Browsing by Author "Shaffrey, C"

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Open Access
Area under the Curve: Analysis of Approach-Related Recovery Time in 165 Operative Cervical Spondylotic Myelopathy Patients with a 2-Year Follow-Up
(Global Spine Journal, 2015-05-01) Challier, V; Smith, J; Shaffrey, C; Kim, HJ; Arnold, P; Liu, S; Scheer, J; Chapman, J; Protopsaltis, T; Lafage, V; Schwab, F; Massicotte, E; Yoon, ST; Fehlings, M; Ames, C
Introduction Much debate about postoperative outcomes regarding surgical approaches for cervical spondylotic myelopathy (CSM) exists in the literature with no clear evidence of superiority. We propose a novel method for assessing health-related quality of life (HRQOL) outcomes by taking into account each patient's baseline at postoperative time points and analyzing the “area under the curve” (AUC), a proxy for suffering time. Patients and Methods Post hoc analysis of a prospective, multicenter database of patients with CSM. A total of 165 patients met the following inclusion criteria: symptomatic CSM, age older than 18 years, and 2-year follow-up with modified Japanese Orthopaedic Association (mJOA) and neck disability index (NDI). The anterior approach group (AAG) ( n = 110) and posterior approach group (PAG) ( n = 55) were compared at baseline, 1 year, and 2 years for each HRQOL. This comparison was repeated with normalization, using the patient's baseline as the anchor, followed by an integration and comparison of AUC. Results and Conclusion: For the first time, AUC analysis was applied to evaluating patients with CSM. Nonnormalized HRQOLs demonstrated the AAG started higher and met better standards at all times points compared with the PAG. Normalized mJOA demonstrated the PAG actually did better at 2 years, whereas NDI suggested that the AAG did better, although this was not significant. AUC analysis further supported the superiority of the PAG, with statistical significance at 1 and 2 years' time points, suggesting that patients who undergo the posterior approach may suffer less in the first 2 years of their postoperative course.
Open Access
Characteristics of deformity surgery in patients with severe and rigid cervical kyphosis (CK): results of the CSRS-Europe multi-centre study project.
(European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2019-02) Koller, H; Ames, C; Mehdian, H; Bartels, R; Ferch, R; Deriven, V; Toyone, H; Shaffrey, C; Smith, J; Hitzl, W; Schröder, J; Robinson, Yohan
Introduction and purpose
Little information exists on surgical characteristics, complications and outcomes with corrective surgery for rigid cervical kyphosis (CK). To collate the experience of international experts, the CSRS-Europe initiated an international multi-centre retrospective study.
Methods
Included were patients at all ages with rigid CK. Surgical and patient specific characteristics, complications and outcomes were studied. Radiographic assessment included global and regional sagittal parameters. Cervical sagittal balance was stratified according to the CSRS-Europe classification of sagittal cervical balance (types A-D).
Results
Eighty-eight patients with average age of 58 years were included. CK etiology was ankylosing spondlitis (n = 34), iatrogenic (n = 25), degenerative (n = 9), syndromatic (n = 6), neuromuscular (n = 4), traumatic (n = 5), and RA (n = 5). Blood loss averaged 957 ml and the osteotomy grade 4.CK-correction and blood loss increased with osteotomy grade (r = 0.4/0.6, p < .01). Patients with different preop sagittal balance types had different approaches, preop deformity parameters and postop alignment changes (e.g. C7-slope, C2-7 SVA, translation). Correction of the regional kyphosis angle (RKA) was average 34° (p < .01). CK-correction was increased in patients with osteoporosis and osteoporotic vertebrae (POV, p = .006). 22% of patients experienced a major long-term complication and 14% needed revision surgery. Patients with complications had larger preop RKA (p = .01), RKA-change (p = .005), and postop increase in distal junctional kyphosis angle (p = .02). The POV-Group more often experienced postop complications (p < .0001) and revision surgery (p = .02). Patients with revision surgery had a larger RKA-change (p = .003) and postop translation (p = .04). 21% of patients had a postop segmental motor deficit and the risk was elevated in the POV-Group (p = .001).
Conclusions
Preop patient specific, radiographic and surgical variables had a significant bearing on alignment changes, outcomes and complication occurrence in the treatment of rigid CK.
Open Access
Clinical Impact Correlation of a Delphi-Based Proximal Junctional Kyphosis Severity Scale and HRQOL
(Global Spine Journal, 2015-05-01) Lau, D; Funao, H; Clark, A; Smith, J; Bess, S; Shaffrey, C; Schwab, F; Lafage, V; Deviren, V; Hart, R; Kebaish, K; Ames, C
Introduction Proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) are adverse outcomes following adult spinal surgery (ASD) surgery. There is a lack of consensus regarding which patients (pts) require revision surgery. The Hart ISSG PJK severity scale correlates with the need for revision surgery. This study evaluates the Hart International Spine Study Group (ISSG) PJK severity scale and health-related quality of life (HRQOL) measures in pts with PJK. Patients and Methods All ASD pts with PJK and/or PJF who eventually underwent revision surgery were identified from two large academic medical centers. Pts were retrospectively assigned scores based on the Hart ISSG PJK severity scale: neurological status, focal pain, instrumentation problem, kyphosis severity/PLC integrity, UIV/UIV + 1 fracture, and level of UIV. Scores range from 0 to 15. Pre-PJK revision HRQOL measures included: Oswestry disability index (ODI), short-form 36 (SF-36), and Scoliosis Research Society questionnaire (SRS30). Scores were subcategorized into 0 to 2, 3 to 5, 6 to 8, 9 to 11, and 12 to 15, and differences in HRQOL outcomes were determined with linear regression. Correlation was assessed with a Pearson correlation coefficient. Results A total of 54 cases were included, out of which 31.5% were male, and the mean age was 64.9 years. The Hart ISSG PJK severity scale scores ranged from 4 to 15, with the median being 8. PJK/PJF occurred in the upper thoracic spine in 24.1% of the cases. 54.8% had fractures and 77.8% had instrumentation issues. Overall, 55.6% had neurological deficits, with 16.7% having weakness and/or myelopathy. All pts had preoperative pain (median VAS 9/10). While statistical significance on linear regression was not seen, there were obvious trends that correlated with the Hart ISSG PJK severity scale. Higher Hart ISSG PJK severity scale scores were associated with higher ODI (p = 0.283, r = 0.350), lower SRS30 function (p = 0.821, r = −0.323), and lower SRS mental (p = 0.646, r = −0.592). Conclusion The Hart ISSG PJK severity scale has been shown to be predictive in the decision making of when patients require revision surgery. Based on the current study, it may also correlate with functional outcomes, specifically ODI and SRS30 components.
Open Access
Comparison of Best versus Worst Clinical Outcomes for Adult Spinal Deformity Surgery: A Prospective, Multicenter Assessment with Minimum 2-Year Follow-Up
(Global Spine Journal, 2015-05-01) Smith, J; Shaffrey, C; Lafage, V; Schwab, F; Protopsaltis, T; Klineberg, E; Gupta, M; Hostin, R; Ming-Fu, K; Soroceanu, A; Hart, R; Burton, D; Bess, S; Ames, C
Introduction Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population. Patients and Methods This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age < 18 years and ASD. Propensity scores were used to match an op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI–LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met criteria, including 286 op and 403 non-op, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS (p > 0.001) and had worse deformity based on pelvic tilt, PI–LL, and C7SVA (p > 0.002). Before reaching minimum 2-year follow-up, 38 non-op patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up, all HRQL measures assessed significantly improved for op patients (p > 0.001), but none of these measures improved significantly for non-op patients (p < 0.11). Overall, 97 matched op–non-op pairs were identified based on propensity scores. At last follow-up, the 97 matched op patients had significant improvement in all HRQL measures assessed (p > 0.001), but the 97 matched non-op patients lacked significant improvement in any of the HRQL measures (p < 0.20). Paired op–non-op analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed (p > 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability.
Open Access
Comparison of Outcomes between Anterior and Posterior Cervical Procedures: Results of Surgery Involving Four or More Vertebral Levels from the AOSpine North America Cervical Spondylotic Myelopathy Study
(Global Spine Journal, 2015-01-01) Yoon, ST; Fehlings, M; Kopjar, B; Arnold, P; Massicotte, E; Vaccaro, A; Brodke, DS; Shaffrey, C; Woodard, E; Banco, R; Chapman, J; Janssen, M; Bono, C; Sasso, R; Dekutoski, M; Gokaslan, Z; Michael, KW; Thakur, N; Heller, JG; Rhee, JM
Introduction Debate continues about the relative merits of anterior versus posterior surgery for multilevel cervical stenosis causing myelopathy. Conclusions from previous studies were limited because one- or two-level anterior surgeries have been compared with multilevel posterior cases. The objective of this study was to compare outcomes and complications of anterior versus posterior-based cervical procedures (≥ 4 levels) for patients with multilevel disease. Material and Methods Data from the AOSpine North America Cervical Spondylotic Myelopathy Study, a prospective, multicenter study, were analyzed. A subset of patients with myelopathy involving four or five vertebrae was analyzed in this study. The outcome measures included NDI, modified-Japanese Orthopaedic Association scores, SF36v2, and Nurick grades. Adverse events were also collected in a standardized manner and externally monitored. Rates of perioperative complications (within 30 days of surgery) and delayed complications (31 days–2 years following surgery) were tabulated and stratified based on clinical factors. Results Of the 264 patients in the main study, 113 patients (42.8%) had four or more levels of surgery. There were 49 patients who underwent anterior cervical surgery (ACS, combination of anterior cervical decompression fusion ± corpectomy) and 64 patients who underwent posterior-based cervical surgeries (PCS, 45 laminectomy + fusion, 19 laminoplasty). There were statistically significant differences in age, cardiovascular comorbidities, and source of stenosis between these two groups. There was a statistically significant difference in baseline Nurick grades between groups (2.8 ACS vs. 3.3 PCS, p = 0.0075). There was no difference in any outcome measures at baseline. Outcome scores improved in both the ACS and PCS groups from baseline over a period of 2 years. There were no statistically significant differences between the anterior and posterior surgical procedures in terms of outcomes at 2 years ( p > 0.05). This was true for NDI, mJOA, SF36v2, and Nurick scores for both unadjusted and adjusted analyses. There was no significant difference in complication rates between ACS and PCS groups. Each group had 14 reported complications (total 28). Both the groups reported two postoperative C5 radiculopathies. There was one reoperation in the ACS group. Worsening of neck pain was reported in one patient who had an anterior corpectomy/fusion procedure and there was one case of infection in the PCS group. Two patients in the ACS group had worsening of myelopathy. Conclusion In patients with four or five involved vertebral levels of pathology that require surgical intervention for cervical myelopathy, both anterior and posterior surgical procedures demonstrate improved outcomes. With this dataset, we found no evidence of difference between anterior versus posterior surgical procedures in outcomes or associated complication rates. Surgical decision-making related to approach and technique to address issues in these patients can be made by surgeons based on their judgment and experience with these procedures. The limitations of this study include (1) a nonrandomized study design and (2) the grouping together of different subtypes of anterior or posterior procedures.
Open Access
Correction to: Natural History, Predictors of Outcome, and Effects of Treatment in Thoracic Spinal Cord Injury: A Multi-Center Cohort Study from the North American Clinical Trials Network by Wilson, J.R. et al. J. Neurotrauma 2018;35(21):2554–2560. (DOI: 10.1089/neu.2017.5535)
(Journal of Neurotrauma, 2020-03-15) Wilson, JR; Jaja, BNR; Kwon, BK; Guest, JD; Harrop, JS; Aarabi, B; Shaffrey, C; Badhiwala, JH; Toups, EG; Grossman, RG; Fehlings, MG
Open Access
Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity
(Neurosurgery, 2016-09) Smith, JS; Lafage, V; Shaffrey, C
Open Access
Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up
(Global Spine Journal, 2015-05-01) Smith, J; Lafage, V; Shaffrey, C; Schwab, F; Hostin, R; Boachie-Adjei, O; Akbarnia, B; Klineberg, E; Gupta, M; Deviren, V; Hart, R; Burton, D; Bess, S; Ames, C
Introduction Adults with spinal deformity typically present with pain and disability. Aim Our objective was to compare outcomes for operative (op) and nonoperative (nonop) treatment for ASD based on a prospective, multicenter patient population. Material and Methods This is a multicenter, prospective analysis of consecutive ASD patients electing for op or nonop care at enrollment. Inclusion criteria: age > 18 year and ASD. Propensity scores were used to match op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI-LL), and leg pain numeric rating scale (NRS) score. Results A total of 689 patients met with the criteria, including 286 op and 403 nonop, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS (p < 0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA (p ≤ 0.002). Before reaching minimum 2-year follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At minimum 2-year follow-up all HRQL measures assessed significantly improved for op patients (p < 0.001), but none of these measures improved significantly for nonop patients (p ≥ 0.11). Total 97 matched op–nonop pairs were identified based on propensity scores. At last follow-up the 97 matched op patients had significant improvement in all HRQL measures assessed (p < 0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures (p ≥ 0.20). Paired op–nonop analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed (p < 0.001), except SF36 MCS (p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively. Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability.
Open Access
Preoperative Cervical Hyperlordosis and C2–T3 Angle are Correlated to Increased Risk of Post-Op Sagittal Spinal Pelvic Malalignment in Adult Spinal Deformity Patients at 2-Year Follow-Up
(Global Spine Journal, 2015-05-01) Passias, P; Yang, S; Soroceanu, A; Scheer, J; Schwab, F; Shaffrey, C; Kim, HJ; Protopsaltis, T; Mundis, G; Gupta, M; Klineberg, E; Lafage, V; Smith, J; Ames, C
Introduction Cervical deformity (CD) is prevalent among patients with adult spinal deformity (ASD). The effect of baseline cervical alignment and achieving optimal TL alignment in ASD surgery is unclear. This study assesses the relationship between preoperative cervical spinal parameters and global alignment following thoracolumbar ASD surgery at 2-year follow-up. Patients and Methods Using a multicenter prospective database of surgical patients with ASD, we included patients with 2-year follow-up and cervical X-rays. SRS-Schwab sagittal modifiers (PT, GA, and PI–LL) were assessed at 2-year postoperative as either normal (0) or abnormal (“ + ” or “ + +”). Patients were classified in the aligned group (AG) or maligned group (MG) if all the three sagittal modifiers were normal or abnormal, respectively. Patients were assessed for CD based on the following criteria: C2–C7 SVA > 4 cm, C2–C7 SVA < 4 cm, cervical kyphosis (CL > 0), cervical lordosis (CL < 0), any deformity (C2C7 SVA > 4 cm or CL > 0), and both CD (C2C7 SVA > 4 cm and CL > 0). Univariate testing was performed using t test or chi-square test, looking at the following pre-op parameters: CD, C2–C7 SVA, C2–T3 SVA, CL, T1S, T1S–CL, C2–T3 angle, LL, TK, PT, C7–S1 SVA, and PI–LL. Results A total of 184 patients met initial inclusion criteria with 70 in the AG and 34 in MG. Pre-op, patients in the MG had a higher cervical lordosis (11.7 vs. 4.9, p = 0.03), higher C2–T3 angle (13.59 vs. 4.9 p = 0.01), and higher PT ( p < 0.0001), higher SVA ( p < 0.0001), and higher PI–LL ( p < 0.0001) compared with the AG. Interestingly, the prevalence of CD at baseline was similar for both the groups: MG and AG. There was no statistically significant difference in the amount of improvement over 2 years on the ODI or the SF-36 PCS. Conclusion Patients with 2-year sagittal TL malalignment also have preoperative sagittal TL malalignment and concomitant cervical hyperlordosis as a compensatory mechanism to maintain horizontal gaze. Cervical radiographs suggestive of cervical hyperlordosis should be followed up with complete standing radiographs to asses for sagittal TL malalignment.
Open Access
The Clinical Impact of Global Coronal Malalignment Is Underestimated in Adult Patients With Thoracolumbar Scoliosis
(Spine Deformity, 2019-01-01) Plais, N; Bao, H; Lafage, R; Gupta, M; Smith, JS; Shaffrey, C; Mundis, G; Burton, D; Ames, C; Klineberg, E; Bess, S; Schwab, F; Lafage, V
Study Design: Retrospective review of multicenter adult spine deformity (ASD) database. Objectives: A recent publication demonstrated that the laterality of the coronal offset is a key parameter that directly impacts postoperative outcomes. The objective of this study is to analyze the relationship between global coronal malalignment (GCM) and functional outcomes in a North American population of ASD patients with no history of previous surgery. Summary of Background Data: The clinical impact of GCM in patients with ASD remains controversial. Methods: Primary patients were drawn from a multicenter database of ASD patients and categorized with the Qiu classification: Type A = GCM <3 cm; Type B = GCM >3 cm toward the concave side of the curve; and Type C = GCM >3 cm toward the convex side. In addition to the classic radiographic parameter, the coronal truncal inclination was investigated in regard to the pelvic obliquity. Clinical outcomes, radiographic parameters, and demographics were compared across the three Qiu Types using analysis of variance. The analysis was repeated after propensity matching of the three types by age and sagittal alignment (PI-LL mismatch, pelvic tilt, and sagittal vertical axis). Results: 576 ASD patients (mean age 58.8 years) were included. Type B patients had significantly worse functional scores (Oswestry Disability Index, 36-item Short Form Survey physical component summary, and Scoliosis Research Society–22) and a more severe coronal deformity in terms of maximum Cobb angle, global coronal deformity angle, and coronal malalignment; they were also older (65.4 vs. 58.8 years, p = .004) and displayed more severe sagittal malalignment. Similar findings were observed after propensity matching. Conclusions: This study is the first to establish an association between functional outcomes and the severity of the coronal plane deformity in the setting of a specific coronal curve pattern in patients without previous surgery. Coronal malalignment significantly affects the health status of patients when the offset is greater than 3 cm in the direction of curve concavity. Level of Evidence: Level III.

Browsing by Author "Shaffrey, C"

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