PMID- 31675700 OWN - NLM STAT- MEDLINE DCOM- 20200630 LR - 20200630 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 32 IP - 2 DP - 2019 Nov 1 TI - Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery. PG - 182-190 LID - 2019.7.SPINE18651 [pii] LID - 10.3171/2019.7.SPINE18651 [doi] AB - OBJECTIVE: Cervical deformity (CD) correction is clinically challenging. There is a high risk of developing complications with these highly complex procedures. The aim of this study was to use baseline demographic, clinical, and surgical factors to predict a poor outcome following CD surgery. METHODS: The authors performed a retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: cervical kyphosis (C2-7 Cobb angle > 10 degrees ), cervical scoliosis (coronal Cobb angle > 10 degrees ), C2-7 sagittal vertical axis (cSVA) > 4 cm, or chin-brow vertical angle (CBVA) > 25 degrees . Patients were categorized based on having an overall poor outcome or not. Health-related quality of life measures consisted of Neck Disability Index (NDI), EQ-5D, and modified Japanese Orthopaedic Association (mJOA) scale scores. A poor outcome was defined as having all 3 of the following categories met: 1) radiographic poor outcome: deterioration or severe radiographic malalignment 1 year postoperatively for cSVA or T1 slope-cervical lordosis mismatch (TS-CL); 2) clinical poor outcome: failing to meet the minimum clinically important difference (MCID) for NDI or having a severe mJOA Ames modifier; and 3) complications/reoperation poor outcome: major complication, death, or reoperation for a complication other than infection. Univariate logistic regression followed by multivariate regression models was performed, and internal validation was performed by calculating the area under the curve (AUC). RESULTS: In total, 89 patients with CD were included (mean age 61.9 years, female sex 65.2%, BMI 29.2 kg/m2). By 1 year postoperatively, 18 (20.2%) patients were characterized as having an overall poor outcome. For radiographic poor outcomes, patients' conditions either deteriorated or remained severe for TS-CL (73% of patients), cSVA (8%), horizontal gaze (34%), and global SVA (28%). For clinical poor outcomes, 80% and 60% of patients did not reach MCID for EQ-5D and NDI, respectively, and 24% of patients had severe symptoms (mJOA score 0-11). For the complications/reoperation poor outcome, 28 patients experienced a major complication, 11 underwent a reoperation, and 1 had a complication-related death. Of patients with a poor clinical outcome, 75% had a poor radiographic outcome; 35% of poor radiographic and 37% of poor clinical outcome patients had a major complication. A poor outcome was predicted by the following combination of factors: osteoporosis, baseline neurological status, use of a transition rod, number of posterior decompressions, baseline pelvic tilt, T2-12 kyphosis, TS-CL, C2-T3 SVA, C2-T1 pelvic angle (C2 slope), global SVA, and number of levels in maximum thoracic kyphosis. The final model predicting a poor outcome (AUC 86%) included the following: osteoporosis (OR 5.9, 95% CI 0.9-39), worse baseline neurological status (OR 11.4, 95% CI 1.8-70.8), baseline pelvic tilt > 20 degrees (OR 0.92, 95% CI 0.85-0.98), > 9 levels in maximum thoracic kyphosis (OR 2.01, 95% CI 1.1-4.1), preoperative C2-T3 SVA > 5.4 cm (OR 1.01, 95% CI 0.9-1.1), and global SVA > 4 cm (OR 3.2, 95% CI 0.09-10.3). CONCLUSIONS: Of all CD patients in this study, 20.2% had a poor overall outcome, defined by deterioration in radiographic and clinical outcomes, and a major complication. Additionally, 75% of patients with a poor clinical outcome also had a poor radiographic outcome. A poor overall outcome was most strongly predicted by severe baseline neurological deficit, global SVA > 4 cm, and including more of the thoracic maximal kyphosis in the construct. FAU - Horn, Samantha R AU - Horn SR AD - 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York. FAU - Passias, Peter G AU - Passias PG AD - 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York. FAU - Oh, Cheongeun AU - Oh C AD - 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York. FAU - Lafage, Virginie AU - Lafage V AD - 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. FAU - Lafage, Renaud AU - Lafage R AD - 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. FAU - Smith, Justin S AU - Smith JS AD - 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Line, Breton AU - Line B AD - 4Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado. FAU - Anand, Neel AU - Anand N AD - 5Department of Orthopaedic Surgery, Cedars-Sinai Medical Center, Los Angeles, California. FAU - Segreto, Frank A AU - Segreto FA AD - 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York. FAU - Bortz, Cole A AU - Bortz CA AD - 1Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, New York. FAU - Scheer, Justin K AU - Scheer JK AD - 6Department of Neurosurgery, University of Illinois at Chicago, Illinois. FAU - Eastlack, Robert K AU - Eastlack RK AD - 7Department of Orthopaedic Surgery, Scripps Health, La Jolla, California. FAU - Deviren, Vedat AU - Deviren V AD - 8Department of Orthopaedic Surgery, University of California, San Francisco, California. FAU - Mummaneni, Praveen V AU - Mummaneni PV AD - 8Department of Orthopaedic Surgery, University of California, San Francisco, California. FAU - Daniels, Alan H AU - Daniels AH AD - 9Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island. FAU - Park, Paul AU - Park P AD - 10Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan. FAU - Nunley, Pierce D AU - Nunley PD AD - 11Department of Orthopedic Surgery, Spine Institute of Louisiana, Shreveport, Louisiana. FAU - Kim, Han Jo AU - Kim HJ AD - 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. FAU - Klineberg, Eric O AU - Klineberg EO AD - 12Department of Orthopedic Surgery, University of California Davis, Sacramento, California. FAU - Burton, Douglas C AU - Burton DC AD - 13Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. FAU - Hart, Robert A AU - Hart RA AD - 14Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, Washington; and. FAU - Schwab, Frank J AU - Schwab FJ AD - 2Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. FAU - Bess, Shay AU - Bess S AD - 4Denver International Spine Center, Presbyterian/St. Luke's Medical Center and Rocky Mountain Hospital for Children, Denver, Colorado. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 3Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia. FAU - Ames, Christopher P AU - Ames CP AD - 15Department of Neurological Surgery, University of California, San Francisco, California. CN - International Spine Study Group LA - eng PT - Journal Article PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Cervical Vertebrae/*surgery MH - Female MH - Humans MH - Kyphosis/surgery MH - Lordosis/*surgery MH - Male MH - Middle Aged MH - Posture/physiology MH - Prospective Studies MH - Quality of Life MH - Scoliosis/*surgery MH - Thoracic Vertebrae/surgery OTO - NOTNLM OT - AUC = area under the curve OT - CBVA = chin-brow vertical angle OT - CD = cervical deformity OT - CL = C2-7 lordosis OT - MCID = minimum clinically important difference OT - NDI = Neck Disability Index OT - PI-LL = mismatch between pelvic incidence and lumbar lordosis OT - PT = pelvic tilt OT - SVA = sagittal vertical axis OT - TS-CL = mismatch between T1 slope and CL OT - cSVA = C2-7 SVA OT - cervical deformity OT - complications OT - mJOA = modified Japanese Orthopaedic Association OT - poor outcome OT - predictive analytics OT - sagittal malalignment EDAT- 2019/11/02 06:00 MHDA- 2020/07/01 06:00 CRDT- 2019/11/02 06:00 PHST- 2018/05/25 00:00 [received] PHST- 2019/07/09 00:00 [accepted] PHST- 2019/11/02 06:00 [pubmed] PHST- 2020/07/01 06:00 [medline] PHST- 2019/11/02 06:00 [entrez] AID - 2019.7.SPINE18651 [pii] AID - 10.3171/2019.7.SPINE18651 [doi] PST - ppublish SO - J Neurosurg Spine. 2019 Nov 1;32(2):182-190. doi: 10.3171/2019.7.SPINE18651.