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Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity

BACKGROUND: For cervical deformity (CD) surgery, goals include realignment, improved patient quality of life, and improved clinical outcomes. There is limited research identifying patients most likely to achieve all three. OBJECTIVE: The objective is to create a model predicting good 1-year postoper...

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Autores principales: Passias, Peter Gust, Horn, Samantha R., Oh, Cheongeun, Poorman, Gregory W., Bortz, Cole, Segreto, Frank, Lafage, Renaud, Diebo, Bassel, Scheer, Justin K., Smith, Justin S., Shaffrey, Christopher I., Eastlack, Robert, Sciubba, Daniel M., Protopsaltis, Themistocles, Kim, Han Jo, Hart, Robert A., Lafage, Virginie, Ames, Christopher P.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Wolters Kluwer - Medknow 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501815/
https://www.ncbi.nlm.nih.gov/pubmed/34728988
http://dx.doi.org/10.4103/jcvjs.jcvjs_40_21
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author Passias, Peter Gust
Horn, Samantha R.
Oh, Cheongeun
Poorman, Gregory W.
Bortz, Cole
Segreto, Frank
Lafage, Renaud
Diebo, Bassel
Scheer, Justin K.
Smith, Justin S.
Shaffrey, Christopher I.
Eastlack, Robert
Sciubba, Daniel M.
Protopsaltis, Themistocles
Kim, Han Jo
Hart, Robert A.
Lafage, Virginie
Ames, Christopher P.
author_facet Passias, Peter Gust
Horn, Samantha R.
Oh, Cheongeun
Poorman, Gregory W.
Bortz, Cole
Segreto, Frank
Lafage, Renaud
Diebo, Bassel
Scheer, Justin K.
Smith, Justin S.
Shaffrey, Christopher I.
Eastlack, Robert
Sciubba, Daniel M.
Protopsaltis, Themistocles
Kim, Han Jo
Hart, Robert A.
Lafage, Virginie
Ames, Christopher P.
author_sort Passias, Peter Gust
collection PubMed
description BACKGROUND: For cervical deformity (CD) surgery, goals include realignment, improved patient quality of life, and improved clinical outcomes. There is limited research identifying patients most likely to achieve all three. OBJECTIVE: The objective is to create a model predicting good 1-year postoperative realignment, quality of life, and clinical outcomes following CD surgery using baseline demographic, clinical, and radiographic factors. METHODS: Retrospective review of a multicenter CD database. CD patients were defined as having one of the following radiographic criteria: Cervical sagittal vertical axis (cSVA) >4 cm, cervical kyphosis/scoliosis >10°° or chin-brow vertical angle >25°. The outcome assessed was whether a patient achieved both a good radiographic and clinical outcome. The primary analysis was stepwise regression models which generated a dataset-specific prediction model for achieving a good radiographic and clinical outcome. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the final model with 95% confidence intervals. RESULTS: Seventy-three CD patients were included (61.8 years, 58.9% F). The final model predicting the achievement of a good overall outcome (radiographic and clinical) yielded an AUC of 73.5% and included the following baseline demographic, clinical, and radiographic factors: mild-moderate myelopathy (Modified Japanese Orthopedic Association >12), no pedicle subtraction osteotomy, no prior cervical spine surgery, posterior lowest instrumented vertebra (LIV) at T1 or above, thoracic kyphosis >33°°, T1 slope <16 and cSVA <20 mm. CONCLUSIONS: Achievement of a positive outcome in radiographic and clinical outcomes following surgical correction of CD can be predicted with high accuracy using a combination of demographic, clinical, radiographic, and surgical factors, with the top factors being baseline cSVA <20 mm, no prior cervical surgery, and posterior LIV at T1 or above.
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spelling pubmed-85018152021-11-01 Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity Passias, Peter Gust Horn, Samantha R. Oh, Cheongeun Poorman, Gregory W. Bortz, Cole Segreto, Frank Lafage, Renaud Diebo, Bassel Scheer, Justin K. Smith, Justin S. Shaffrey, Christopher I. Eastlack, Robert Sciubba, Daniel M. Protopsaltis, Themistocles Kim, Han Jo Hart, Robert A. Lafage, Virginie Ames, Christopher P. J Craniovertebr Junction Spine Original Article BACKGROUND: For cervical deformity (CD) surgery, goals include realignment, improved patient quality of life, and improved clinical outcomes. There is limited research identifying patients most likely to achieve all three. OBJECTIVE: The objective is to create a model predicting good 1-year postoperative realignment, quality of life, and clinical outcomes following CD surgery using baseline demographic, clinical, and radiographic factors. METHODS: Retrospective review of a multicenter CD database. CD patients were defined as having one of the following radiographic criteria: Cervical sagittal vertical axis (cSVA) >4 cm, cervical kyphosis/scoliosis >10°° or chin-brow vertical angle >25°. The outcome assessed was whether a patient achieved both a good radiographic and clinical outcome. The primary analysis was stepwise regression models which generated a dataset-specific prediction model for achieving a good radiographic and clinical outcome. Model internal validation was achieved by bootstrapping and calculating the area under the curve (AUC) of the final model with 95% confidence intervals. RESULTS: Seventy-three CD patients were included (61.8 years, 58.9% F). The final model predicting the achievement of a good overall outcome (radiographic and clinical) yielded an AUC of 73.5% and included the following baseline demographic, clinical, and radiographic factors: mild-moderate myelopathy (Modified Japanese Orthopedic Association >12), no pedicle subtraction osteotomy, no prior cervical spine surgery, posterior lowest instrumented vertebra (LIV) at T1 or above, thoracic kyphosis >33°°, T1 slope <16 and cSVA <20 mm. CONCLUSIONS: Achievement of a positive outcome in radiographic and clinical outcomes following surgical correction of CD can be predicted with high accuracy using a combination of demographic, clinical, radiographic, and surgical factors, with the top factors being baseline cSVA <20 mm, no prior cervical surgery, and posterior LIV at T1 or above. Wolters Kluwer - Medknow 2021 2021-09-08 /pmc/articles/PMC8501815/ /pubmed/34728988 http://dx.doi.org/10.4103/jcvjs.jcvjs_40_21 Text en Copyright: © 2021 Journal of Craniovertebral Junction and Spine https://creativecommons.org/licenses/by-nc-sa/4.0/This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-NonCommercial-ShareAlike 4.0 License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is given and the new creations are licensed under the identical terms.
spellingShingle Original Article
Passias, Peter Gust
Horn, Samantha R.
Oh, Cheongeun
Poorman, Gregory W.
Bortz, Cole
Segreto, Frank
Lafage, Renaud
Diebo, Bassel
Scheer, Justin K.
Smith, Justin S.
Shaffrey, Christopher I.
Eastlack, Robert
Sciubba, Daniel M.
Protopsaltis, Themistocles
Kim, Han Jo
Hart, Robert A.
Lafage, Virginie
Ames, Christopher P.
Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
title Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
title_full Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
title_fullStr Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
title_full_unstemmed Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
title_short Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
title_sort predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity
topic Original Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8501815/
https://www.ncbi.nlm.nih.gov/pubmed/34728988
http://dx.doi.org/10.4103/jcvjs.jcvjs_40_21
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