Faculty Bibliography

BACKGROUND CONTEXT: Despite increased recognition of the clinical benefit of optimal sagittal realignment among symptomatic ASD patients, persistent malalignment remains prevalent following corrective surgery. Following surgery it remains difficult to predict the changes in truncal inclination and pelvic retroversion depending on segmental and regional correction of the lumbar spine. PURPOSE: Establish simultaneous focal and regional corrective guidelines accounting for reciprocal global and pelvic compensation STUDY DESIGN/SETTING: Retrospective review of a prospective database PATIENT SAMPLE: A total of 433 Surgical Adult Spinal Deformity (ASD) patients with 2-year follow-up. OUTCOME MEASURES: Prediction of postoperative sagittal alignment (PT, SVA and TPA).
METHOD(S): Patients were included based on the presence of radiographic ASD and having undergone corrective realignment at minimum incorporating L1-pelvis. Established sagittal radiographic parameters, as well as segmental and regional (T10-L1, L1-L4, and L4-S1) Cobb angles were assessed prior to and following surgery. To distinguish the impact of the realignment on pelvic versus truncal inclination a virtual postoperative alignment was generated by combining postoperative alignment of the fused spine with the preoperative alignment on the unfused thoracic kyphosis and the preoperative pelvic retroversion. Incorporating virtual alignment, regression models were then generated to predict the relative impact of segmental (L4-L5) and regional (L1-L4) corrections on PT, SVA (virtual), and TPA.
RESULT(S): A total of 433/667 patients were included (mean age 62.9 years, 81.3% women). Following surgical intervention significant improvement of sagittal alignment occurred; PI-LL (21degree to 4degree), PT (26degree to 23degree), SVA (79mm to 33mm) and TPA (26degree to 19degree)(all p<0.001). Regarding segmental and regional alignment, baseline analysis revealed a distal lordosis of 33+/-15degree, a flat proximal lordosis (1.7+/-17degree), and segmental kyphosis from L2-L3 to T10-T11. Following surgery, there was no mean change in distal lordosis (L5-S1 decreased by 2degree, and L4-L5 increased by 2degree), while the more proximal lordosis increased by 18+/-16degree. Regression analysis based on the virtual alignment yielded the following equations: PT = 2.42 - 0.46*L4S1 - 0.35*L1L4 - 0.23*T10L1 (r-square = 0.65, mean error -0.2degree, RMSE 5.5degree)TPA = -0.75*L4S1 - 0.55*L1L4 - 0.36*T10L1 (r-square = 0. 95, mean error: -0.3degree, RMSE 4.3degree)SVA = -8*L4S1 -6.14*L1L4 - 4*T10L1 (r-square = 0. 95, mean error: -2.6mm RMSE 50mm). Summarily, a 10degree in distal lordosis resulted in a 10degree in TPA, associated with 100mm in SVA or 3degree in PT; 10degree in proximal lordosis yields 5degree in TPA associated with 50mm in SVA; and finally 10degree in thoraco-lumbar junction yields 2.5degree in TPA associated with 25mm in SVA and no impact on PT correction.
CONCLUSION(S): This study establishes that the overall impact of lumbar lordosis restoration is critically determined by the location of the correction. For any given amount of lordosis correction, a distal correction leads to a greater impact on global alignment and pelvic retroversion. More specifically, it can be assumed that 1degree L4-S1 correction implies 1degree change in TPA / 10mm change in SVA and 0.5degree in PT. Based on regional objectives (PI-LL) and global perspectives (TPA/SVA and PT), preoperative planning can be adjusted to optimize realignment. 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: Choosing the surgical approach and osteotomy type is challenging when surgically treating cervical deformity. Preoperative assessment of flexibility and final alignment would be useful for surgeons treating this complex problem. Currently extension lateral XR are inconstantly taken for the management of cervical deformity for planning purposes. PURPOSE: Investigate the relationship of surgical procedure choice and the pre-operative flexibility of the cervical spine. Determine if extension lateral XR (ELXR) can also predict the final postoperative alignment. STUDY DESIGN/SETTING: Retrospective review of prospective, consecutively enrolled multicenter cervical deformity database PATIENT SAMPLE: A total of 106 cervical deformity patients OUTCOME MEASURES: Surgical treatment, radiographic alignment parameters (SS, T1S-CL, cSVA, C2 slope, T1 slope) METHODS: A prospective database of operative cervical deformity patients was analyzed. Inclusion was cervical kyphosis>10degree, cervical scoliosis>10degree, C2-C7 SVA>4cm or chin-brow vertical angle>25degree. Patients were excluded if they did not have neutral and ELXR or did not have deformity limited to the cervical or cervicothoracic spine. The ELXR was compared to preoperative neutral lateral, and 3 mo alignment XR and type of surgical osteotomy based upon the Ames Classification. Statistical analysis included t-test and chi-squared.
RESULT(S): A total of 106 from 164 patients met the inclusion criteria. Mean age of 60 yo, with 58% females. Of the study population, 43.4% of patients had prior cervical surgery. The evaluation of ELXR in patients who received grade 1-2 osteotomies (as compared to those who received grade 5,6 or 7), shows they have statistically lower T1S (23.06 vs 35.46; p=.021), lower T1S-CL (20.90 vs 36.29; p=.033), lower cSVA (24.66 vs 48.35; p<.001) and lower C2Slope (18.69 vs 37.46; p=.008). Subsequent analysis revealed the anterior approach chosen over the post approach when, in extension, patients achieved more normal radiographic alignment T1S (21.17 vs 31.59; p=.018), lower cSVA (11.18 vs 36.44; p<.001), lower T1S-CL (13.68 vs 28.13; p=.014) and lower C2 slope (8.49 vs 28.28; p<.001). Patients were more likely to have a post approach when they had larger than normativeT1S-CL>17 in the ELXR (46.77% vs 36.36%; p=.033). Overall, while surgery created a significant change in all radiographic parameters; the 3 month lateral XR and baseline ELXR were statistically similar for T1S-CL (26.04 vs 24.83; p=.542) and C2Slope (23.27 vs 22.87; p=.839).
CONCLUSION(S): Preoperative ELXR had a significant association with surgical approach and grade of osteotomy. The ELXR was statistically similar to the post-operative 3-month lateral XR and should be used to predict final cervical alignment. Obtaining ELXR is a critical alignment tool, and should be obtained as a part of the preoperative surgical plan. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a comprehensive self-report measurement tool with patient functions, symptoms, behaviors, and mental health outcomes. Little work has been done correlating PROMIS physical health domain metrics with established adult spinal deformity (ASD) classifications such as SRS-Schwab. PURPOSE: To correlate sagittal alignment components via the SRS-Schwab classification system with established PROMIS domains in a cohort of ASD patients. STUDY DESIGN/SETTING: Retrospective review of a single-center stereoradiographic database. PATIENT SAMPLE: A total of 41 ASD patients with complete baseline radiographic and PROMIS data. OUTCOME MEASURES: PROMIS physical health domain metrics (Pain Intensity [PI], Physical Function [PF], Pain Interference [Interference]), SRS-Schwab modifiers (SVA, PI-LL, PT) METHODS: Surgical ASD patients (SVA>=5cm, PT>=25degree or TK >=60degree) >=18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the single-center comprehensive Spine Quality Database (Quality). Patients were classified according to SRS-Schwab deformity modifiers(0,+,++) for SVA, PI-LL and PT. Descriptives and univariate analyses compared population-weighted PROMIS scores for PI, PF and Interference across ASD deformity modifiers. Conditional Tree Analysis (CTA) with logistic regression sampling established cut-off points for PROMIS scores predicting severe malalignment (++) at BL compared to mild or moderate (0,+).
RESULT(S): A total of 41 patients (58.95 yrs,75.6%F,29.1kg/m2) met inclusion criteria. BL SRS modifiers were as follows: SVA 51.2%, 2.4%, 46.3% (0,+,++); PI-LL 27.3%, 12.1%, 60.6%(0,+,++); PT 18.2%, 36.4%, 45.5% (0,+,++). Mean cohort PI score was 94.2+/-6.0, mean PF score 8.95+/-10.1, mean Inter score 57.84+/-5.46. PF and Interference differed significantly across low and high SVA groups, with low SVA having significantly higher PF (13.50 vs 3.68,p<0.001) and lower Inter (59.62 vs 56.30, p=0.05). PI did not differ across SVA groups (p>0.05). Low PI-LL pts had significantly higher PF than pts with ++PI-LL (19.3 vs 4.15,p=0.001) and trended lower PI and Inter without significance. No significant differences in PI, PF or Inter were found across PT groups (all p>0.05). CTA found a PI score>98 or PF score <6 were independent predictors of Severe (++) SVA as opposed to Mild/Moderate SVA. For example, a PF score<6 increased odds of ++SVA by at least 2.7x compared to 0/+SVA. Similarly, significant thresholds for PI (>98) and PF (<8) scores were found for ++PI-LL, but not ++PT (p>0.05). Pain Interference did not predict SRS metrics to a significant degree (all p>0.05).
CONCLUSION(S): Inferior PROMIS scores of pain intensity and physical function predicted increasingly severe SRS sagittal modifiers at baseline, specifically severe sagittal vertical axis and lumbopelvic mismatch. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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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.
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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.
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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: Risk factors have been identified for complications following adult spinal deformity (ASD) surgery; however, the risk of complications following ASD surgery in relation to the degree of surgical invasiveness is unknown. Understanding the relationship between surgical invasiveness and risk of major complications is important to patients and surgeons for estimating these risks based upon the planned surgical treatment. PURPOSE: To define a surgical invasiveness threshold that predicts increased likelihood of major complications following surgical treatment of ASD. STUDY DESIGN/SETTING: Retrospective review of a prospective multicenter database PATIENT SAMPLE: Five hundred seventy-four of 760 (76%) eligible ASD patients (>5 levels fused) were identified in a multicenter database with complete 2-year follow-up OUTCOME MEASURES: Our primary outcome was development of a major complication at any time point in the postoperative period METHODS: Surgical invasiveness was calculated according to the previously published and validated ASD Surgical and Radiographic (ASD-SR) score, which assigns point values to 13 operative and radiographic factors. Youden's index was used to identify the highest predicted probability cut-off of developing a major complication to be an ASD-SR of 90. Using this value, patients were divided into quartiles (Q1: ASD-SR 0-65; Q2: ASD-SR 66-89; Q3: ASD-SR 90-119; Q4: ASD-SR 120+). Odds of developing a major complication were analyzed after controlling for baseline frailty and radiographic deformity.
RESULT(S): Mean age of patients was 59 +/- 14 years, 79% females. Mean levels fused were 11.2 +/- 4.3. The overall risk of a major complication was 17% in Q1, 21% in Q2, 35% in Q3 and 33% in Q4 (p<0.001). Comparing the odds of a major complication by adjacent quartiles demonstrated a significant increase between Q2 and Q3 (OR 1.8, 95% CI 1.03, 2.98), while the risk of increasing invasiveness from Q1 to Q2, and Q3 to Q4 were not significant (p<0.05). Similarly, patients above an ASD-SR cutoff point of 90 (Q3/Q4) were 1.9 times more likely to have a major complication than patients with a surgical invasiveness below this threshold (Q1/Q2) (OR 1.9, 95% CI 1.3 - 2.9). There were no significant differences in the odds of having a minor complication or inpatient medical complication between invasiveness groups (all p>0.05). The mean ASD-SR scores above and below the ASD-SR threshold of 90 were 120.7 +/- 25.4 and 63.4 +/- 16.8, respectively. Example of a patient with an ASD-SR of 63 (low invasiveness): T11-Pelvis, 6 Smith-Peterson Osteotomies, -.9cm change in SVA, +1degree change in TK, + 43degree change in PT. Example of a patient with an ASD-SR of 121 (high invasiveness): T8-Pelvis, 3-column osteotomy, -2.3cm change in SVA, -5degree change in TK, +38degree change in PT.
CONCLUSION(S): ASD patients have an increased risk of major complications above an ASD-SR score of 90, while the risk of minor complications and inpatient medical complications is not significantly increased. The ASD-SR score can be used as a tool to counsel patients regarding these increased risks. 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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