PMID- 30930292 OWN - NLM STAT- MEDLINE DCOM- 20200413 LR - 20200413 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 19 IP - 8 DP - 2019 Aug TI - Recovery kinetics following spinal deformity correction: a comparison of isolated cervical, thoracolumbar, and combined deformity morphometries. PG - 1422-1433 LID - S1529-9430(19)30116-0 [pii] LID - 10.1016/j.spinee.2019.03.006 [doi] AB - BACKGROUND CONTEXT: The postoperative recovery patterns of cervical deformity patients, thoracolumbar deformity patients, and patients with combined cervical and thoracolumbar deformities, all relative to one another, is not well understood. Clear objective benchmarks are needed to quantitatively define a "good" versus a "bad" postoperative recovery across multiple follow-up visits, varying deformity types, and guide expectations. PURPOSE: To objectively define and compare the complete 2-year postoperative recovery process among operative cervical only, thoracolumbar only, and combined deformity patients using area-under-the-curve (AUC) methodology. STUDY DESIGN/SETTING: Retrospective review of 2 prospective, multicenter adult cervical and spinal deformity databases. PATIENT SAMPLE: One hundred seventy spinal deformity patients. OUTCOME MEASURES: Common health-related quality of life (HRQOL) assessments across both databases included the EuroQol 5-Dimension Questionnaire and Numeric Rating Scale (NRS) back pain assessment. In order to compare disability improvements, the Neck Disability Index (NDI) and the Oswestry Disability Index (ODI) were merged into one outcome variable, the ODI-NDI. Both assessments are gauged on the same scale, with minimal question deviation. Sagittal Radiographic Alignment was also assessed at pre- and all postoperative time points. METHODS: Operative deformity patients >18 years old with baseline (BL) to 2-year HRQOLs were included. Patients were stratified by cervical only (C), thoracolumbar only (T), and combined deformities (CT). HRQOL and radiographic outcomes were compared within and between deformity groups. AUC normalization generated normalized HRQOL scores at BL and all follow-up intervals (6 weeks, 3 months, 1 year, and 2 year). Normalized scores were plotted against follow-up time interval. AUC was calculated for each follow-up interval, and total area was divided by cumulative follow-up length, determining overall, time-adjusted HRQOL recovery (Integrated Health State, IHS). Multiple linear regression models determined significant predictors of HRQOL discrepancies among deformity groups. RESULTS: One hundred seventy patients were included (27 C, 27 T, and 116 CT). Age, BMI, sex, smoking status, osteoporosis, depression, and BL HRQOL scores were similar among groups (p >. 05). T and CT patients had higher comorbidity severities (CCI: C 0.696, T 1.815, CT 1.699, p = .020). Posterior surgical approaches were most common (62.9%) followed by combined (28.8%) and anterior (6.5%). Standard HRQOL analysis found no significant differences among groups until 1-year follow-up, where C patients exhibited comparatively greater NRS back pain (4.88 vs. 3.65 vs. 3.28, p = .028). NRS Back pain differences between groups subsided by 2-years (p>.05). Despite C patients exhibiting significantly faster ODI-NDI minimal clinically important difference (MCID) achievement (33.3% vs. 0% vs. 23.0%, p < .001), all deformity groups exhibited similar ODI-NDI MCID achievement by 2-years (51.9% vs. 59.3% vs. 62.9%, p = 0.563). After HRQOL normalization, similar results were observed relative to the standard analysis (1-year NRS Back: C 1.17 vs. T 0.50 vs. CT 0.51, p < .001; 2-year NRS Back: 1.20 vs. 0.51 vs. 0.69, p = .060). C patients exhibited a worse NRS back normalized IHS (C 1.18 vs. T 0.58 vs. CT 0.63, p = .004), indicating C patients were in a greater state of postoperative back pain for a longer amount of time. Linear regression models determined postoperative distal junctional kyphosis (adjusted beta: 0.207, p = .039) and osteoporosis (adjusted beta: 0.269, p = .007) as the strongest predictors of a poor NRS back IHS (model summary: R(2) = 0.177, p = .039). CONCLUSIONS: Despite C patients exhibiting a quicker rate of MCID disability (ODI-NDI) improvement, they exhibited a poorer overall recovery of back pain with worse NRS back scores compared with BL status and other deformity groups. Postoperative distal junctional kyphosis and osteoporosis were identified as primary drivers of a poor postoperative NRS back IHS. Utilization of the IHS, a single number adjusting for all postoperative HRQOL visits, in conjunction with predictive modelling may pose as an improved method of gauging the effect of surgical details and complications on a patient's entire recovery process. CI - Copyright (c) 2019. Published by Elsevier Inc. FAU - Passias, Peter G AU - Passias PG AD - Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA. Electronic address: Peter.Passias@nyumc.org. FAU - Segreto, Frank A AU - Segreto FA AD - Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA. FAU - Lafage, Renaud AU - Lafage R AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. FAU - Line, Breton G AU - Line BG AD - Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA. FAU - Scheer, Justin K AU - Scheer JK AD - Department of Neurosurgery, University of Illinois at Chicago, Chicago, IL, USA. FAU - Mundis, Gregory M AU - Mundis GM AD - Department of Orthopaedics, San Diego Center for Spinal Disorders, La Jolla, CA, USA. FAU - Hamilton, D Kojo AU - Hamilton DK AD - Department of Neurosurgery, University of Pittsburgh, Pittsburgh, PA, USA. FAU - Kim, Han Jo AU - Kim HJ AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Horn, Samantha R AU - Horn SR AD - Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA. FAU - Bortz, Cole A AU - Bortz CA AD - Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA. FAU - Diebo, Bassel G AU - Diebo BG AD - Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, USA. FAU - Vira, Shaleen AU - Vira S AD - Department of Orthopaedics, New York Spine Institute, NYU Medical Center-Orthopaedic Hospital, New York, NY, USA. FAU - Gupta, Munish C AU - Gupta MC AD - Department of Orthopaedic Surgery, Washington University, St. Louis, MO, USA. FAU - Klineberg, Eric O AU - Klineberg EO AD - Department of Orthopaedic Surgery, University of California, Davis, Davis, CA, USA. FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS, USA. FAU - Hart, Robert A AU - Hart RA AD - Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, WA, USA. FAU - Schwab, Frank J AU - Schwab FJ AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA. FAU - Bess, Shay AU - Bess S AD - Department of Orthopaedic Surgery, Denver International Spine Center, Denver, CO, USA. CN - International Spine Study Group LA - eng PT - Journal Article PT - Multicenter Study DEP - 20190328 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Adolescent MH - Adult MH - Aged MH - Female MH - Humans MH - Kyphosis/classification/pathology/*surgery MH - Male MH - Middle Aged MH - Neurosurgical Procedures/*adverse effects/statistics & numerical data MH - Postoperative Complications/*epidemiology MH - Spine/pathology/surgery MH - Surveys and Questionnaires OTO - NOTNLM OT - Adult spine deformity OT - Cervical deformity OT - Distal junctional kyphosis OT - HRQOL OT - Proximal junctional kyphosis OT - Recovery kinetics EDAT- 2019/04/02 06:00 MHDA- 2020/04/14 06:00 CRDT- 2019/04/02 06:00 PHST- 2018/05/03 00:00 [received] PHST- 2019/03/19 00:00 [revised] PHST- 2019/03/21 00:00 [accepted] PHST- 2019/04/02 06:00 [pubmed] PHST- 2020/04/14 06:00 [medline] PHST- 2019/04/02 06:00 [entrez] AID - S1529-9430(19)30116-0 [pii] AID - 10.1016/j.spinee.2019.03.006 [doi] PST - ppublish SO - Spine J. 2019 Aug;19(8):1422-1433. doi: 10.1016/j.spinee.2019.03.006. Epub 2019 Mar 28.