Redefining cervical spine deformity classification through novel cutoffs: An assessment of the relationship between radiographic parameters and functional neurological outcomes.
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2021-04
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Abstract
Purpose
The aim is to investigate the relationship between cervical parameters and the modified Japanese Orthopedic Association scale (mJOA).Materials and methods
Surgical adult cervical deformity (CD) patients were included in this retrospective analysis. After determining data followed a parametric distribution through the Shapiro-Wilk Normality (P = 0.15, P > 0.05), Pearson correlations were run for radiographic parameters and mJOA. For significant correlations, logistic regressions were performed to determine a threshold of radiographic measures for which the correlation with mJOA scores was most significant. mJOA score of 14 and <12 reported cut-off values for moderate (M) and severe (S) disability. New modifiers were compared to an existing classification using Spearman's rho and logistic regression analyses to predict outcomes up to 2 years.Results
A total of 123 CD patients were included (60.5 years, 65%F, 29.1 kg/m2). For significant baseline factors from Pearson correlations, the following thresholds were predicted: MGS (M:-12 to-9° and 0°-19°, P = 0.020; S: >19° and <-12°, χ2= 4.291, P = 0.036), TS-CL (M: 26°to 45°, P = 0.201; S: >45°, χ2= 7.8, P = 0.005), CL (M:-21° to 3°, χ2= 8.947, P = 0.004; S: <-21°, χ2= 9.3, P = 0.009), C2-T3 (M: -35° to -25°, χ2= 5.485, P = 0.046; S: <-35°, χ2= 4.1, P = 0.041), C2 Slope (M: 33° to 49°, P = 0.122; S: >49°, χ2= 5.7, P = 0.008), and Frailty (Mild: 0.18-0.27, P = 0.129; Severe: >0.27, P = 0.002). Compared to existing Ames- International Spine Study Group classification, the novel thresholds demonstrated significant predictive value for reoperation and mortality up to 2 years.Conclusions
Collectively, these radiographic values can be utilized in refining existing classifications and developing collective understanding of severity and surgical targets in corrective surgery for adult CD.Type
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Passias, Peter Gust, Katherine E Pierce, Avery E Brown, Cole A Bortz, Haddy Alas, Renaud Lafage, Virginie Lafage, Breton Line, et al. (2021). Redefining cervical spine deformity classification through novel cutoffs: An assessment of the relationship between radiographic parameters and functional neurological outcomes. Journal of craniovertebral junction & spine, 12(2). pp. 157–164. 10.4103/jcvjs.jcvjs_22_21 Retrieved from https://hdl.handle.net/10161/28111.
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