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

dc.contributor.author Shaffrey, Christopher
dc.contributor.author Segreto, Frank A
dc.contributor.author Lafage, Virginie
dc.contributor.author Lafage, Renaud
dc.contributor.author Smith, Justin S
dc.contributor.author Line, Breton G
dc.contributor.author Eastlack, Robert K
dc.contributor.author Scheer, Justin K
dc.contributor.author Chou, Dean
dc.contributor.author Frangella, Nicholas J
dc.contributor.author Horn, Samantha R
dc.contributor.author Bortz, Cole A
dc.contributor.author Diebo, Bassel G
dc.contributor.author Neuman, Brian J
dc.contributor.author Protopsaltis, Themistocles S
dc.contributor.author Kim, Han Jo
dc.contributor.author Klineberg, Eric O
dc.contributor.author Burton, Douglas C
dc.contributor.author Hart, Robert A
dc.contributor.author Schwab, Frank J
dc.contributor.author Bess, Shay
dc.contributor.author Ames, Christopher P
dc.contributor.author Passias, Peter G
dc.date.accessioned 2019-08-01T13:27:09Z
dc.date.available 2019-08-01T13:27:09Z
dc.date.issued 2019-07
dc.identifier 5110520
dc.identifier.issn 0148-396X
dc.identifier.issn 1524-4040
dc.identifier.uri https://hdl.handle.net/10161/19124
dc.description.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.
dc.language eng
dc.publisher Oxford University Press (OUP)
dc.relation.ispartof Neurosurgery
dc.relation.isversionof 10.1093/neuros/nyy435
dc.subject Cervical deformity
dc.subject HRQL
dc.subject Primary surgery
dc.subject Recovery kinetics
dc.subject Revision surgery
dc.subject Sagittal alignment
dc.subject Salvage surgery
dc.title Recovery Kinetics: Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area Under the Curve Methodology.
dc.type Journal article
duke.contributor.id Shaffrey, Christopher|0911491
dc.date.updated 2019-08-01T13:27:08Z
pubs.begin-page E40
pubs.end-page E51
pubs.issue 1
pubs.organisational-group School of Medicine
pubs.organisational-group Duke
pubs.organisational-group Orthopaedics
pubs.organisational-group Clinical Science Departments
pubs.organisational-group Neurosurgery
pubs.publication-status Published
pubs.volume 85


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