Patient-related and radiographic predictors of inferior health-related quality-of-life measures in adult patients with nonoperative spinal deformity.
| dc.contributor.author | Passias, Peter G | |
| dc.contributor.author | Alas, Haddy | |
| dc.contributor.author | Bess, Shay | |
| dc.contributor.author | Line, Breton G | |
| dc.contributor.author | Lafage, Virginie | |
| dc.contributor.author | Lafage, Renaud | |
| dc.contributor.author | Ames, Christopher P | |
| dc.contributor.author | Burton, Douglas C | |
| dc.contributor.author | Brown, Avery | |
| dc.contributor.author | Bortz, Cole | |
| dc.contributor.author | Pierce, Katherine | |
| dc.contributor.author | Ahmad, Waleed | |
| dc.contributor.author | Naessig, Sara | |
| dc.contributor.author | Kelly, Michael P | |
| dc.contributor.author | Hostin, Richard | |
| dc.contributor.author | Kebaish, Khaled M | |
| dc.contributor.author | Than, Khoi D | |
| dc.contributor.author | Nunley, Pierce | |
| dc.contributor.author | Shaffrey, Christopher I | |
| dc.contributor.author | Klineberg, Eric O | |
| dc.contributor.author | Smith, Justin S | |
| dc.contributor.author | Schwab, Frank J | |
| dc.contributor.author | International Spine Study Group | |
| dc.date.accessioned | 2023-06-19T18:41:46Z | |
| dc.date.available | 2023-06-19T18:41:46Z | |
| dc.date.issued | 2021-04 | |
| dc.date.updated | 2023-06-19T18:41:45Z | |
| dc.description.abstract | ObjectivePatients with nonoperative (N-Op) adult spinal deformity (ASD) have inferior long-term spinopelvic alignment and clinical outcomes. Predictors of lower quality-of-life measures in N-Op populations have yet to be sufficiently investigated. The aim of this study was to identify patient-related factors and radiographic parameters associated with inferior health-related quality-of-life (HRQOL) scores in N-Op ASD patients.MethodsN-Op ASD patients with complete radiographic and outcome data at baseline and 2 years were included. N-Op patients and operative (Op) patients were propensity score matched for baseline disability and deformity. Patient-related factors and radiographic alignment parameters (pelvic tilt [PT], sagittal vertical axis [SVA], pelvic incidence [PI]-lumbar lordosis [LL] mismatch, mismatch between cervical lordosis and T1 segment slope [TS-CL], cervical-thoracic pelvic angle [PA], and others) at baseline and 2 years were analyzed as predictors for moderate to severe 2-year Oswestry Disability Index (ODI > 20) and failing to meet the minimal clinically importance difference (MCID) for 2-year Scoliosis Research Society Outcomes Questionnaire (SRS) scores (< 0.4 increase from baseline). Conditional inference decision trees identified predictors of each HRQOL measure and established cutoffs at which factors have a global effect. Random forest analysis (RFA) generated 5000 conditional inference trees to compute a variable importance table for top predictors of inferior HRQOL. Statistical significance was set at p < 0.05.ResultsSix hundred sixty-two patients with ASD (331 Op patients and 331 N-Op patients) with complete radiographic and HRQOL data at their 2-year follow-up were included. There were no differences in demographics, ODI, and Schwab deformity modifiers between groups at baseline (all p > 0.05). N-Op patients had higher 2-year ODI scores (27.9 vs 20.3, p < 0.001), higher rates of moderate to severe disability (29.3% vs 22.4%, p = 0.05), lower SRS total scores (3.47 vs 3.91, p < 0.001), and higher rates of failure to reach SRS MCID (35.3% vs 15.7%, p < 0.001) than Op patients at 2 years. RFA ranked the top overall predictors for moderate to severe ODI at 2 years for N-Op patients as follows: 1) frailty index > 2.8, 2) BMI > 35 kg/m2, T4PA > 28°, and 4) Charlson Comorbidity Index > 1. Top radiographic predictors were T4PA > 28° and C2-S1 SVA > 93 mm. RFA also ranked the top overall predictors for failure to reach 2-year SRS MCID for N-Op patients, as follows: 1) T12-S1 lordosis > 53°, 2) cervical SVA (cSVA) > 28 mm, 3) C2-S1 angle > 14.5°, 4) TS-CL > 12°, and 5) PT > 23°. The top radiographic predictors were T12-S1 Cobb angle, cSVA, C2-S1 angle, and TS-CL.ConclusionsWhen controlling for baseline deformity in N-Op versus Op patients, subsequent deterioration in frailty, BMI, and radiographic progression over a 2-year follow-up were found to drive suboptimal patient-reported outcome measures in N-Op cohorts as measured by validated ODI and SRS clinical instruments. | |
| dc.identifier | 2020.9.SPINE20519 | |
| dc.identifier.issn | 1547-5654 | |
| dc.identifier.issn | 1547-5646 | |
| dc.identifier.uri | ||
| dc.language | eng | |
| dc.publisher | Journal of Neurosurgery Publishing Group (JNSPG) | |
| dc.relation.ispartof | Journal of neurosurgery. Spine | |
| dc.relation.isversionof | 10.3171/2020.9.spine20519 | |
| dc.subject | International Spine Study Group | |
| dc.title | Patient-related and radiographic predictors of inferior health-related quality-of-life measures in adult patients with nonoperative spinal deformity. | |
| dc.type | Journal article | |
| duke.contributor.orcid | Passias, Peter G|0000-0002-1479-4070|0000-0003-2635-2226 | |
| duke.contributor.orcid | Shaffrey, Christopher I|0000-0001-9760-8386 | |
| pubs.begin-page | 1 | |
| pubs.end-page | 7 | |
| pubs.issue | 6 | |
| pubs.organisational-group | Duke | |
| pubs.organisational-group | School of Medicine | |
| pubs.organisational-group | Clinical Science Departments | |
| pubs.organisational-group | Orthopaedic Surgery | |
| pubs.organisational-group | Neurosurgery | |
| pubs.publication-status | Published | |
| pubs.volume | 34 |
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