Recovery Kinetics

Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology

Frank A. Segreto, Virginie Lafage, Renaud Lafage, Justin S. Smith, Breton G. Line, Robert K. Eastlack, Justin K. Scheer, Dean Chou, Nicholas J. Frangella, Samantha R. Horn, Cole A. Bortz, Bassel G. Diebo, Brian J Neuman, Themistocles S. Protopsaltis, Han Jo Kim, Eric O. Klineberg, Douglas C. Burton, Robert A. Hart, Frank J. Schwab, Shay Bess & 3 others Christopher I. Shaffrey, Christopher P. Ames, Peter G. Passias

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Pages (from-to)E40-E51
JournalNeurosurgery
Volume85
Issue number1
DOIs
StatePublished - Jul 1 2019

Fingerprint

Area Under Curve
Quality of Life
Neck Pain
Spinal Cord Diseases
Health
Postoperative Pain
Reoperation
Osteoporosis
Comorbidity
Body Mass Index

Keywords

  • Cervical deformity
  • HRQL
  • Primary surgery
  • Recovery kinetics
  • Revision surgery
  • Sagittal alignment
  • Salvage surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

Recovery Kinetics : Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology. / Segreto, Frank A.; Lafage, Virginie; Lafage, Renaud; Smith, Justin S.; Line, Breton G.; Eastlack, Robert K.; Scheer, Justin K.; Chou, Dean; Frangella, Nicholas J.; Horn, Samantha R.; Bortz, Cole A.; Diebo, Bassel G.; Neuman, Brian J; Protopsaltis, Themistocles S.; Kim, Han Jo; Klineberg, Eric O.; Burton, Douglas C.; Hart, Robert A.; Schwab, Frank J.; Bess, Shay; Shaffrey, Christopher I.; Ames, Christopher P.; Passias, Peter G.

In: Neurosurgery, Vol. 85, No. 1, 01.07.2019, p. E40-E51.

Research output: Contribution to journalArticle

Segreto, FA, Lafage, V, Lafage, R, Smith, JS, Line, BG, Eastlack, RK, Scheer, JK, Chou, D, Frangella, NJ, Horn, SR, Bortz, CA, Diebo, BG, Neuman, BJ, Protopsaltis, TS, Kim, HJ, Klineberg, EO, Burton, DC, Hart, RA, Schwab, FJ, Bess, S, Shaffrey, CI, Ames, CP & Passias, PG 2019, 'Recovery Kinetics: Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology', Neurosurgery, vol. 85, no. 1, pp. E40-E51. https://doi.org/10.1093/neuros/nyy435
Segreto, Frank A. ; Lafage, Virginie ; Lafage, Renaud ; Smith, Justin S. ; Line, Breton G. ; Eastlack, Robert K. ; Scheer, Justin K. ; Chou, Dean ; Frangella, Nicholas J. ; Horn, Samantha R. ; Bortz, Cole A. ; Diebo, Bassel G. ; Neuman, Brian J ; Protopsaltis, Themistocles S. ; Kim, Han Jo ; Klineberg, Eric O. ; Burton, Douglas C. ; Hart, Robert A. ; Schwab, Frank J. ; Bess, Shay ; Shaffrey, Christopher I. ; Ames, Christopher P. ; Passias, Peter G. / Recovery Kinetics : Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology. In: Neurosurgery. 2019 ; Vol. 85, No. 1. pp. E40-E51.
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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.",
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TY - JOUR

T1 - Recovery Kinetics

T2 - Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology

AU - Segreto, Frank A.

AU - Lafage, Virginie

AU - Lafage, Renaud

AU - Smith, Justin S.

AU - Line, Breton G.

AU - Eastlack, Robert K.

AU - Scheer, Justin K.

AU - Chou, Dean

AU - Frangella, Nicholas J.

AU - Horn, Samantha R.

AU - Bortz, Cole A.

AU - Diebo, Bassel G.

AU - Neuman, Brian J

AU - Protopsaltis, Themistocles S.

AU - Kim, Han Jo

AU - Klineberg, Eric O.

AU - Burton, Douglas C.

AU - Hart, Robert A.

AU - Schwab, Frank J.

AU - Bess, Shay

AU - Shaffrey, Christopher I.

AU - Ames, Christopher P.

AU - Passias, Peter G.

PY - 2019/7/1

Y1 - 2019/7/1

N2 - 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.

AB - 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.

KW - Cervical deformity

KW - HRQL

KW - Primary surgery

KW - Recovery kinetics

KW - Revision surgery

KW - Sagittal alignment

KW - Salvage surgery

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