Predicting the combined occurrence of poor clinical and radiographic outcomes following cervical deformity corrective surgery

被引:19
作者
Horn, Samantha R. [1 ]
Passias, Peter G. [1 ]
Oh, Cheongeun [1 ]
Lafage, Virginie [2 ]
Lafage, Renaud [2 ]
Smith, Justin S. [3 ]
Line, Breton [4 ,5 ]
Anand, Neel [6 ]
Segreto, Frank A. [1 ]
Bortz, Cole A. [1 ]
Scheer, Justin K. [7 ]
Eastlack, Robert K. [8 ]
Deviren, Vedat [9 ]
Mummaneni, Praveen, V [9 ]
Daniels, Alan H. [10 ]
Park, Paul [11 ]
Nunley, Pierce D. [12 ]
Kim, Han Jo [2 ]
Klineberg, Eric O. [13 ]
Burton, Douglas C. [14 ]
Hart, Robert A. [15 ]
Schwab, Frank J. [2 ]
Bess, Shay [4 ,5 ]
Shaffrey, Christopher, I [3 ]
Ames, Christopher P. [16 ]
机构
[1] NYU Langone Med Ctr, Dept Orthopaed, Orthopaed Hosp, New York, NY USA
[2] Hosp Special Surg, Dept Orthopaed Surg, 535 E 70th St, New York, NY 10021 USA
[3] Univ Virginia Hlth Syst, Dept Neurosurg, Charlottesville, VA USA
[4] Presbyterian St Lukes Med Ctr, Denver Int Spine Ctr, Denver, CO USA
[5] Rocky Mt Hosp Children, Denver, CO USA
[6] Cedars Sinai Med Ctr, Dept Orthopaed Surg, Los Angeles, CA 90048 USA
[7] Univ Illinois, Dept Neurosurg, Chicago, IL 60680 USA
[8] Scripps Hlth, Dept Orthopaed Surg, La Jolla, CA USA
[9] Univ Calif San Francisco, Dept Orthopaed Surg, San Francisco, CA USA
[10] Brown Univ, Dept Orthopaed Surg, Med Ctr, Providence, RI 02912 USA
[11] Univ Michigan, Dept Neurosurg, Ann Arbor, MI 48109 USA
[12] Spine Inst Louisiana, Dept Orthoped Surg, Shreveport, LA USA
[13] Univ Calif Davis, Dept Orthoped Surg, Sacramento, CA 95817 USA
[14] Univ Kansas, Med Ctr, Dept Orthopaed Surg, Kansas City, KS 66103 USA
[15] Swedish Neurosci Inst, Dept Orthopaed Surg, Seattle, WA USA
[16] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA
关键词
cervical deformity; poor outcome; complications; predictive analytics; sagittal malalignment; SAGITTAL DEFORMITY; SPINE; MALALIGNMENT; STRATEGIES; VALIDATION; ALIGNMENT; FUSION; RISK;
D O I
10.3171/2019.7.SPINE18651
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
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/m(2)). 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 complicationrelated 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 0.09-10.03). 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 contract.
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收藏
页码:182 / 190
页数:9
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