Faculty Bibliography

BACKGROUND CONTEXT: Intraoperative CT image-guided navigation (IGN) and robotic assistance have been increasingly implemented during spine surgery to improve accuracy in pedicle screw positioning. However, studies have shown that they increase operative time and ionizing radiation exposure, and it remains controversial whether they improve patient outcomes. PURPOSE: Assess use of IGN and robotic assistance in posterior lumbar surgery and their relationship with patient radiation exposure and perioperative outcomes. STUDY DESIGN/SETTING: Retrospective cohort study at single institution. PATIENT SAMPLE: A total of 165 patients undergoing 1- or 2-level posterior spinal fusion, with or without TLIF. OUTCOME MEASURES: Preoperative CT scan utilization and radiation dose, intraoperative radiation dose (fluoroscopy and/or CT) and total-procedure radiation dose (sum of preoperative CT and intraoperative radiation doses), levels fused, operative time, estimated blood loss (EBL), length of stay (LOS), postoperative complications.
METHOD(S): Patients >=18 years old undergoing 1- or 2-level posterior spinal fusion, with or without TLIF, in a 12-month period included. Chart review performed for pre- and intraoperative data on radiation dose and perioperative outcomes. All radiation doses quantified in milli-Grays (mGy). Univariate analysis and multivariate logistic regression analysis for categorical variables and one-way ANOVA for continuous variables utilized, with significance set at p<0.05.
RESULT(S): A total of 165 patients (51.83% F, 59.13+/-13.18yrs, BMI 29.43+/-6.72, Charlson comorbidity index [CCI] 1.20+/-1.56) were assessed: 12 IGN, 62 robotic, 56 open, 35 MIS without IGN/robotics. Lower proportion of women in open and MIS group (66.67% F IGN, 64.52% robotic, 38.18% open, 45.71% MIS, p=0.010). Younger patients in MIS group (63.42 yrs IGN, 61.74 robotic, 60.63 open, 50.63 MIS, p<0.001). MIS group had lowest mean posterior levels fused (1.42 IGN, 1.27 robotic, 1.32 open, 1.06 MIS, p=0.015). Total-procedure radiation (50.21mGy IGN, 59.84 robotic, 22.56 open, 82.02 MIS), total-procedure radiation/level fused (41.88mGy IGN, 51.18 robotic, 18.56 open, 79.41 MIS) and intraop radiation (44.69mGy IGN, 44.85 robotic, 14.81 open, 80.28 MIS) were lowest in the open group and highest in the MIS group compared to IGN and robotic (all p<0.001). A higher proportion of robotic and lower proportion MIS patients had preop CT (25% IGN, 82.26% robotic, 37.5% open, 8.57% MIS, p<0.001). EBL (441.67mL IGN, 380.24 robotic, 355.36 open, 162.14 MIS, p=0.002) and LOS (4.75 days IGN, 3.89 robotic, 3.89 open, 2.83 MIS, p=0.039) were lowest in the MIS group. Highest operative time for IGN patients (303.5 min vs 264.85 robotic, 229.91 open, 213.43 MIS p<0.001). No differences in BMI, CCI, postoperative complications (p=0.313, 0.051, 0.644, respectively).
CONCLUSION(S): IGN and robotic assistance in posterior lumbar fusion were associated with higher intraoperative and total-procedure radiation exposure than open cases without IGN/robotics, but significantly less than MIS without IGN/robotics, without differences in perioperative outcomes. While MIS procedures reported highest radiation exposure to patient, of more concern is that the proportion of total radiation dose applied to surgeon would also be considerably higher in MIS group. FDA DEVICE/DRUG STATUS: Brainlab Airo Mobile Intraoperative CT scanner (Approved for this indication).
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BACKGROUND CONTEXT: Adult spinal deformity (ASD) surgery often involves complex deformity correction. It's unknown which baseline (BL) patient factors predict lower total costs in ASD surgery. PURPOSE: Identify predictors of lower total surgery costs for ASD patients. STUDY DESIGN/SETTING: Retrospective review of a prospective multicenter adult spinal deformity database. PATIENT SAMPLE: A total of 311 operative ASD patients >=18 years old with baseline and 3Y demographic, surgical, and frailty data. OUTCOME MEASURES: Schwab sagittal vertebral axis (SVA) modifier grade, Owestry Disability Index (ODI), costs of ASD surgery, predictors of lower costs.
METHOD(S): Inclusion criteria included surgical ASD (scoliosis >=20degree, SVA >=5cm, PT >=25degree, or thoracic kyphosis >=60degree) patients >18 years with available frailty, demographic, and radiographic data at BL and 1 year postop. Descriptive analyses assessed mean age, frailty, and surgical data. Total costs for surgery were calculated using the PearlDiver database. A conditional variable importance table used nonreplacement sampling set of 20,000 conditional inference trees to identify the top factors associated with lower cost surgery for low (LSVA), moderate (MSVA), and high (HSVA) Schwab modifier grades. LSVA were SVA<4 cm, MSVA 4 cm-9.5 cm, HSVA were >9.5 cm. Linear and logistic regression assessed the relationship between significant predictors and the odds of lower cost surgery.
RESULT(S): Of the 322 total ASD patients, 322 met inclusion criteria. Descriptive statistics were: age 58.9 +/- 14.9, 76% women, BMI 27.8 +/- 6.2, 62% osteotomy, 54% decompression, and 11.0 +/- 4.1 average levels fused. At 3yrfollow-up, the potential cost of ASD surgery ranged from $57,606.88 to $116,312.54. There were 152 LSVA patients, 53 MSVA patients, and 111 HSVA patients. For all patients, BL ODI < 50 (2.22 [1.53-3.23], p<0.001), BL SRS Activity >1.5 (2.62 [1.402-4.875], p=0.002], no previous spine surgery (1.77 [1.22-2.58], p=0.003), frailty scores <0.19 (2.92 [1.69-5.08], p<0.001), no SVA modifiers (1.59 [1.09-2.33], p=0.017), no PI-LL modifiers (1.62 [1.10-2.40] p=0.015), invasiveness scores below 80.8 (1.51 [1.02-2.24] p=0.04), and no depression (1.55 [1.03-2.31] p=0.03) were predictive of lower costs. For LSVA patients specifically, no osteoporosis (7.87 [2.47-25.09] p=<0.001), SRS activity >1.5 (6.76 [1.68-27.18] p=0.007), age <64 (4.37 [1.74-10.99] p=0.002), BL ODI <50 (2.83 [1.14-7.04] p=0.025), SRS total scores >2.38 (3.93 [1.54-10.18] p=0.004), frailty scores <0.37 (2.74 [1.07-6.99] p=0.035), and increasing invasiveness (1.01 [1.00-1.03] p=0.041) were predictive of lower costs. For MSVA patients, invasiveness <94.16 (9.82 [1.00-104.17] p=0.058), no cancer (16.00 [0.80-42.5] p=0.071), and frailty scores <0.3 (3.8 [0.48-30.42] p=0.21) trended towards lower costs. For HSVA, no history of smoking (4.50 [0.90-22.47] p=0.06) and BMI <27.8 (2.84 [0.94-8.60] p=0.06) trended towards lower costs.
CONCLUSION(S): For ASD patients, low frailty, no prior spine surgery, no depression, and higher baseline SRS activity scores were predictive of lower total surgery costs. When assessed by baseline deformity, decreased frailty and the lack of comorbidities and risk factors such as cancer, smoking, or high BMI, were associated with lower costs. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The efficacy of surgical intervention for central cord syndrome (CCS) is shown in the literature; however, it is unclear whether disparities in patient presentation and treatment exist between those who initially undergo operative treatment and those who delay operative treatment. PURPOSE: In a population of CCS patients, assess disparities in presentation and treatment between those undergoing immediate surgery and those who delay operative treatment. STUDY DESIGN/SETTING: Retrospective analysis of New York State Inpatient Database years 2004-2013. PATIENT SAMPLE: A total of 1,301 CCS patients (ICD-9 codes 952.03, 952.08, 952.13, 952.18). OUTCOME MEASURES: Time to surgery, length of stay (LOS).
METHOD(S): Patient-specific linkage codes allowed longitudinal tracking of inpatient stays within the study period. Demographics, comorbidities (Charlson Comorbidity Index [CCI]), complications, and surgical factors, including Mirza invasiveness score, were compared between CCS patients that initially underwent surgery (Initial) and patients that delayed operative treatment (Delayed) using Chi-squared tests and independent samples t-tests as appropriate. Similar tests assessed differences in demographics and comorbidity burden between nonoperative patients and surgical crossover patients.
RESULT(S): Included: 1,301 CCS patients (62+/-16 yrs, 27% female). Follow-up rate was 67.3%; mean follow-up time was 515+/-707 days. By level of CCS injury, 61.0% of patients were injured between C1 and C4, 59.2% between C5-C7, 1.0% between T1-T6, and 0.6% between T7-T12. Overall, 800 (61%) patients underwent surgical treatment (procedural breakdown: 80% fusion, 59% decompression, including 38% discectomy and 23% other decompression of the spinal canal). Of the surgical patients, 621 (78%) had surgery at first recorded hospital visit, while 179 (22%) experienced a delay before surgical treatment. For patients that delayed treatment, mean time to surgery was 203+/-358 days. Initial and Delayed patients did not differ in sex (p=0.109) or CCI (p=0.894), though Initial patients were younger than Delayed (60+/-15 yrs vs 63+/-13, p=0.016) and had lower rates of diabetes and valvular disease (both p<0.04). Initial patients underwent more invasive procedures than Delayed (5.1+/-2.6 vs 4.3+/-3.2, p=0.003), including higher rates of fusion (84% vs 71%, p<0.001), but not decompression: overall (59% vs 60%, p=0.816), discectomy (39% vs 35%, p=0.306), other canal decompression (22% vs 27%, p=0.175). LOS was longer for Initial patients (16+/-20 days vs 7+/-10, p<0.001), but complication rates did not differ (all p>0.05). Patients who delayed operative treatment did not differ from nonop patients in age (63+/-13 vs 63+/-17, p=0.802) or CCI (1.04+/-1.49 vs 1.06+/-1.49, p=0.923); however, Delayed patients had higher rates of diabetes (26% vs 18%, p=0.037), neurologic disorders (7% vs 1%, p<0.001), and valvular disease (6% vs 2%, p=0.026) than patients that remained nonoperative.
CONCLUSION(S): Although patients managed with initial surgical treatment of CCS had longer hospital stays and were treated with more invasive procedures, perioperative complications did not differ. Twenty-two percent of CCS patients crossed over from nonoperative to operative treatment, with a mean time to crossover of 203 days. Patients who crossed over to operative care were more comorbid than patients who remained nonoperative, indicating comorbidity burden may play a role in the decision to operate. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Lateral interbody fusion (LLIF) is often performed with biologic adjuvants to promote fusion. Commercially available bone allograft containing allogeneic stem cells (ASC) and bone morphogenetic protein-2 (BMP) are designed to promote fusion while avoiding the morbidity of iliac crest autograft; however, no study to date has directly compared the two in LLIF. The ASC studied is Osteocel Pro (NuVasive, Inc). PURPOSE: This non-industry funded study compares fusion rate, complications, and costs between LLIF with BMP and ASC. STUDY DESIGN/SETTING: Single center retrospective comparative study. PATIENT SAMPLE: Patients with 1-3 lumbar levels treated with LLIF. OUTCOME MEASURES: Outcomes measures are fusion at 1 year postoperative, complication rates, length of stay, and costs.
METHOD(S): A retrospective chart review was conducted to identify patients treated with LLIF and ASC or BMP from February 2012 through September 2017. Patients were included who had from 1-3 lumbar levels treated with LLIF and at least 1 year of radiographic follow up. Interbody fusion was assessed on lumbar X-ray images using a validated scale.
RESULT(S): A total of 94 patients were included representing 162 levels fused. Of these, 74 patients and 133 levels were treated with BMP; 20 patients and 29 levels were treated with ASC. Comparing patients treated with BMP or ASC, there were no differences in age [61.6 vs 60.4, p=0.7], BMI [29.8 vs 28.3, p=0.3], gender [60.8% vs 55.0% female], smoking status [12.2% vs 10.0%, p=1], diabetes [28.4% vs 15.0%, p=0.2], Charleston Comorbidity Index [4.3 vs 3.5, p=0.2], revision status [47.3% vs 45.0%, p=0.9], intraoperative complications [4.1% vs 5.0%, p=1], postoperative complications [37.8% vs 30.0%, p=0.5], or blood loss [881 vs 528ml, p=0.2]. More levels were fused in the BMP group (1.8 vs 1.45, p=0.04) and the BMP group tended toward a longer length of stay [4.8 vs 3.8 days, p=0.06]. There was a nonsignificant trend toward a higher fusion rate with BMP vs ASC[98.5% vs 93.1%, p=0.1]. The average amount of rhBMP used per level was 2.0 cc compared to 5.9 cc of ASC. There was no difference in the cost of the BMP per level compared with ASC [4.45% vs 4.80%, p=0.33], but the BMP group tended toward a higher cost of total care [103.5% vs 87.6%, p=0.1].
CONCLUSION(S): ASC and BMP are both acceptable adjuvants in LLIF that demonstrate comparable fusion rates at 1 year with comparable cost in the setting of similar groups of patients. The radiographic fusion rate seen in our study compares to previous reports in the literature using ASC. Cost considerations are becoming ever more cogent in spine surgery; the results of this study can inform decision making regarding which biologic adjuvant to use in lumbar interbody fusion. FDA DEVICE/DRUG STATUS: Osteocel (Approved for this indication), rhBMP (Infuse) (Not approved for this indication)
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BACKGROUND CONTEXT: The Adult Spinal Deformity Invasiveness Index incorporates deformity-specific components to assess the magnitude of correction. It's unknown how invasiveness relates to outcomes in each frailty state. PURPOSE: Investigate the relationship between increasing invasiveness and outcomes in ASD surgery in each frailty states. STUDY DESIGN/SETTING: Retrospective review of prospective, consecutively enrolled multicenter ASD database. PATIENT SAMPLE: A total of 195 ASD patients with baseline demographic and surgical details. OUTCOME MEASURES: Invasiveness, frailty, minimal clinically important differences (MCID) for the Oswestry Disability Index, SF-36 Physical Component Scores, and Scoliosis Research Society Scores.
METHOD(S): ASD patients (scoliosis >=20degree, SVA >=5cm, PT >=25degree, or TK >=60degree) with baseline frailty and invasiveness scores. Invasiveness index included; posterior: decompression (1), fusion (2), instrumentation (1), osteotomies: 3-coloumn (14), Ponte (1), interbody fusion; anterior lumbar (8), transforaminal/posterior lumbar (2), iliac fixation (2), revision surgery (3). Invasiveness scores were calculated within different frailty states (not frail, NF, <0.3), frail (F, 0.3-0.5), severely frail (SF, >0.5). Logistic regression analysis assessed the relationship between increasing invasiveness and major complications or reoperations and meeting MCID for any of the measured HRQLs at 3 years. Decision tree analysis assessed thresholds for an invasiveness risk benefit cutoff point, above which experiencing complications or reoperations and not reaching MCID were higher. Significance was set to p<0.05.
RESULT(S): One hundred ninety-five of 322 patients met inclusion criteria. Baseline demographic info: age 59.9 +/- 14.4, 75% female, BMI 27.8 +/- 6.2, CCI 1.7 +/- 1.7. Baseline surgical info: 61% osteotomy, 52% decompression, 11.0 +/- 4.1 levels fused. There were 98 NF, 65 F, and 30 SF patients. For the entire cohort, binary regression analysis found a significant relationship between increasing invasiveness and experiencing a major complication or reoperation (1.01 [1.00-1.02], p=0.01). Within each frailty subgroup, the results were 1.01 ([1.00-1.03], p=0.05) for NF, 1.01 ([1.01-1.02], p<0.001) for F, and 1.01 ([1.00-1.01], p=0.02) for SF. When defining no major complications or reoperation and meeting MCID in any HRQL at 3 years as a favorable outcome, decision tree analysis established an invasiveness risk benefit cutoff of 63.9. Patients below this threshold were 1.8 [1.38-2.35] (p<0.001) times more likely to not have a major complication/reoperation and meet MCID at 3 years. Invasiveness above this point was a negative predictor (0.55 [0.401-0.754], p<0.001). When factoring in frailty, for NF patients the risk benefit cutoff was 79.3 (2.11 [1.39-3.20] (p<0.001), 111 for F (2.62 [1.70-4.06] (p<0.001), and 53.3 for SF (2.35 [0.78-7.13] (p=0.13).
CONCLUSION(S): Increasing invasiveness is associated with increased odds of major complications and reoperations. A risk/benefit cutoff for decreasing major complications/reoperations and meeting MCID was found to be 79.3 for NF patients, 111 for F patients, and 53.3 for SF patients. Above these thresholds, increasing invasiveness is associated with increasing the risk of major complications or reoperations and not meeting MCID at 3 years. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Sexual function is an important contributor to quality of life. Adult spinal deformity (ASD) patients have been shown to have sexual limitations due to their deformity. PURPOSE: This investigation sought to assess sexual dysfunction due to lumbar stiffness before and after fusion surgery. STUDY DESIGN/SETTING: Retrospective analysis of a multi-center, prospectively-collected, consecutive cohort of ASD patients. PATIENT SAMPLE: Only patients with 2-year follow-up were included. In total, 365 patients were included in this study, comprising 76 males and 289 females. OUTCOME MEASURES: The primary outcome in this study was the Lumbar Spine Disability Index (LSDI) question 10: "Choose the statement that best describes the effect of low back stiffness on your ability to engage in sexual intercourse." METHODS: Differences in sexual function between baseline and 2-year follow-up were assessed with a Wilcoxon-Mann-Whitney test. Patient factors associated with poor baseline sexual function were evaluated with multiple linear regression. The association between sexual function and HRQOL at baseline and 2-year follow-up was evaluated with multiple linear regression, adjusting for all factors previously included in analyses of baseline sexual function.
RESULT(S): Baseline LSDI sexual function scores averaged 2.7 (SD 1.3), which improved to 2.3 (SD 1.2) at 2-year postsurgical follow-up (p = 0.0009). Predictors of poorer baseline sexual function included older age, BMI, and higher Charlson Comorbidity Index (p<0.05 for all comparisons). After adjusting for confounding factors, worse LSDI sexual function score was strongly associated with worse ODI, SRS total, and SF-36 PCS at both baseline and 2-year follow-up (p<0.001 for all comparisons).
CONCLUSION(S): This study found that sexual dysfunction due to lumbar stiffness is strongly related to HRQOL measures such as ODI and SRS-22r total score. Further, sexual function was not diminished postoperatively, possibly due to reduced pain that accompanied improved stability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Often patients with cervical deformity (CD) require extensive fusions that extend into the thoracic spine. However, factors that influence the treatment approach and level selection are poorly understood. PURPOSE: To examine if there are significant differences between patients with CD who have a lowest instrumented vertebrae (LIV) to the upper thoracic (UT) vs the midthoracic (MT) spine. STUDY DESIGN/SETTING: Comparative cohort study. PATIENT SAMPLE: Prospective adult cervical deformity database. OUTCOME MEASURES: NDI, mJOA, SWAL-QOL.
METHOD(S): A prospective CD database was analyzed for the following inclusion criteria: LIV between C7-T5 and a UIV of C2, and 1 yr min follow-up (f/u). Patient demographics, operative details, radiographic parameters and clinical outcomes were compared between those with a LIV from C7-T2 (UT) vs T3-T5 (MT). X2 and independent samples T-Tests were performed for statistical analysis RESULTS: A total of 64 patients met inclusion criteria for the study and 46 were included in the analysis (avg. age 62, 58% female, avg 1yr f/u) with 22 in UT vs 24 in the MT groups. No differences were seen in age or revision case prevalence, EBL, operative time or surgical approach (anterior, posterior, combined) types between groups. MT patients had a higher pre-op cSVA, TS-CL, Max Kyphosis and T9PA and were treated with a larger number of PSOs (p<0.01). There was a larger correction in Cervical Lordosis (CL) seen in the MT group (29 vs 17, p=0.04) and larger changes in T4-T12 (9.6 vs 0.0, p<0.01). No differences were seen in DJK (p=0.22) or rates of revision surgery (5% vs 21%, p=0.19,

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: Osteoporosis (OP) is a common condition affecting nearly 200 million individuals globally. Similarly, adult spinal deformity has a peak prevalence of 65% of the adult population. While bone health is instrumental in orthopaedic surgery, few studies have described the long-term outcomes of osteoporosis following surgery for ASD. PURPOSE: We sought to evaluate the impact of OP on two-year postoperative complication rates when compared to patients without OP. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: Utilizing the New York State Statewide Planning and Research Cooperative System (SPARCS), we identified all patients who underwent >=4-level fusion with ICD-9 codes diagnostic for ASD (progressive idiopathic scoliosis and degenerative lumbar disease) from 2009-2011 with >=2-year follow-up. Patients with osteoporosis (OP) and without OR were identified following exclusions. OUTCOME MEASURES: Patient demographics, hospital-related parameters, postoperative complications and reoperations.
METHOD(S): Using SPARCS, we identified all patients who underwent >=4-level fusion with ICD-9 codes diagnostic for ASD (progressive idiopathic scoliosis and degenerative lumbar disease) from 2009-2011 for >=2-year minimum follow-up. Patients with osteoporosis (OP) and without OP were identified. Any patients with bone mineralization disorders (osteomalacia, rickets, hyperparathyroidism [primary, secondary, tertiary], vitamin D deficiency) and other systemic (fibrous dysplasia, sickle cell disease, renal osteodystrophy) and endocrine disorders (thyroid hypo- or hyperfunctioning disorders, adrenal insufficiency, adrenal hyperplastic syndromes) affecting bone quality or production were excluded, as were patients with surgical indications of trauma, systemic disease, infection, or cancer. The two cohorts were compared for demographics, hospital-related parameters, and 2-year postoperative complications and reoperations. Multivariate binary stepwise logistic regressions was utilized to identify significant predictors of these outcomes (covariates: OP, age, sex, race, and Charlson/Deyo).
RESULT(S): A total of 6,132 patients were identified (OP, n=490 (7.99%); No-OP, n=5,642). OP patients were older (67.6 vs 56.7 years), more often female (83.7% vs 46.2%) and white (84.3% vs 79.1%), and had higher comorbidity scores (Charlson/Deyo: 0.72 vs 0.61), all p<0.05. Patients with OP incurred higher hospital charges ($122,801 vs $108,649) and length of stay (6.7 days vs 5.8 days), both p<0.001. OP patients had higher rates of postop wound complications (13.5% vs 10.6%), acute renal failure (12.2% vs 7.90%), pseudarthrosis (3.7% vs 1.4%), blood transfusions (54.3% vs 34.6%), pneumonia (10.4% vs 6.1%), and implant-related complications (22.4% vs 14.5%); all p<=0.047. Patients in OP and no-OP cohorts experienced similar rates of postop PE, DVT, acute myocardial infarction, pneumonia, UTIs, dural tears, and CNS complications. Regression revealed that while controlling for demographics and comorbidities, OP is independently associated with increased odds of 2-year medical complications (OR=1.46), surgical complications (OR=1.55), and reoperations (OR=1.46); all p<=0.024.
CONCLUSION(S): Osteoporosis was associated with two-year postoperative complications in ASD patients. Aside from being an etiology of ASD due to vertebral fracture, osteoporosis should be considered as a comorbidity that needs to be optimized and managed perioperatively. Furthermore, this data is a call to every spine surgeon to consider metabolic bone disorders screening prior to any spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Cervical deformity (CD) correction is becoming more challenging and complex. Understanding the factors that drive optimal outcomes has been understudied in CD corrective surgery. PURPOSE: To weight baseline factors on impact upon outcomes following CD surgery. STUDY DESIGN/SETTING: Retrospective review of a single-center database. PATIENT SAMPLE: A total of 61 cervical patients. OUTCOME MEASURES: Two outcomes were measured: 'improved outcome'(IO):(1) radiographic improvement: 'non-deformed' Schwab PT/SVA, Ames cSVA/TS-CL, (2) clinical: MCID EQ5D, NDI, or improve in mJOA modifier, (3) complications/reop: no reop or major complications; 'poor outcome'(PO):(1) radiographic deterioration: 'moderate' or 'severely' deformed Schwab SVA/PT, Ames cSVA/TS-CL, (2) clinical: not meeting MCID EQ5D, NDI worsening in mJOA modifier; (3) complications/reop: reoperation or complications.
METHOD(S): CD patients included: full baseline (BL) and 1-year (1Y) radiographic measures and HRQLs. Reoperation for infection excluded. Patients were categorized by IO, PO or not. Random forest assessed ratios of predictors for IO and PO. Categorical regression models predicted how BL regional deformity (Ames cSVA, TS-CL, horizontal gaze), BL global deformity (Schwab PI-LL, SVA, PT), regional/global change (BL to 1Y), BL disability (mJOA score) and BL pain/function impact outcomes.
RESULT(S): A total of 61 patients were included (55.8yrs, 54.1% F). Surgical approach: 18.3% anterior, 51.7% posterior, 30% combined. Avg levels fused: 7.7. Mean operative time: 823min, EBL:1037ccs. At 1Y, 24.6% had an IO, 9.8% PO. Random forest analysis showed the top 5 individual factors associated with an IO: BL Maximum Kyphosis, Maximum Lordosis, C0-C2, L4 Pelvic Angle, and NSR Back Pain (80% radiographic, 20% clinical). Categorical IO regression model (R2=0.328,p=0.007): low BL regional deformity (beta=-0.082), low BL global deformity (beta=-0.099), global improve (beta=0.532), regional improve (beta=0.230), low BL disability (beta=0.100), low BL NDI (beta=0.024). Random forest demonstrated of the top 5 individual baseline factors associated with PO, 80% were radiographic: BL CL Apex, DJK angle, cervical lordosis, T1 slope and NSC Neck Pain. Categorical PO regression model (R2=0.306,p=0.012): high BL regional deformity (beta=-0.108), high BL global deformity (beta=-0.255), global decline (beta=0.272), regional decline (beta=0.443), baseline disability (beta=-0.164), BL severe NDI (>69)(beta=0.181).
CONCLUSION(S): Categorical weight demonstrated radiographic as the strongest predictor of both improved (global alignment) and poor outcome (regional deformity/deterioration). Radiographic factors carry the most weight in determining an improved or poor outcome, and can be ultimately utilized in preoperative planning and surgical decision-making in order to optimize outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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