PMID- 34634113
OWN - NLM
STAT- MEDLINE
DCOM- 20220323
LR  - 20220323
IS  - 1524-4040 (Electronic)
IS  - 0148-396X (Linking)
VI  - 89
IP  - 6
DP  - 2021 Nov 18
TI  - Classifying Patients Operated for Spondylolisthesis: A K-Means Clustering 
      Analysis of Clinical Presentation Phenotypes.
PG  - 1033-1041
LID - 10.1093/neuros/nyab355 [doi]
AB  - BACKGROUND: Trials of lumbar spondylolisthesis are difficult to compare because 
      of the heterogeneity in the populations studied. OBJECTIVE: To define patterns of 
      clinical presentation. METHODS: This is a study of the prospective Quality 
      Outcomes Database spondylolisthesis registry, including patients who underwent 
      single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. 
      Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means 
      clustering analysis-an unsupervised machine learning algorithm-was used to 
      identify clinical presentation phenotypes. RESULTS: Overall, 608 patients were 
      identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 
      distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body 
      mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and 
      globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older 
      and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline 
      radiographic parameters were similar (P > .05). Both clusters improved clinically 
      (P < .001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo 
      Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric 
      Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the 
      high-disease-burden cluster (adjusted-P < .001). However, the high-disease-burden 
      cluster demonstrated greater 24-mo improvements for ODI, NRS-BP, and EQ-5D 
      (adjusted-P < .05) and a higher proportion reaching ODI minimal clinically 
      important difference (MCID) (adjusted-P = .001). High-disease-burden cluster had 
      lower satisfaction (adjusted-P = .02). CONCLUSION: We define 2 distinct 
      phenotypes-those with high vs intermediate disease burden-operated for lumbar 
      spondylolisthesis. Those with high disease burden were less satisfied, had a 
      lower quality of life, and more disability, more back pain, and more leg pain 
      than those with intermediate disease burden, but had greater magnitudes of 
      improvement in disability, back pain, quality of life, and more often reached ODI 
      MCID.
CI  - (c) Congress of Neurological Surgeons 2021.
FAU - Chan, Andrew K
AU  - Chan AK
AD  - Department of Neurological Surgery, University of California, San Francisco, San 
      Francisco, California, USA.
FAU - Wozny, Thomas A
AU  - Wozny TA
AD  - Department of Neurological Surgery, University of California, San Francisco, San 
      Francisco, California, USA.
FAU - Bisson, Erica F
AU  - Bisson EF
AD  - Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
FAU - Pennicooke, Brenton H
AU  - Pennicooke BH
AD  - Department of Neurological Surgery, University of California, San Francisco, San 
      Francisco, California, USA.
FAU - Bydon, Mohamad
AU  - Bydon M
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Glassman, Steven D
AU  - Glassman SD
AD  - Norton Leatherman Spine Center, Louisville, Kentucky, USA.
FAU - Foley, Kevin T
AU  - Foley KT
AD  - Department of Neurosurgery, Semmes-Murphey Neurologic and Spine Institute, 
      University of Tennessee, Memphis, Tennessee, USA.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AUID- ORCID: 0000-0001-9760-8386
AD  - Department of Neurosurgery, Duke University, Durham, North Carolina, USA.
AD  - Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA.
FAU - Potts, Eric A
AU  - Potts EA
AUID- ORCID: 0000-0003-4349-2327
AD  - Department of Neurological Surgery, Goodman Campbell Brain and Spine, 
      Indianapolis, Indiana, USA.
FAU - Shaffrey, Mark E
AU  - Shaffrey ME
AD  - Department of Neurosurgery, University of Virginia, Charlottesville, Virginia, 
      USA.
FAU - Coric, Domagoj
AU  - Coric D
AD  - Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas 
      Healthcare System, Charlotte, North Carolina, USA.
FAU - Knightly, John J
AU  - Knightly JJ
AD  - Atlantic Neurosurgical Specialists, Morristown, New Jersey, USA.
FAU - Park, Paul
AU  - Park P
AD  - Department of Neurosurgery, University of Michigan, Ann Arbor, Michigan, USA.
FAU - Wang, Michael Y
AU  - Wang MY
AD  - Department of Neurological Surgery, University of Miami, Miami, Florida, USA.
FAU - Fu, Kai-Ming
AU  - Fu KM
AD  - Department of Neurological Surgery, Weill Cornell Medical Center, New York, New 
      York, USA.
FAU - Slotkin, Jonathan R
AU  - Slotkin JR
AD  - Geisinger Health, Danville, Pennsylvania, USA.
FAU - Asher, Anthony L
AU  - Asher AL
AD  - Neuroscience Institute, Carolina Neurosurgery & Spine Associates, Carolinas 
      Healthcare System, Charlotte, North Carolina, USA.
FAU - Virk, Michael S
AU  - Virk MS
AD  - Department of Neurological Surgery, Weill Cornell Medical Center, New York, New 
      York, USA.
FAU - Kerezoudis, Panagiotis
AU  - Kerezoudis P
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Alvi, Mohammed A
AU  - Alvi MA
AD  - Department of Neurologic Surgery, Mayo Clinic, Rochester, Minnesota, USA.
FAU - Guan, Jian
AU  - Guan J
AD  - Department of Neurosurgery, University of Utah, Salt Lake City, Utah, USA.
FAU - Haid, Regis W
AU  - Haid RW
AD  - Atlanta Brain and Spine Care, Atlanta, Georgia, USA.
FAU - Mummaneni, Praveen V
AU  - Mummaneni PV
AD  - Department of Neurological Surgery, University of California, San Francisco, San 
      Francisco, California, USA.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
PL  - United States
TA  - Neurosurgery
JT  - Neurosurgery
JID - 7802914
SB  - IM
MH  - Cluster Analysis
MH  - Humans
MH  - Lumbar Vertebrae/surgery
MH  - Phenotype
MH  - Prospective Studies
MH  - Quality of Life
MH  - *Spondylolisthesis/surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - Classification
OT  - Clinical phenotypes
OT  - Lumbar
OT  - Patient-reported outcomes
OT  - Presentation
OT  - Quality Outcomes Database
OT  - Spondylolisthesis
EDAT- 2021/10/12 06:00
MHDA- 2022/03/24 06:00
CRDT- 2021/10/11 17:21
PHST- 2021/03/05 00:00 [received]
PHST- 2021/07/16 00:00 [accepted]
PHST- 2021/10/12 06:00 [pubmed]
PHST- 2022/03/24 06:00 [medline]
PHST- 2021/10/11 17:21 [entrez]
AID - 6389652 [pii]
AID - 10.1093/neuros/nyab355 [doi]
PST - ppublish
SO  - Neurosurgery. 2021 Nov 18;89(6):1033-1041. doi: 10.1093/neuros/nyab355.