Browsing by Author "Moattari, Kevin"
Now showing 1 - 3 of 3
Results Per Page
Sort Options
Item Open Access Evolution of Adult Cervical Deformity Surgery Clinical and Radiographic Outcomes Based on a Multicenter Prospective Study: Are Behaviors and Outcomes Changing With Experience?(Spine, 2022-11) Passias, Peter G; Krol, Oscar; Moattari, Kevin; Williamson, Tyler K; Lafage, Virginie; Lafage, Renaud; Kim, Han Jo; Daniels, Alan; Diebo, Bassel; Protopsaltis, Themistocles; Mundis, Gregory; Kebaish, Khaled; Soroceanu, Alexandra; Scheer, Justin; Hamilton, D Kojo; Klineberg, Eric; Schoenfeld, Andrew J; Vira, Shaleen; Line, Breton; Hart, Robert; Burton, Douglas C; Schwab, Frank A; Shaffrey, Christopher; Bess, Shay; Smith, Justin S; Ames, Christopher P; International Spine Study GroupStudy design
Retrospective cohort study.Objective
Assess changes in outcomes and surgical approaches for adult cervical deformity surgery over time.Summary of background data
As the population ages and the prevalence of cervical deformity increases, corrective surgery has been increasingly seen as a viable treatment. Dramatic surgical advancements and expansion of knowledge on this procedure have transpired over the years, but the impact on cervical deformity surgery is unknown.Materials and methods
Adult cervical deformity patients (18 yrs and above) with complete baseline and up to the two-year health-related quality of life and radiographic data were included. Descriptive analysis included demographics, radiographic, and surgical details. Patients were grouped into early (2013-2014) and late (2015-2017) by date of surgery. Univariate and multivariable regression analyses were used to assess differences in surgical, radiographic, and clinical outcomes over time.Results
A total of 119 cervical deformity patients met the inclusion criteria. Early group consisted of 72 patients, and late group consisted of 47. The late group had a higher Charlson Comorbidity Index (1.3 vs. 0.72), more cerebrovascular disease (6% vs. 0%, both P <0.05), and no difference in age, frailty, deformity, or cervical rigidity. Controlling for baseline deformity and age, late group underwent fewer three-column osteotomies [odds ratio (OR)=0.18, 95% confidence interval (CI): 0.06-0.76, P =0.014]. At the last follow-up, late group had less patients with: a moderate/high Ames horizontal modifier (71.7% vs. 88.2%), and overcorrection in pelvic tilt (4.3% vs. 18.1%, both P <0.05). Controlling for baseline deformity, age, levels fused, and three-column osteotomies, late group experienced fewer adverse events (OR=0.15, 95% CI: 0.28-0.8, P =0.03), and neurological complications (OR=0.1, 95% CI: 0.012-0.87, P =0.03).Conclusion
Despite a population with greater comorbidity and associated risk, outcomes remained consistent between early and later time periods, indicating general improvements in care. The later cohort demonstrated fewer three-column osteotomies, less suboptimal realignments, and concomitant reductions in adverse events and neurological complications. This may suggest a greater facility with less invasive techniques.Item Open Access Highest Achievable Outcomes for Patients Undergoing Cervical Deformity Corrective Surgery by Frailty.(Neurosurgery, 2022-11) Passias, Peter G; Kummer, Nicholas; Williamson, Tyler K; Williamson, Tyler K; Moattari, Kevin; Lafage, Virginie; Lafage, Renaud; Kim, Han Jo; Daniels, Alan H; Gum, Jeffrey L; Diebo, Bassel G; Protopsaltis, Themistocles S; Mundis, Gregory M; Eastlack, Robert K; Soroceanu, Alexandra; Scheer, Justin K; Hamilton, D Kojo; Klineberg, Eric O; Line, Breton; Hart, Robert A; Burton, Douglas C; Mummaneni, Praveen; Chou, Dean; Park, Paul; Schwab, Frank J; Shaffrey, Christopher I; Bess, Shay; Ames, Christopher P; Smith, Justin S; International Spine Study GroupBackground
Frailty is influential in determining operative outcomes, including complications, in patients with cervical deformity (CD).Objective
To assess whether frailty status limits the highest achievable outcomes of patients with CD.Methods
Adult patients with CD with 2-year (2Y) data included. Frailty stratification: not frail (NF) <0.2, frail (F) 0.2 to 0.4, and severely frail (SF) >0.4. Analysis of covariance established estimated marginal means based on age, invasiveness, and baseline deformity, for improvement, deterioration, or maintenance in Neck Disability Index (NDI), Modified Japanese Orthopaedic Association (mJOA), and Numerical Rating Scale Neck Pain.Results
One hundred twenty-six patients with CD included 29 NF, 83 F, and 14 SF. The NF group had the highest rates of deterioration and lowest rates of improvement in cervical Sagittal Vertical Axis and horizontal gaze modifiers. Two-year improvements in NDI by frailty: NF: -11.2, F: -16.9, and SF: -14.6 ( P = .524). The top quartile of NF patients also had the lowest 1-year (1Y) NDI (7.0) compared with F (11.0) and SF (40.5). Between 1Y and 2Y, 7.9% of patients deteriorated in NDI, 71.1% maintained, and 21.1% improved. Between 1Y and 2Y, SF had the highest rate of improvement (42%), while NF had the highest rate of deterioration (18.5%).Conclusion
Although frail patients improved more often by 1Y, SF patients achieve most of their clinical improvement between 1 and 2Y. Frailty is associated with factors such as osteoporosis, poor alignment, neurological status, sarcopenia, and other medical comorbidities. Similarly, clinical outcomes can be affected by many factors (fusion status, number of pain generators within treated levels, integrity of soft tissues and bone, and deformity correction). Although accounting for such factors will ultimately determine whether frailty alone is an independent risk factor, these preliminary findings may suggest that frailty status affects the clinical outcomes and improvement after CD surgery.Item Open Access The impact of postoperative neurologic complications on recovery kinetics in cervical deformity surgery.(Journal of craniovertebral junction & spine, 2021-10) Passias, Peter Gust; Brown, Avery E; Alas, Haddy; Pierce, Katherine E; Bortz, Cole A; Diebo, Bassel; Lafage, Renaud; Lafage, Virginie; Burton, Douglas C; Hart, Robert; Kim, Han Jo; Bess, Shay; Moattari, Kevin; Joujon-Roche, Rachel; Krol, Oscar; Williamson, Tyler; Tretiakov, Peter; Imbo, Bailey; Protopsaltis, Themistocles S; Shaffrey, Christopher; Schwab, Frank; Eastlack, Robert; Line, Breton; Klineberg, Eric; Smith, Justin; Ames, Christopher; International Spine Study GroupObjective
The objective of the study is to investigate which neurologic complications affect clinical outcomes the most following cervical deformity (CD) surgery.Methods
CD patients (C2-C7 Cobb >10°, CL >10°, cSVA >4 cm or chin-brow vertical angle >25°) >18 years with follow-up surgical and health-related quality of life (HRQL) data were included. Descriptive analyses assessed demographics. Neurologic complications assessed were C5 motor deficit, central neurodeficit, nerve root motor deficits, nerve sensory deficits, radiculopathy, and spinal cord deficits. Neurologic complications were classified as major or minor, then: intraoperative, before discharge, before 30 days, before 90 days, and after 90 days. HRQL outcomes were assessed at 3 months, 6 months, and 1 year. Integrated health state (IHS) for the neck disability index (NDI), EQ5D, and modified Japanese Orthopaedic Association (mJOA) were assessed using all follow-up time points. A subanalysis assessed IHS outcomes for patients with 2Y follow-up.Results
153 operative CD patients were included. Baseline characteristics: 61 years old, 63% female, body mass index 29.7, operative time 531.6 ± 275.5, estimated blood loss 924.2 ± 729.5, 49% posterior approach, 18% anterior approach, 33% combined. 18% of patients experienced a total of 28 neurologic complications in the postoperative period (15 major). There were 7 radiculopathy, 6 motor deficits, 6 sensory deficits, 5 C5 motor deficits, 2 central neurodeficits, and 2 spinal cord deficits. 11.2% of patients experienced neurologic complications before 30 days (7 major) and 15% before 90 days (12 major). 12% of neurocomplication patients went on to have revision surgery within 6 months and 18% within 2 years. Neurologic complication patients had worse mJOA IHS scores at 1Y but no significant differences between NDI and EQ5D (0.003 vs. 0.873, 0.458). When assessing individual complications, central neurologic deficits and spinal cord deficit patients had the worst outcomes at 1Y (2.6 and 1.8 times worse NDI scores, P = 0.04, no improvement in EQ5D, 8% decrease in EQ5D). Patients with sensory deficits had the best NDI and EQ5D outcomes at 1Y (31% decrease in NDI, 8% increase in EQ5D). In a subanalysis, neurologic patients trended toward worse NDI and mJOA IHS outcomes (P = 0.263, 0.163).Conclusions
18% of patients undergoing CD surgery experienced a neurologic complication, with 15% within 3 months. Patients who experienced any neurologic complication had worse mJOA recovery kinetics by 1 year and trended toward worse recovery at 2 years. Of the neurologic complications, central neurologic deficits and spinal cord deficits were the most detrimental.