PMID- 30069521 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20220318 IS - 2414-469X (Print) IS - 2414-4630 (Electronic) IS - 2414-4630 (Linking) VI - 4 IP - 2 DP - 2018 Jun TI - Evaluating cervical deformity corrective surgery outcomes at 1-year using current patient-derived and functional measures: are they adequate? PG - 295-303 LID - 10.21037/jss.2018.05.29 [doi] AB - BACKGROUND: Current health-related quality of life (HRQL) metrics used to assess patient outcomes following surgical correction of cervical deformity (CD) are not deformity-specific and thus cannot capture all aspects of a patient's deformity and outcomes. The purpose of this study is to evaluate the sensitivity of different HRQL outcome measures in assessing CD patients' outcomes 1-year post-operatively. METHODS: Retrospective review of prospective multi-center database. Inclusion criteria: CD patients >/=18 yrs with pre- and 1-year post-operative radiographs and HRQLs [modified Japanese Orthopaedic Association (mJOA), EuroQol five-dimensions (EQ-5D), neck disability index (NDI)]. Associations between changes in EQ5D and NDI with improvement at 1-year in mJOA scores were assessed by whether or not the patient met the minimum clinically important difference (MCID) as well as whether or not they improved by one or more categories (i.e., change from moderate to mild). Odds ratios reported with 95% confidence intervals. RESULTS: Sixty-three CD patients were included (mean 62 y, 55.6% F). Average baseline NDI scores were 46.75, mJOA was 13.68, and EQ-5D 0.74. Overall baseline myelopathy breakdown: none-9.5%, mild-30.2%, moderate-42.9%, high-17.5%. At 1-year, 46% of patients improved in mJOA, 71.4% NDI, and 65.1% EQ-5D. 19% of patients met mJOA MCID, 44.4% NDI MCID, 19% EQ-5D MCID. One-point improvement in NDI increased the odds of mJOA improvement and reaching mJOA MCID (improvement: OR, 1.06, CI: 1.01-1.10, P=0.01; MCID: OR, 1.06, CI: 1.02-1.11, P=0.006). Improvement in EQ-5D by 0.1 increased the odds of improving in mJOA and reaching mJOA MCID at 1-year (improvement: OR, 3.85, CI: 1.51-9.76, P=0.005; MCID: OR, 3.88, CI: 1.52-9.88, P=0.005). While correlations exist between outcome measures, when modeling these outcomes while controlling for confounders including cSVA change, surgical invasiveness, age and CCI, these HRQLs were not strongly correlated. CONCLUSIONS: Improvements in functional outcomes, as defined by mJOA score, were correlated with changes in neck based disability and general health state, defined by NDI and EQ-5D respectively. In an adjusted model, however, these direct relationships were not maintained. A CD-specific HRQL might be more useful for surgeons in assessing patient outcomes using a single metric. FAU - Passias, Peter G AU - Passias PG AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Horn, Samantha R AU - Horn SR AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Oh, Cheongeun AU - Oh C AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Ramchandran, Subaraman AU - Ramchandran S AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedics, University of Kansas Medical Center, Kansas City, KS, USA. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA. FAU - Lafage, Renaud AU - Lafage R AD - Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA. FAU - Poorman, Gregory W AU - Poorman GW AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Steinmetz, Leah AU - Steinmetz L AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Segreto, Frank A AU - Segreto FA AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Bortz, Cole A AU - Bortz CA AD - Department of Orthopaedics, NYU Langone Orthopedic Hospital, New York, NY, USA. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. FAU - Ames, Christopher AU - Ames C AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Department of Orthopaedics, University of Virginia, Charlottesville, VA, USA. FAU - Kim, Han Jo AU - Kim HJ AD - Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA. FAU - Soroceanu, Alexandra AU - Soroceanu A AD - Department of Orthopaedics, University of Calgary, Alberta, Canada. FAU - Klineberg, Eric O AU - Klineberg EO AD - Department of Orthopaedic Surgery, University of California, Davis, Sacramento, CA, USA. CN - International Spine Study Group (ISSG) LA - eng PT - Journal Article PL - China TA - J Spine Surg JT - Journal of spine surgery (Hong Kong) JID - 101685460 PMC - PMC6046308 OTO - NOTNLM OT - Cervical deformity (CD) OT - alignment OT - cervical spine OT - health-related quality of life metrics (HRQL metrics) OT - myelopathy OT - outcomes OT - sagittal malalignment OT - spinal deformity OT - spino-pelvic alignment OT - surgical correction COIS- Conflicts of Interest: The authors have no conflicts of interest to declare. EDAT- 2018/08/03 06:00 MHDA- 2018/08/03 06:01 PMCR- 2018/06/01 CRDT- 2018/08/03 06:00 PHST- 2018/08/03 06:00 [entrez] PHST- 2018/08/03 06:00 [pubmed] PHST- 2018/08/03 06:01 [medline] PHST- 2018/06/01 00:00 [pmc-release] AID - jss-04-02-295 [pii] AID - 10.21037/jss.2018.05.29 [doi] PST - ppublish SO - J Spine Surg. 2018 Jun;4(2):295-303. doi: 10.21037/jss.2018.05.29.