Classifying Patients Operated for Spondylolisthesis: A K-Means Clustering Analysis of Clinical Presentation Phenotypes.

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2021-11

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Abstract

Background

Trials of lumbar spondylolisthesis are difficult to compare because of the heterogeneity in the populations studied.

Objective

To define patterns of clinical presentation.

Methods

This is a study of the prospective Quality Outcomes Database spondylolisthesis registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means clustering analysis-an unsupervised machine learning algorithm-was used to identify clinical presentation phenotypes.

Results

Overall, 608 patients were identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (P > .05). Both clusters improved clinically (P < .001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the high-disease-burden cluster (adjusted-P < .001). However, the high-disease-burden cluster demonstrated greater 24-mo improvements for ODI, NRS-BP, and EQ-5D (adjusted-P < .05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-P = .001). High-disease-burden cluster had lower satisfaction (adjusted-P = .02).

Conclusion

We define 2 distinct phenotypes-those with high vs intermediate disease burden-operated for lumbar spondylolisthesis. Those with high disease burden were less satisfied, had a lower quality of life, and more disability, more back pain, and more leg pain than those with intermediate disease burden, but had greater magnitudes of improvement in disability, back pain, quality of life, and more often reached ODI MCID.

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Journal article

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Lumbar Vertebrae, Humans, Spondylolisthesis, Treatment Outcome, Cluster Analysis, Prospective Studies, Phenotype, Quality of Life

Citation

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https://hdl.handle.net/10161/28062

Published Version (Please cite this version)

10.1093/neuros/nyab355

Publication Info

Chan, Andrew K, Thomas A Wozny, Erica F Bisson, Brenton H Pennicooke, Mohamad Bydon, Steven D Glassman, Kevin T Foley, Christopher I Shaffrey, et al. (2021). Classifying Patients Operated for Spondylolisthesis: A K-Means Clustering Analysis of Clinical Presentation Phenotypes. Neurosurgery, 89(6). pp. 1033–1041. 10.1093/neuros/nyab355 Retrieved from https://hdl.handle.net/10161/28062.

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