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...
| Main Authors: | , , , , , , , , , , , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wolters Kluwer Medknow Publications
2021-01-01
|
| Series: | Journal of Craniovertebral Junction and Spine |
| Subjects: | |
| Online Access: | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2021;volume=12;issue=3;spage=228;epage=235;aulast=Passias |
| _version_ | 1819041185490010112 |
|---|---|
| author | Peter Gust Passias Samantha R Horn Cheongeun Oh Gregory W Poorman Cole Bortz Frank Segreto Renaud Lafage Bassel Diebo Justin K Scheer Justin S Smith Christopher I Shaffrey Robert Eastlack Daniel M Sciubba Themistocles Protopsaltis Han Jo Kim Robert A Hart Virginie Lafage Christopher P Ames International Spine Study Group |
| author_facet | Peter Gust Passias Samantha R Horn Cheongeun Oh Gregory W Poorman Cole Bortz Frank Segreto Renaud Lafage Bassel Diebo Justin K Scheer Justin S Smith Christopher I Shaffrey Robert Eastlack Daniel M Sciubba Themistocles Protopsaltis Han Jo Kim Robert A Hart Virginie Lafage Christopher P Ames International Spine Study Group |
| author_sort | Peter Gust Passias |
| collection | DOAJ |
| 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. |
| first_indexed | 2024-12-21T09:20:59Z |
| format | Article |
| id | doaj.art-be73ca6b8b33477fbae1b1deea6d01fa |
| institution | Directory Open Access Journal |
| issn | 0974-8237 |
| language | English |
| last_indexed | 2024-12-21T09:20:59Z |
| publishDate | 2021-01-01 |
| publisher | Wolters Kluwer Medknow Publications |
| record_format | Article |
| series | Journal of Craniovertebral Junction and Spine |
| spelling | doaj.art-be73ca6b8b33477fbae1b1deea6d01fa2022-12-21T19:09:00ZengWolters Kluwer Medknow PublicationsJournal of Craniovertebral Junction and Spine0974-82372021-01-0112322823510.4103/jcvjs.jcvjs_40_21Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformityPeter Gust PassiasSamantha R HornCheongeun OhGregory W PoormanCole BortzFrank SegretoRenaud LafageBassel DieboJustin K ScheerJustin S SmithChristopher I ShaffreyRobert EastlackDaniel M SciubbaThemistocles ProtopsaltisHan Jo KimRobert A HartVirginie LafageChristopher P AmesInternational Spine Study GroupBackground: 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.http://www.jcvjs.com/article.asp?issn=0974-8237;year=2021;volume=12;issue=3;spage=228;epage=235;aulast=Passiascervical deformityclinical outcomespredictive modelingradiographic alignmentsurgical correction |
| spellingShingle | Peter Gust Passias Samantha R Horn Cheongeun Oh Gregory W Poorman Cole Bortz Frank Segreto Renaud Lafage Bassel Diebo Justin K Scheer Justin S Smith Christopher I Shaffrey Robert Eastlack Daniel M Sciubba Themistocles Protopsaltis Han Jo Kim Robert A Hart Virginie Lafage Christopher P Ames International Spine Study Group Predictive model for achieving good clinical and radiographic outcomes at one-year following surgical correction of adult cervical deformity Journal of Craniovertebral Junction and Spine cervical deformity clinical outcomes predictive modeling radiographic alignment surgical correction |
| 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 | cervical deformity clinical outcomes predictive modeling radiographic alignment surgical correction |
| url | http://www.jcvjs.com/article.asp?issn=0974-8237;year=2021;volume=12;issue=3;spage=228;epage=235;aulast=Passias |
| work_keys_str_mv | AT petergustpassias predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT samantharhorn predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT cheongeunoh predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT gregorywpoorman predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT colebortz predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT franksegreto predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT renaudlafage predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT basseldiebo predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT justinkscheer predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT justinssmith predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT christopherishaffrey predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT roberteastlack predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT danielmsciubba predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT themistoclesprotopsaltis predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT hanjokim predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT robertahart predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT virginielafage predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT christopherpames predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity AT internationalspinestudygroup predictivemodelforachievinggoodclinicalandradiographicoutcomesatoneyearfollowingsurgicalcorrectionofadultcervicaldeformity |