Justin K Scheer1, Joseph A Osorio2, Justin S Smith3, Frank Schwab4, Robert A Hart5, Richard Hostin6, Virginie Lafage4, Amit Jain7, Douglas C Burton8, Shay Bess9, Tamir Ailon10, Themistocles S Protopsaltis4, Eric O Klineberg11, Christopher I Shaffrey3, Christopher P Ames2. 1. Department of Neurosurgery, University of Illinois at Chicago, 912 South Wood St., Chicago, IL 60612, USA. Electronic address: jscheer@uic.edu. 2. Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA 94131, USA. 3. Department of Neurosurgery, University of Virginia Health System, 1215 Lee St., Charlottesville, VA 22903, USA. 4. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. 5. Department of Orthopaedic Surgery, Oregon Health & Science University, 3181 S.W. Sam Jackson Park Rd., Portland, OR 97239-3098, USA. 6. Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd #800, Plano, TX 75093, USA. 7. Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, MD 21218, USA. 8. Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA. 9. Denver International Spine Clinic, Presbyterian St. Luke's Medical Center, 1719 E 19th Ave., Denver, CO 80218, USA. 10. University of British Columbia, 2329 West Mall, Vancouver, BC, Canada V6T 1Z4. 11. Department of Orthopaedic Surgery, University of California, 1 Shields Ave., Davis, CA 95616, USA.
Abstract
STUDY DESIGN: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. OBJECTIVE: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. SUMMARY OF BACKGROUND DATA: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. METHODS: ASD patients ≥18 years and baseline ODI ≥ 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. RESULTS: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0%, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. CONCLUSIONS: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. LEVEL OF EVIDENCE: Level II.
STUDY DESIGN: Retrospective review of prospective multicenter adult spinal deformity (ASD) database. OBJECTIVE: To create a model based on baseline demographic, radiographic, health-related quality of life (HRQOL), and surgical factors that can predict patients meeting the Oswestry Disability Index (ODI) minimal clinically important difference (MCID) at the two-year postoperative follow-up. SUMMARY OF BACKGROUND DATA: Surgical correction of ASD can result in significant improvement in disability as measured by ODI, with the goal of reaching at least one MCID. However, a predictive model for reaching MCID following ASD correction does not exist. METHODS:ASDpatients ≥18 years and baseline ODI ≥ 30 were included. Initial training of the model comprised forty-three variables including demographic data, comorbidities, modifiable surgical variables, baseline HRQOL, and coronal/sagittal radiographic parameters. Patients were grouped by whether or not they reached at least one ODI MCID at two-year follow-up. Decision trees were constructed using the C5.0 algorithm with five different bootstrapped models. Internal validation was accomplished via a 70:30 data split for training and testing each model, respectively. Final predictions from the models were chosen by voting with random selection for tied votes. Overall accuracy, and the area under a receiver operating characteristic curve (AUC) were calculated. RESULTS: 198 patients were included (MCID: 109, No-MCID: 89). Overall model accuracy was 86.0%, with an AUC of 0.94. The top 11 predictors of reaching MCID were gender, Scoliosis Research Society (SRS) activity subscore, back pain, sagittal vertical axis (SVA), pelvic incidence-lumbar lordosis mismatch (PI-LL), primary version revision, T1 spinopelvic inclination angle (T1SPI), American Society of Anesthesiologists (ASA) grade, T1 pelvic angle (T1PA), SRS pain, SRS total. CONCLUSIONS: A successful model was built predicting ODI MCID. Most important predictors were not modifiable surgical parameters, indicating that baseline clinical and radiographic status is a critical factor for reaching ODI MCID. LEVEL OF EVIDENCE: Level II.
Authors: Peter G Passias; Cole A Bortz; Katherine E Pierce; Haddy Alas; Avery Brown; Dennis Vasquez-Montes; Sara Naessig; Waleed Ahmad; Bassel G Diebo; Tina Raman; Themistocles S Protopsaltis; Aaron J Buckland; Michael C Gerling; Renaud Lafage; Virginie Lafage Journal: Int J Spine Surg Date: 2020-12
Authors: Rushikesh S Joshi; Darryl Lau; Justin K Scheer; Miquel Serra-Burriel; Alba Vila-Casademunt; Shay Bess; Justin S Smith; Ferran Pellise; Christopher P Ames Journal: Spine Deform Date: 2021-05-18
Authors: Christopher P Ames; Justin S Smith; Ferran Pellisé; Michael Kelly; Jeffrey L Gum; Ahmet Alanay; Emre Acaroğlu; Francisco Javier Sánchez Pérez-Grueso; Frank S Kleinstück; Ibrahim Obeid; Alba Vila-Casademunt; Christopher I Shaffrey; Douglas C Burton; Virginie Lafage; Frank J Schwab; Christopher I Shaffrey; Shay Bess; Miquel Serra-Burriel Journal: Eur Spine J Date: 2019-07-19 Impact factor: 3.134