PMID- 30122396 OWN - NLM STAT- MEDLINE DCOM- 20190128 LR - 20200109 IS - 2212-1358 (Electronic) IS - 2212-134X (Linking) VI - 6 IP - 5 DP - 2018 Sep-Oct TI - Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients. PG - 593-599 LID - S2212-134X(18)30028-5 [pii] LID - 10.1016/j.jspd.2018.02.010 [doi] AB - STUDY DESIGN: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. OBJECTIVE: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. SUMMARY OF BACKGROUND DATA: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. METHODS: ASD patients >/=18 years and baseline ODI >/= 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. RESULTS: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0%, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. CONCLUSIONS: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. LEVEL OF EVIDENCE: Level II. CI - Copyright (c) 2018 Scoliosis Research Society. Published by Elsevier Inc. All rights reserved. FAU - Scheer, Justin K AU - Scheer JK AD - Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood St., Chicago, IL 60612, USA. Electronic address: jscheer@uic.edu. FAU - Osorio, Joseph A AU - Osorio JA AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Health System, 1215 Lee St., Charlottesville, VA 22903, USA. FAU - Schwab, Frank AU - Schwab F AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Hart, Robert A AU - Hart RA AD - Department of Orthopaedic Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA. FAU - Hostin, Richard AU - Hostin R AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd #800, Plano, TX 75093, USA. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Jain, Amit AU - Jain A AD - Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD 21218, USA. FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA. FAU - Bess, Shay AU - Bess S AD - Denver International Spine Clinic, Presbyterian St. Luke's Medical Center, 1719 E 19th Ave., Denver, CO 80218, USA. FAU - Ailon, Tamir AU - Ailon T AD - University of British Columbia, 2329 West Mall, Vancouver, BC, Canada V6T 1Z4. FAU - Protopsaltis, Themistocles S AU - Protopsaltis TS AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Klineberg, Eric O AU - Klineberg EO AD - Department of Orthopaedic Surgery, University of California, 1 Shields Ave., Davis, CA 95616, USA. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Department of Neurosurgery, University of Virginia Health System, 1215 Lee St., Charlottesville, VA 22903, USA. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA. CN - International Spine Study Group LA - eng PT - Journal Article PT - Multicenter Study PL - England TA - Spine Deform JT - Spine deformity JID - 101603979 SB - IM MH - Aged MH - Decision Trees MH - Female MH - Humans MH - Male MH - Middle Aged MH - Minimal Clinically Important Difference MH - Models, Theoretical MH - Preoperative Period MH - Prospective Studies MH - Quality of Life/*psychology MH - Retrospective Studies MH - Spinal Curvatures/psychology/*surgery OTO - NOTNLM OT - Adult spinal deformity OT - Minimum clinically important difference OT - Oswestry Disability Index OT - Predictive modeling OT - Scoliosis EDAT- 2018/08/21 06:00 MHDA- 2019/01/29 06:00 CRDT- 2018/08/21 06:00 PHST- 2017/10/21 00:00 [received] PHST- 2018/02/10 00:00 [revised] PHST- 2018/02/16 00:00 [accepted] PHST- 2018/08/21 06:00 [entrez] PHST- 2018/08/21 06:00 [pubmed] PHST- 2019/01/29 06:00 [medline] AID - S2212-134X(18)30028-5 [pii] AID - 10.1016/j.jspd.2018.02.010 [doi] PST - ppublish SO - Spine Deform. 2018 Sep-Oct;6(5):593-599. doi: 10.1016/j.jspd.2018.02.010.