Development of Risk Stratification Predictive Models for Cervical Deformity Surgery.

dc.contributor.author

Passias, Peter G

dc.contributor.author

Ahmad, Waleed

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Oh, Cheongeun

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Imbo, Bailey

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Naessig, Sara

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Pierce, Katherine

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Lafage, Virginie

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Lafage, Renaud

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Hamilton, D Kojo

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Protopsaltis, Themistocles S

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Klineberg, Eric O

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Gum, Jeffrey

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Schoenfeld, Andrew J

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Line, Breton

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Hart, Robert A

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Burton, Douglas C

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Bess, Shay

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Schwab, Frank J

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Smith, Justin S

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Shaffrey, Christopher I

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Ames, Christopher P

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International Spine Study Group

dc.date.accessioned

2023-06-15T16:54:06Z

dc.date.available

2023-06-15T16:54:06Z

dc.date.issued

2022-12

dc.date.updated

2023-06-15T16:54:06Z

dc.description.abstract

Background

As corrective surgery for cervical deformity (CD) increases, so does the rate of complications and reoperations. To minimize suboptimal postoperative outcomes, it is important to develop a tool that allows for proper preoperative risk stratification.

Objective

To develop a prognostic utility for identification of risk factors that lead to the development of major complications and unplanned reoperations.

Methods

CD patients age 18 years or older were stratified into 2 groups based on the postoperative occurrence of a revision and/or major complication. Multivariable logistic regressions identified characteristics that were associated with revision or major complication. Decision tree analysis established cutoffs for predictive variables. Models predicting both outcomes were quantified using area under the curve (AUC) and receiver operating curve characteristics.

Results

A total of 109 patients with CD were included in this study. By 1 year postoperatively, 26 patients experienced a major complication and 17 patients underwent a revision. Predictive modeling incorporating preoperative and surgical factors identified development of a revision to include upper instrumented vertebrae > C5, lowermost instrumented vertebrae > T7, number of unfused lordotic cervical vertebrae > 1, baseline T1 slope > 25.3°, and number of vertebral levels in maximal kyphosis > 12 (AUC: 0.82). For developing a major complication, a model included a current smoking history, osteoporosis, upper instrumented vertebrae inclination angle < 0° or > 40°, anterior diskectomies > 3, and a posterior Smith Peterson osteotomy (AUC: 0.81).

Conclusion

Revisions were predicted using a predominance of radiographic parameters while the occurrence of major complications relied on baseline bone health, radiographic, and surgical characteristics.
dc.identifier

00006123-202212000-00014

dc.identifier.issn

0148-396X

dc.identifier.issn

1524-4040

dc.identifier.uri

https://hdl.handle.net/10161/27992

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

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Neurosurgery

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10.1227/neu.0000000000002136

dc.subject

International Spine Study Group

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Cervical Vertebrae

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Thoracic Vertebrae

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Humans

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Kyphosis

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Lordosis

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Risk Assessment

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Retrospective Studies

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Adolescent

dc.title

Development of Risk Stratification Predictive Models for Cervical Deformity Surgery.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

928

pubs.end-page

935

pubs.issue

6

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

91

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