PMID- 33799291 OWN - NLM STAT- PubMed-not-MEDLINE LR - 20230619 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 34 IP - 6 DP - 2021 Apr 2 TI - Patient-related and radiographic predictors of inferior health-related quality-of-life measures in adult patients with nonoperative spinal deformity. PG - 907-913 LID - 10.3171/2020.9.SPINE20519 [doi] AB - OBJECTIVE: Patients with nonoperative (N-Op) adult spinal deformity (ASD) have inferior long-term spinopelvic alignment and clinical outcomes. Predictors of lower quality-of-life measures in N-Op populations have yet to be sufficiently investigated. The aim of this study was to identify patient-related factors and radiographic parameters associated with inferior health-related quality-of-life (HRQOL) scores in N-Op ASD patients. METHODS: N-Op ASD patients with complete radiographic and outcome data at baseline and 2 years were included. N-Op patients and operative (Op) patients were propensity score matched for baseline disability and deformity. Patient-related factors and radiographic alignment parameters (pelvic tilt [PT], sagittal vertical axis [SVA], pelvic incidence [PI]-lumbar lordosis [LL] mismatch, mismatch between cervical lordosis and T1 segment slope [TS-CL], cervical-thoracic pelvic angle [PA], and others) at baseline and 2 years were analyzed as predictors for moderate to severe 2-year Oswestry Disability Index (ODI > 20) and failing to meet the minimal clinically importance difference (MCID) for 2-year Scoliosis Research Society Outcomes Questionnaire (SRS) scores (< 0.4 increase from baseline). Conditional inference decision trees identified predictors of each HRQOL measure and established cutoffs at which factors have a global effect. Random forest analysis (RFA) generated 5000 conditional inference trees to compute a variable importance table for top predictors of inferior HRQOL. Statistical significance was set at p < 0.05. RESULTS: Six hundred sixty-two patients with ASD (331 Op patients and 331 N-Op patients) with complete radiographic and HRQOL data at their 2-year follow-up were included. There were no differences in demographics, ODI, and Schwab deformity modifiers between groups at baseline (all p > 0.05). N-Op patients had higher 2-year ODI scores (27.9 vs 20.3, p < 0.001), higher rates of moderate to severe disability (29.3% vs 22.4%, p = 0.05), lower SRS total scores (3.47 vs 3.91, p < 0.001), and higher rates of failure to reach SRS MCID (35.3% vs 15.7%, p < 0.001) than Op patients at 2 years. RFA ranked the top overall predictors for moderate to severe ODI at 2 years for N-Op patients as follows: 1) frailty index > 2.8, 2) BMI > 35 kg/m2, T4PA > 28 degrees , and 4) Charlson Comorbidity Index > 1. Top radiographic predictors were T4PA > 28 degrees and C2-S1 SVA > 93 mm. RFA also ranked the top overall predictors for failure to reach 2-year SRS MCID for N-Op patients, as follows: 1) T12-S1 lordosis > 53 degrees , 2) cervical SVA (cSVA) > 28 mm, 3) C2-S1 angle > 14.5 degrees , 4) TS-CL > 12 degrees , and 5) PT > 23 degrees . The top radiographic predictors were T12-S1 Cobb angle, cSVA, C2-S1 angle, and TS-CL. CONCLUSIONS: When controlling for baseline deformity in N-Op versus Op patients, subsequent deterioration in frailty, BMI, and radiographic progression over a 2-year follow-up were found to drive suboptimal patient-reported outcome measures in N-Op cohorts as measured by validated ODI and SRS clinical instruments. FAU - Passias, Peter G AU - Passias PG AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Alas, Haddy AU - Alas H AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Bess, Shay AU - Bess S AD - 2Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado. FAU - Line, Breton G AU - Line BG AD - 2Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado. FAU - Lafage, Virginie AU - Lafage V AD - 3Department of Orthopedics, Hospital for Special Surgery, New York, New York. FAU - Lafage, Renaud AU - Lafage R AD - 3Department of Orthopedics, Hospital for Special Surgery, New York, New York. FAU - Ames, Christopher P AU - Ames CP AD - 4Department of Neurological Surgery, University of California, San Francisco, California. FAU - Burton, Douglas C AU - Burton DC AD - 5Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. FAU - Brown, Avery AU - Brown A AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Bortz, Cole AU - Bortz C AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Pierce, Katherine AU - Pierce K AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Ahmad, Waleed AU - Ahmad W AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Naessig, Sara AU - Naessig S AD - 1Division of Spinal Surgery, Departments of Orthopaedic Surgery and Neurosurgery, NYU Medical Center, New York Spine Institute, New York, New York. FAU - Kelly, Michael P AU - Kelly MP AD - 6Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri. FAU - Hostin, Richard AU - Hostin R AD - 7Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas. FAU - Kebaish, Khaled M AU - Kebaish KM AD - 8Department of Orthopaedics, Johns Hopkins University School of Medicine, Baltimore, Maryland. FAU - Than, Khoi D AU - Than KD AD - 9Department of Neurosurgery, Oregon Health & Science University, Portland, Oregon. FAU - Nunley, Pierce AU - Nunley P AD - 10Spine Institute of Louisiana, Shreveport, Louisiana. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - 11Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and. FAU - Klineberg, Eric O AU - Klineberg EO AD - 12Department of Orthopaedic Surgery, University of California, Davis, California. FAU - Smith, Justin S AU - Smith JS AD - 11Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; and. FAU - Schwab, Frank J AU - Schwab FJ AD - 3Department of Orthopedics, Hospital for Special Surgery, New York, New York. CN - International Spine Study Group LA - eng PT - Journal Article DEP - 20210402 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM OTO - NOTNLM OT - adult spinal deformity OT - health-related quality of life OT - nonoperative OT - predictor EDAT- 2021/04/03 06:00 MHDA- 2021/04/03 06:01 CRDT- 2021/04/02 20:38 PHST- 2020/04/06 00:00 [received] PHST- 2020/09/21 00:00 [accepted] PHST- 2021/04/03 06:01 [medline] PHST- 2021/04/03 06:00 [pubmed] PHST- 2021/04/02 20:38 [entrez] AID - 2020.9.SPINE20519 [pii] AID - 10.3171/2020.9.SPINE20519 [doi] PST - epublish SO - J Neurosurg Spine. 2021 Apr 2;34(6):907-913. doi: 10.3171/2020.9.SPINE20519.