN/SETTING: Retrospective review of prospective multicenter adult spinal deformity database. PATIENT SAMPLE: Inclusion criteria are age >18, and one of the following: PT>25, PI-LL>10, or SVA>5 cm. OUTCOME MEASURES: NRS leg, ODI, SF-12, EQ5D, SRS-22.
METHOD(S): A prospective database was retrospectively reviewed. Inclusion criteria were age >18, and one of the following: PT>25, PI-LL>10, or SVA>5 cm. Patients were grouped as cMIS (percutaneous screws) or OPEN. Propensity matching was used to create two equal groups controlling for: age, BMI, preop (PI-LL, PI, TPA), and number of posterior levels fused.
RESULT(S): A total of 154 (77 cMIS, 77 OPEN) patients were included after matching for age, BMI, PI-LL (15 vs 17degree), PI (54degree vs 54degree), TPA (21degree vs 22degree), and mean number of levels fused (6 vs 6), for cMIS and OPEN, respectively. 3-column osteotomies were excluded. Baseline and postop ODI, SRS total, EQ5D were not different between MIS and OPEN (p=0.50, 0.45, 0.33). Maximum Cobb angles were similar for OPEN and cMIS, respectively, at baseline (26.3degree, 25.9degree, p=0.85) and at 1-yr postop (17.5degree, 15.0degree, p=0.17). Patients reaching minimal clinically important difference (MCID) were 58.3% for OPEN and 64.4% for cMIS (p=0.31) at 1 year. At 1 year, no difference was observed between PI-LL, SVA, PT, or Cobb (p=0.71, 0.46, 0.9, 0.20). OPEN vs MIS had greater EBL (1.36L vs 0.524L, p<0.05), fewer levels of interbody fusion (1.87 vs 3.46, p<0.05), but shorter OR time (356 vs 452min, p=0.003). Revision surgery rates between the two cohorts were not different (p=0.097).
CONCLUSION(S): When comparing cMIS to OPEN adult scoliosis correction with propensity matching, HRQL improvement, spino-pelvic parameters, revision surgery rates, and patients reaching MCID were not different between cohorts. However, cMIS had lower blood loss with comparable results in well-selected patients, but longer OR time. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Opioid use prior to surgery is associated with worse postop outcomes. Little is known regarding the economic impact that preop opioid use has upon patient preferred health state, quality adjusted life years (QALYs) and the cost/QALY of surgical treatment for adult spinal deformity (ASD). PURPOSE: Compare the health state preference values, QALYs, and cost/QALY for operatively treated ASD patients that used opioids vs did not use opioids prior to surgery. STUDY DESIGN/SETTING: Cost/QALY analysis of operatively treated patients identified from a prospective, multi-center ASD study. PATIENT SAMPLE: Propensity score matched (PSM) cohorts of patients that used opioids (OPIOID) vs nonusers (NON) prior to ASD surgery, at 1- and minimum 2-year follow up. OUTCOME MEASURES: Short Form-36v2 questionnaire (SF-36), SF6D derived from SF-36, hospital costs for operative treatment of ASD based on CMS DRG reimbursements, QALYs, cost/QALY for index surgery, perioperative complications, and 1- and 2-year postop opioid use.
METHOD(S): ASD patients (age>18 years) enrolled into a prospective multicenter ASD database were divided into preop opioid (OPIOID) vs nonopioid (NON) users. PSM was performed to control for confounding demographic, radiographic, and surgical variables. Preop, 1-year, and minimum 2-year postop SF6D values obtained, 1- and 2-year post QALYs were calculated using SF6D change from baseline, hospital costs at the time of index surgery were calculated using CMS DRG reimbursements adjusted for inflation to 2019 US dollars, cost/QALY evaluated at 1- and 2-years postop, perioperative complications, and 1- and 2-year postop opioid use was evaluated for OPIOID vs NON.
RESULT(S): DRG data was available for 182/262 patients meeting inclusion criteria. Following PSM, preoperative demographics, radiographic parameters, surgical treatment, and mean follow up (3.4 vs 3.3 years) were similar for OPIOID (n=68) vs NON (n=114), respectively (p>0.05). OPIOID had longer ICU (49 vs 23 hours) and hospital stay (9.7 vs 6.8 days) than NON, respectively (p<0.05). SF6D was worse for OPIOID at preop (0.521 vs 0.598), 1-year (0.613 vs 0.749), and 2-years postop (0.626 vs 0.749) than NON, respectively (p<0.05). QALYs were worse at 1- (0.567 vs 0.674) and 2-years postop (0.674 vs 0.825) for OPIOID vs NON, respectively (p<0.05). Cost of care at index surgery was greater for OPIOID ($83,363.02) vs NON ($70,281.17). Cost/QALY was higher for OPIOID at 1-year ($150,294.51vs $107,947.19) and 2-years postoperative ($69,615.78 vs $48,761.14) than NON (p<0.05). Perioperative complications were similar for OPIOID vs NON (p>0.05). Continued opioid use at 2-years postop was greater for OPIOID (52.4%) vs NON (8.7%; p>0.05).
CONCLUSION(S): Opioid use prior to ASD surgery is associated with worse patient perceived health state and greater costs to society. After controlling for patient demographics, deformity magnitude, and type of surgery, OPIOID had greater cost of care, despite similar perioperative complication rates. At 2-years postop both OPIOID and NON demonstrated cost effectiveness of index surgery (cost/QALY<$100,000), however the residual cost to society was $21,300 greater for OPIOID vs NON. Over 52% of OPIOD had continued opioid usage at 2-years postop compared to 8.7% of NON. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Neurologic complications following adult spinal deformity (ASD) are common and may play a role in the outcomes for our patients. Neurologic complications may include radiculopathy, sensory deficit or motor weakness. The impact that these specific complications have on HRQL is unknown. PURPOSE: Neurologic complications are common following ASD. Understanding their impact on Health-related quality of life (HRQL) measures is critical. STUDY DESIGN/SETTING: Retrospective cohort study of prospective ASD database. PATIENT SAMPLE: Retrospective cohort study, 733 patients. OUTCOME MEASURES: Neurologic complications, HRQL scores.
METHOD(S): ASD patients (>18yrs, scoliosis >=20degree, SVA >=5cm, PT >=25degree and/or TK >60degree). Inclusion criteria was HRQL at baseline (BL) and 1 year, and lower extremity motor score (LEMS) at BL, 6-week and 1-year ODI, SRS22r and SF36 were determined at BL and 1yr LEMS was calculated from 0-50, with 50 designated as normal motor function. Patients were divided into 4 groups: pLEMS (perfect, no deficit), dLEMS (new postop deficit that returned to normal at 1 year), iLEMS (deficit improved from abnormal baseline), and wLEMS (new postop deficit persistent at one year).
RESULT(S): A total of 733 patients were eligible, with 95 (12.96%) reporting neurologic complications (NC). Impact of any NC vs no complication at 1yr was significant for ODI (5.1), PCS (3.6) and SRSpain (0.2) at 1 year (p<0.001 all). For NC vs any other complication, there was still a decrease in ODI (3.9) and PCS (2.4) at 1 year (p<0.01). NC subtype: radiculopathy caused worse outcomes for (4.3) and SRS pain (0.3) (p<0.05), sensory deficit caused worse SRSmental (0.5) (p<0.05), but no HRQL change was detected for motor deficit at 1 year. PLEMS (456/733) had improvement in all HRQL, and these improvements were not different with or w/o NC, or non-NC. Compared to pLEMS w/o complication, dLEMS (62/733) and iLEMS (147/733) were statically similar, however wLEMS (68/733) had worse ODI (7.1), SRStotal (0.3), activity (0.3), mental (0.3), pain (0.3) (p<0.05 all).
CONCLUSION(S): Neurologic complications that occur following ASD have a significant effect on HRQLs. The magnitude of effect is driven by radiculopathy and by lower extremity motor score. LEMS scores that remain normal, return back to normal or improve have similar outcomes, while patients that have continued weakness remain statistically worse at 1 year. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Emphasis has been placed upon reducing perioperative complications in spinal operations, of which cardiac complications remain among the most devastating for patients. Myocardial infarction (MI), along with its predictive factors, has been an understudied complication. PURPOSE: To assess the incidence and risk factors for perioperative myocardial infarctions in spine surgery patients. STUDY DESIGN/SETTING: Retrospective case control study PATIENT SAMPLE: A total of 196,086 surgical spine patients OUTCOME MEASURES: Predictors of MI following surgical spine intervention METHODS: A patient was categorized as having sustained a postsurgical MI in this study if it occurred intraoperatively or within 30 days of surgery, manifested by documentation of ECG changes accordingly: ST elevation >1mm in two or more contiguous leads, new left bundle branch, new Q-wave in two or more contiguous leads, or new elevation in troponin greater than three times upper level of the reference range. The relationship between MI and non-MI spine patients was assessed using chi-squared and independent samples t-tests, as appropriate. Descriptive statistics, including frequency counts for categorical variables and means and standard deviations, were calculated to summarize demographics and clinical profiles such as spinal diagnoses and comorbidity. Univariate/multivariate analyses were run to assess predictive factors of MI in spine surgery patients. Logistic regression with stepwise model selection was employed to create a model to predict MI occurrence.
RESULT(S): Of 196,523 patients (57.1+/-14.2 years, 48% female, 30.4+/-6.5 kg/m2) undergoing elective spine surgery, 436 patients had an acute MI intraoperatively or within 30 days postoperatively (Spine-MI) (69.07+/-10.4 years, 42% female, 30.39+/-6.22 kg/m2). Incidence of MI did not change significantly from 2010 to 2016 (0.2% to 0.3%, p=0.298). Spine-MI patients underwent significantly more fusions than elective spine surgical patients who did not have an MI (73.6% vs 58.4%, p<0.001), with an average of 1.03 levels fused. Spine-MI patients also had significantly more Smith-Peterson osteotomies (5.0% vs 1.8%, p<0.001) and three-column osteotomies (0.9% vs 0.2%, p<0.001), but had far fewer decompression-only procedures (26.4% vs 41.6%, p<0.001). Overall, patients who developed a perioperative MI underwent more revisions compared to all elective spine surgery patients (5.3% vs 2.9%, p=0.003). Spine-MI patients had significantly greater invasiveness scores (3.41 vs 2.73, p<0.001) and total operative time (211.6 vs 147.3 min, p<0.001). The average number of post-operative days until developing an MI was 5.27 days; 9.9% day of operation, 50.8% 1-3 days after, 20.8% 4-7 days 10.9% 8-15 days, 7.6% 16-30 days. Mortality rate for Spine-MI patients was 4.6% versus 0.05% in the entire elective spine surgical population (p<0.001). Multivariate modeling for Spine-MI predictors yielded an AUC of 83.7%, and included history of diabetes mellitus, cardiac arrest and peripheral vascular disease, past blood transfusion, dialysis-dependence, high preoperative platelet count, superficial surgical site infection and days from operation to discharge.
CONCLUSION(S): A model with good predictive capacity to predict MI after spine surgery now exists. Predictive modeling of myocardial infarction following spine operations can aid in risk-stratification of patients, consequently improving preoperative patient counseling and optimization in the peri-operative period. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright