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Development of Risk Stratification Predictive Models for Cervical Deformity Surgery.

Publication ,  Journal Article
Passias, PG; Ahmad, W; Oh, C; Imbo, B; Naessig, S; Pierce, K; Lafage, V; Lafage, R; Hamilton, DK; Protopsaltis, TS; Klineberg, EO; Gum, J ...
Published in: Neurosurgery
December 1, 2022

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.

Duke Scholars

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

December 1, 2022

Volume

91

Issue

6

Start / End Page

928 / 935

Location

United States

Related Subject Headings

  • Thoracic Vertebrae
  • Risk Assessment
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Lordosis
  • Kyphosis
  • Humans
  • Cervical Vertebrae
  • Adolescent
  • 5202 Biological psychology
 

Citation

APA
Chicago
ICMJE
MLA
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Passias, P. G., Ahmad, W., Oh, C., Imbo, B., Naessig, S., Pierce, K., … International Spine Study Group, . (2022). Development of Risk Stratification Predictive Models for Cervical Deformity Surgery. Neurosurgery, 91(6), 928–935. https://doi.org/10.1227/neu.0000000000002136
Passias, Peter G., Waleed Ahmad, Cheongeun Oh, Bailey Imbo, Sara Naessig, Katherine Pierce, Virginie Lafage, et al. “Development of Risk Stratification Predictive Models for Cervical Deformity Surgery.Neurosurgery 91, no. 6 (December 1, 2022): 928–35. https://doi.org/10.1227/neu.0000000000002136.
Passias PG, Ahmad W, Oh C, Imbo B, Naessig S, Pierce K, et al. Development of Risk Stratification Predictive Models for Cervical Deformity Surgery. Neurosurgery. 2022 Dec 1;91(6):928–35.
Passias, Peter G., et al. “Development of Risk Stratification Predictive Models for Cervical Deformity Surgery.Neurosurgery, vol. 91, no. 6, Dec. 2022, pp. 928–35. Pubmed, doi:10.1227/neu.0000000000002136.
Passias PG, Ahmad W, Oh C, Imbo B, Naessig S, Pierce K, Lafage V, Lafage R, Hamilton DK, Protopsaltis TS, Klineberg EO, Gum J, Schoenfeld AJ, Line B, Hart RA, Burton DC, Bess S, Schwab FJ, Smith JS, Shaffrey CI, Ames CP, International Spine Study Group. Development of Risk Stratification Predictive Models for Cervical Deformity Surgery. Neurosurgery. 2022 Dec 1;91(6):928–935.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

December 1, 2022

Volume

91

Issue

6

Start / End Page

928 / 935

Location

United States

Related Subject Headings

  • Thoracic Vertebrae
  • Risk Assessment
  • Retrospective Studies
  • Neurology & Neurosurgery
  • Lordosis
  • Kyphosis
  • Humans
  • Cervical Vertebrae
  • Adolescent
  • 5202 Biological psychology