Frank A Segreto1, Virginie Lafage2, Renaud Lafage2, Justin S Smith3, Breton G Line4, Robert K Eastlack5, Justin K Scheer6, Dean Chou7, Nicholas J Frangella1, Samantha R Horn1, Cole A Bortz1, Bassel G Diebo8, Brian J Neuman9, Themistocles S Protopsaltis1, Han Jo Kim2, Eric O Klineberg10, Douglas C Burton11, Robert A Hart12, Frank J Schwab2, Shay Bess4, Christopher I Shaffrey3, Christopher P Ames7, Peter G Passias1. 1. Department of Orthopaedics, NYU Medical Center-Orthopaedic Hospital, New York, New York. 2. Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York. 3. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia. 4. Department of Orthopaedic Surgery, Denver International Spine Center, Denver, Colorado. 5. Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, California. 6. Department of Neurosurgery, University of Illinois at Chicago, Chicago, Illinois. 7. Department of Orthopaedics, University of California, San Francisco, California. 8. Department of Orthopaedics, SUNY Downstate Medical Center, Brooklyn, New York. 9. Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland. 10. Department of Orthopaedic Surgery, University of California, Davis, Sacramento, California. 11. Department of Orthopaedics, University of Kansas Medical Center, Kansas City, Kansas. 12. Department of Orthopaedics, Swedish Neuroscience Institute, Seattle, Washington.
Abstract
BACKGROUND: Limited data are available to objectively define what constitutes a "good" versus a "bad" recovery for operative cervical deformity (CD) patients. Furthermore, the recovery patterns of primary versus revision procedures for CD is poorly understood. OBJECTIVE: To define and compare the recovery profiles of CD patients undergoing primary or revision procedures, utilizing a novel area-under-the-curve normalization methodology. METHODS: CD patients undergoing primary or revision surgery with baseline to 1-yr health-related quality of life (HRQL) scores were included. Clinical symptoms and HRQL were compared among groups (primary/revision). Normalized HRQL scores at baseline and follow-up intervals (3M, 6M, 1Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State). Subanalysis identified recovery patterns through 2-yr follow-up. RESULTS: Eighty-three patients were included (45 primary, 38 revision). Age (61.3 vs 61.9), gender (F: 66.7% vs 63.2%), body mass index (27.7 vs 29.3), Charlson Comorbidity Index, frailty, and osteoporosis (20% vs 13.2%) were similar between groups (P > .05). Primary patients were more preoperatively neurologically symptomatic (55.6% vs 31.6%), less sagittally malaligned (cervical sagittal vertical axis [cSVA]: 32.6 vs 46.6; T1 slope: 28.8 vs 36.8), underwent more anterior-only approaches (28.9% vs 7.9%), and less posterior-only approaches (37.8% vs 60.5%), all P < .05. Combined approaches, decompressions, osteotomies, and construct length were similar between groups (P > .05). Revisions had longer op-times (438.0 vs 734.4 min, P = .008). Following surgery, complication rate was similar between groups (66.6% vs 65.8%, P = .569). Revision patients remained more malaligned (cSVA, TS-CL; P < .05) than primary patients until 1-yr follow-up (P > .05). Normalized HRQLs determined primary patients to exhibit less neck pain (numeric rating scale [NRS]) and myelopathy (modified Japanese Orthopaedic Association) symptoms through 1-yr follow-up compared to revision patients (P < .05). These differences subsided when following patients through 2 yr (P > .05). Despite similar 2-yr HRQL outcomes, revision patients exhibited worse neck pain (NRS) Integrated Health State recovery (P < .05). CONCLUSION: Despite both primary and revision patients exhibiting similar HRQL outcomes at final follow-up, revision patients were in a greater state of postoperative neck pain for a greater amount of time.
BACKGROUND: Limited data are available to objectively define what constitutes a "good" versus a "bad" recovery for operative cervical deformity (CD) patients. Furthermore, the recovery patterns of primary versus revision procedures for CD is poorly understood. OBJECTIVE: To define and compare the recovery profiles of CDpatients undergoing primary or revision procedures, utilizing a novel area-under-the-curve normalization methodology. METHODS:CDpatients undergoing primary or revision surgery with baseline to 1-yr health-related quality of life (HRQL) scores were included. Clinical symptoms and HRQL were compared among groups (primary/revision). Normalized HRQL scores at baseline and follow-up intervals (3M, 6M, 1Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State). Subanalysis identified recovery patterns through 2-yr follow-up. RESULTS: Eighty-three patients were included (45 primary, 38 revision). Age (61.3 vs 61.9), gender (F: 66.7% vs 63.2%), body mass index (27.7 vs 29.3), Charlson Comorbidity Index, frailty, and osteoporosis (20% vs 13.2%) were similar between groups (P > .05). Primary patients were more preoperatively neurologically symptomatic (55.6% vs 31.6%), less sagittally malaligned (cervical sagittal vertical axis [cSVA]: 32.6 vs 46.6; T1 slope: 28.8 vs 36.8), underwent more anterior-only approaches (28.9% vs 7.9%), and less posterior-only approaches (37.8% vs 60.5%), all P < .05. Combined approaches, decompressions, osteotomies, and construct length were similar between groups (P > .05). Revisions had longer op-times (438.0 vs 734.4 min, P = .008). Following surgery, complication rate was similar between groups (66.6% vs 65.8%, P = .569). Revision patients remained more malaligned (cSVA, TS-CL; P < .05) than primary patients until 1-yr follow-up (P > .05). Normalized HRQLs determined primary patients to exhibit less neck pain (numeric rating scale [NRS]) and myelopathy (modified Japanese Orthopaedic Association) symptoms through 1-yr follow-up compared to revision patients (P < .05). These differences subsided when following patients through 2 yr (P > .05). Despite similar 2-yr HRQL outcomes, revision patients exhibited worse neck pain (NRS) Integrated Health State recovery (P < .05). CONCLUSION: Despite both primary and revision patients exhibiting similar HRQL outcomes at final follow-up, revision patients were in a greater state of postoperative neck pain for a greater amount of time.
Authors: Han Jo Kim; Yu-Cheng Yao; Christopher I Shaffrey; Justin S Smith; Michael P Kelly; Munish Gupta; Todd J Albert; Themistocles S Protopsaltis; Gregory M Mundis; Peter Passias; Eric Klineberg; Shay Bess; Virginie Lafage; Christopher P Ames Journal: Global Spine J Date: 2020-11-23
Authors: Peter Gust Passias; Avery E Brown; Haddy Alas; Katherine E Pierce; Cole A Bortz; Bassel Diebo; Renaud Lafage; Virginie Lafage; Douglas C Burton; Robert Hart; Han Jo Kim; Shay Bess; Kevin Moattari; Rachel Joujon-Roche; Oscar Krol; Tyler Williamson; Peter Tretiakov; Bailey Imbo; Themistocles S Protopsaltis; Christopher Shaffrey; Frank Schwab; Robert Eastlack; Breton Line; Eric Klineberg; Justin Smith; Christopher Ames Journal: J Craniovertebr Junction Spine Date: 2021-12-11