- Email: [email protected]
207. Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity
The Spine Journal 19 (2019) S101−S140
Friday, September 27, 2019 7:30 − 8:55 AM Spinal Deformity IV 206. Does ACR result in greater morbidity than LLIF alone when treating adult spinal deformity? Robert K. Eastlack, MD1, Juan S. Uribe, MD2, Richard G. Fessler, MD, PhD3, Khoi D. Than, MD4, Stacie Tran, MPH5, Dean Chou, MD6, Paul Park, MD7, Kai-Ming G. Fu, MD, PhD8, Michael Y. Wang, MD9, Adam S. Kanter, MD10, David O. Okonkwo, MD11, Pierce D. Nunley, MD12, Gregory M. Mundis Jr., MD13, International Spine Study Group 14; 1 Scripps Clinic, San Diego, CA, US; 2 Barrow Neurological Institute, Phoenix, AZ, US; 3 Rush University Medical Center, Dept of Neuro Surgery, Chicago, IL, US; 4 Oregon Health & Science University, Portland, OR, US; 5 San Diego Spine Foundation, San Diego, CA, US; 6 University of California San Francisco, San Francisco, CA, US; 7 University Of Michigan - Dept of Neurosurgery, Ann Arbor, MI, US; 8 Weill Cornell Medicine/NewYork Presbyterian, New York, NY, US; 9 University of Miami, Dept of Neurosurgery, Miami, FL, US; 10 UPMC-Presbyterian/Dept of Neurological Surgery, Pittsburgh, PA, US; 11 Pittsburgh, PA, US; 12 Spine Institute of Louisiana, Shreveport, LA, US; 13 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, US; 14 Brighton, CO, US BACKGROUND CONTEXT: Anterior column realignment (ACR) can be utilized for correction of adult spinal deformity (ASD), but the additional benefit over lateral lumbar interbody fusion (LLIF) alone is unclear. PURPOSE: To evaluate the relative impact of ACR vs LLIF on clinical and radiographic outcomes, as well as complication rates, when surgically treating ASD. STUDY DESIGN/SETTING: Prospective multicenter database review. PATIENT SAMPLE: A total of 127 patients. OUTCOME MEASURES: Oswestry Disability Index (ODI), visual analog score (VAS), SRS-22. METHODS: Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20˚, SVA>5cm, PT>20˚, PI-LL >10˚. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery, underwent LLIF (LLIF group) or ACR/LLIF (ACR group) and had 1-year minimum follow-up. RESULTS: A total of 127 patients met inclusion criteria, 101 underwent LLIF and 26 had ACR. Average age and BMI were 66.3/27.7 and 67.8/ 27.4 (p=0.654/0.957). The groups had similar rates of prior spine surgery (48.5% vs 57.7%; p=0.403), cMIS (58.7% vs 73.1%; p=0.222), posterior osteotomies (43.6% vs 34.6%; p=0.409), levels instrumented (7.8 vs 8; p=0.895), and interbody fusion levels (3.4 vs 3.6; p=0.478). Preop and postop spinopelvic parameters were similar between groups, except for postop SVA which was higher in the LLIF group (40mm vs 13mm; p = 0.028). One year PI-LL (3.8 vs 5.8; p=0.555), PT (20.6 vs 22.9; p=0.536), and SVA were normalized in both groups. Preoperative and postoperative ODI, VAS, and SRS -22 scores were similar between groups. Complication rates between groups were similar as well (57.4% LLIF vs 57.7% ACR; p=0.98), including neurologic (16.8% vs 15.4%; p=0.859) and vascular (0% for both groups) injuries. CONCLUSIONS: Use of ACR via lateral approach for correction of adult spinal deformity results in no increase in neurologic, vascular, or other overall complications rates, when compared to using LLIF alone, but is a more complex procedure and should be performed by highly experienced
surgeons. Optimization of spino-pelvic parameters was achieved regardless of the technique employed. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.221
207. Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity Robert K. Eastlack, MD1, Richard G. Fessler, MD, PhD2, Khoi D. Than, MD3, Stacie Tran, MPH4, Dean Chou, MD5, Andrew K. Chan, MD6, Kai-Ming G. Fu, MD, PhD7, Paul Park, MD8, Michael Y. Wang, MD9, Adam S. Kanter, MD10, David O. Okonkwo, MD11, Pierce D. Nunley, MD12, Juan S. Uribe, MD13, Gregory M. Mundis Jr., MD14, International Spine Study Group 15; 1 Scripps Clinic, San Diego, CA, US; 2 Rush University Medical Center, Dept of Neuro Surgery, Chicago, IL, US; 3 Oregon Health & Science University, Portland, OR, US; 4 San Diego Spine Foundation, San Diego, CA, US; 5 University of California San Francisco, San Francisco, CA, US; 6 Department of Neurological Surgery, UCSF, San Francisco, CA, US; 7 Weill Cornell Medicine/ NewYork Presbyterian, New York, NY, US; 8 University Of Michigan Dept of Neurosurgery, Ann Arbor, MI, US; 9 University of Miami, Dept of Neurosurgery, Miami, FL, US; 10 UPMC-Presbyterian/Dept of Neurological Surgery, Pittsburgh, PA, US; 11 Pittsburgh, PA, US; 12 Spine Institute of Louisiana, Shreveport, LA, US; 13 Barrow Neurological Institute, Phoenix, AZ, US; 14 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, US; 15 Brighton, CO, US BACKGROUND CONTEXT: Previous research has demonstrated short term benefit in radiographic and clinical outcomes using minimally invasive (cMIS) and Hybrid techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. PURPOSE: Evaluate the durability of radiologic and clinical outcomes in cMIS and Hybrid correction of ASD. STUDY DESIGN/SETTING: Multicenter retrospective review of ASD database PATIENT SAMPLE: A total of 197 (99%) patients were evaluated at 2 years and 96 (49%) patients had 3 year data available. Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20˚, SVA>5cm, PT>20˚, PI-LL >10˚. OUTCOME MEASURES: Adjusting for age and preoperative Cobb angle, radiographic, clinical outcomes and complications were assessed at 2 and 3 years postoperatively. METHODS: A retrospective data base was analyzed using paired t-test and Mann-Whitney U analysis for continuous variables and Chi-Square analysis for categorical variables RESULTS: A total of 197 (99%) patients were evaluated at 2 years and 96 (49%) patients had 3-year data available. When analyzing the latest data available, cMIS corrected the Cobb angle greater than Hybrid technique (18.3 vs 15.2, p<.029). At 2 years postoperatively cMIS improved back pain (3.8 vs 2.7, p<.002) and ODI (35.6 vs 25.5, p<.002) more than Hybrid technique. CMIS had greater overall change in back pain from baseline (3.8 vs 2.7 p<.023) and as a percentage of baseline (58% vs 35%, p<.01). These were no longer significant at 3 years. Consistent with this, between the 2 and 3 year data points, cMIS had greater loss of improvement in
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
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Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140
overall ODI score (p<.017) and as a percentage (p<.028). cMIS technique had significantly fewer complications than Hybrid technique in overall complications, major and minor complications, infections, neurologic and cardiopulmonary categories. CONCLUSIONS: In this retrospective review of a large database of patients undergoing minimally invasive and Hybrid surgery for ASD, both techniques significantly improved radiographic parameters, and this was maintained through 2 and 3 years. When controlling for age and pre-operative Cobb angle, cMIS improved Cobb angle slightly more than Hybrid technique. Although back pain and ODI were significantly more improved using cMIS technique at 2 years, this difference was no longer significant by 3 years. Complications were significantly less frequent using cMIS than Hybrid technique. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.222
208. Predictors of superior recovery kinetics in adult cervical deformity correction: an analysis using a novel area under the curve methodology Katherine E. Pierce, BS1, Peter G. Passias, MD2, Renaud Lafage, MSc3, Virginie Lafage, PhD3, Douglas C. Burton, MD4, Robert A. Hart, MD5, D. Kojo Hamilton, MD6, Jeffrey L. Gum, MD7, Justin K. Scheer, MD8, Alan H. Daniels, MD9, Shay Bess, MD10, Daniel M. Sciubba, MD16, Alexandra Soroceanu, MD, MPH11, Eric O. Klineberg, MD12, Christopher I. Shaffrey, MD13, Breton Line, BS14, Frank J. Schwab, MD3, Justin S. Smith, MD, PhD15, Christopher P. Ames, MD8, International Spine Study Group 16,17; 1 New York, NY, US; 2 NY Spine Institute, NYU Langone Health, New York, NY, US; 3 Hospital for Special Surgery, New York, NY, US; 4 University of Kansas Medical Center, Kansas City, KS, US; 5 Swedish Neuroscience Institute, Seattle, WA, US; 6 University of Pittsburgh School of Medicine, Pittsburgh, PA, US; 7 Norton Leatherman Spine Center, Louisville, KY, US; 8 University of California, San Francisco, San Francisco, CA, US; 9 Warren Alpert Medical School of BU/ RI Hospital, Providence, RI, US; 10 Denver, CO, US; 11 University of Calgary, Calgary, Canada; 12 UC, Davis School of Medicine, Sacramento, CA, US; 13 University of Virginia, Charlottesville, VA, US; 14 Denver International Spine Center, Denver, CO, US; 15 UVA Health System, Charlottesville, VA, US; 16 Brighton, CO, US; 16 John Hopkins University, School of Medicine BACKGROUND CONTEXT: Novel analyses of clinical outcomes following cervical deformity (CD) corrective surgery use an area-under-thecurve (AUC) method to assess health-related quality of life (HRQL) metrics throughout the surgical recovery process. It remains unclear how demographics, preop parameters, and surgical decisions are associated with superior recovery. PURPOSE: Identify demographic, surgical and radiographic factors that predict superior recovery kinetics. STUDY DESIGN/SETTING: Retrospective review of a prospective CD database. PATIENT SAMPLE: A total of 98 CD patients. OUTCOME MEASURES: Baseline (BL) to 1-year (1Y) HRQL Instruments: Neck Disability Index (NDI). METHODS: CD database criteria:C2-7 Cobb angle>10˚, coronal Cobb angle >10˚, cSVA>4cm or TS-CL>10˚, or CBVA>25˚. Following univariate analyses, the AUC normalization method was utilized by dividing all reported BL and postoperative(3M, 1Y) outcome measures by the BL score. Normalized scores(y-axis) were plotted against follow-up time interval(x-axis). Total area was calculated for all follow-up, divided by cumulative follow-up length, determining overall, time-adjusted HRQL recovery (Integrated Health State[IHS]). IHS NDI scores were stratified by quartile, the uppermost 25% were categorized as having “superior” recovery kinetics (SRK) vs “normal” recovery kinetics (NRK). BL demographic, clinical
and surgical information were used to predict SRK using generalized linear modeling. RESULTS: A total of 98 patients included(62§10yrs, 28§6kg/m2, 65%F). Mean CCI: 0.95, 6% smokers, and 31% history of smoking. Surgical approach: combined(33%), posterior(49%), anterior(18%). Average posterior levels fused: 8.7, anterior levels fused: 3.6, EBL: 915.9ccs, op time: 495min. According to the Ames CD classification at BL: cSVA (53.2% minor deformity and 46.8% moderate), TS-CL (9.8% minor, 4.3% moderate, 85.9% marked), and horizontal gaze (27.4% minor, 46.6% moderate, 26% marked). Relative to BL NDI scores (mean: 47), normalized postop NDI scores showed decrease in disability at 3M(0.9§0.5, p=0.260) and a further decrease at 1Y (0.78§0.41, p<0.001). As assessed with normalized NDI scores, patients showed significant improvement in neck disability from BL to 1Y postoperative (p<0.001). NDI IHS scores demonstrated correlation with age (p=0.011), gender (p=0.042), anterior approach only (p=0.042), posterior approach (p=0.042). After grouping by quartile, patients with greater BL PT (SRK:25.6˚, NRK:17˚, p=0.002), PILL (SRK:8.4˚, NRK:-2.8˚, p=0.009), and anterior approach (SRK:34.8%, NRK:13.3%; p=0.020) correlated strongly with SRK. A total of 69.4% of patients met MCID for NDI (
209. Global spinal deformity from the upper cervical perspective: what is “abnormal” in the upper cervical spine? Peter G. Passias, MD1, Haddy Alas, BS2, Renaud Lafage, MSc3, Bassel G. Diebo, MD4, Christopher P. Ames, MD5, Paul Park, MD6, Khoi D. Than, MD7, Alan H. Daniels, MD8, D. Kojo Hamilton, MD9, Douglas C. Burton, MD10, Robert A. Hart, MD11, Shay Bess, MD12, Breton Line, BS13, Eric O. Klineberg, MD14, Christopher I. Shaffrey, MD15, Justin S. Smith, MD, PhD16, Frank J. Schwab, MD3, Virginie Lafage, PhD3, International Spine Study Group 17; 1 NY Spine Institute, NYU Langone Health, New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 Hospital for Special Surgery, New York, NY, US; 4 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, US; 5 University of California, San Francisco, San Francisco, CA, US; 6 University Of Michigan - Dept of Neurosurgery, Ann Arbor, MI, US; 7 Oregon Health & Science University, Portland, OR, US; 8 Warren Alpert Medical School of BU/RI Hospital, Providence, RI, US; 9 University of Pittsburgh School of Medicine, Pittsburgh, PA, US; 10 University of Kansas Medical Center, Kansas City, KS, US; 11 Swedish Neuroscience Institute, Seattle, WA, US; 12 Denver, CO, US; 13 Denver International Spine Center, Denver, CO, US; 14 UC, Davis School of Medicine, Sacramento, CA, US; 15 University of Virginia, Charlottesville, VA, US; 16 UVA Health System, Charlottesville, VA, US; 17 Brighton, CO, US BACKGROUND CONTEXT: Reciprocal changes in cervical alignment occur with incremental degrees of adult spinal deformity (ASD) severity, or across different sagittal morphotypes as described respectively by Schwab and Roussouly systems. The extent to which these systems relate changes in the upper cervical spine remains underexplored.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
Friday, September 27, 2019 7:30 − 8:55 AM Spinal Deformity IV 206. Does ACR result in greater morbidity than LLIF alone when treating adult spinal deformity? Robert K. Eastlack, MD1, Juan S. Uribe, MD2, Richard G. Fessler, MD, PhD3, Khoi D. Than, MD4, Stacie Tran, MPH5, Dean Chou, MD6, Paul Park, MD7, Kai-Ming G. Fu, MD, PhD8, Michael Y. Wang, MD9, Adam S. Kanter, MD10, David O. Okonkwo, MD11, Pierce D. Nunley, MD12, Gregory M. Mundis Jr., MD13, International Spine Study Group 14; 1 Scripps Clinic, San Diego, CA, US; 2 Barrow Neurological Institute, Phoenix, AZ, US; 3 Rush University Medical Center, Dept of Neuro Surgery, Chicago, IL, US; 4 Oregon Health & Science University, Portland, OR, US; 5 San Diego Spine Foundation, San Diego, CA, US; 6 University of California San Francisco, San Francisco, CA, US; 7 University Of Michigan - Dept of Neurosurgery, Ann Arbor, MI, US; 8 Weill Cornell Medicine/NewYork Presbyterian, New York, NY, US; 9 University of Miami, Dept of Neurosurgery, Miami, FL, US; 10 UPMC-Presbyterian/Dept of Neurological Surgery, Pittsburgh, PA, US; 11 Pittsburgh, PA, US; 12 Spine Institute of Louisiana, Shreveport, LA, US; 13 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, US; 14 Brighton, CO, US BACKGROUND CONTEXT: Anterior column realignment (ACR) can be utilized for correction of adult spinal deformity (ASD), but the additional benefit over lateral lumbar interbody fusion (LLIF) alone is unclear. PURPOSE: To evaluate the relative impact of ACR vs LLIF on clinical and radiographic outcomes, as well as complication rates, when surgically treating ASD. STUDY DESIGN/SETTING: Prospective multicenter database review. PATIENT SAMPLE: A total of 127 patients. OUTCOME MEASURES: Oswestry Disability Index (ODI), visual analog score (VAS), SRS-22. METHODS: Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20˚, SVA>5cm, PT>20˚, PI-LL >10˚. Patients were treated with circumferential MIS (cMIS) surgery or hybrid MIS surgery, underwent LLIF (LLIF group) or ACR/LLIF (ACR group) and had 1-year minimum follow-up. RESULTS: A total of 127 patients met inclusion criteria, 101 underwent LLIF and 26 had ACR. Average age and BMI were 66.3/27.7 and 67.8/ 27.4 (p=0.654/0.957). The groups had similar rates of prior spine surgery (48.5% vs 57.7%; p=0.403), cMIS (58.7% vs 73.1%; p=0.222), posterior osteotomies (43.6% vs 34.6%; p=0.409), levels instrumented (7.8 vs 8; p=0.895), and interbody fusion levels (3.4 vs 3.6; p=0.478). Preop and postop spinopelvic parameters were similar between groups, except for postop SVA which was higher in the LLIF group (40mm vs 13mm; p = 0.028). One year PI-LL (3.8 vs 5.8; p=0.555), PT (20.6 vs 22.9; p=0.536), and SVA were normalized in both groups. Preoperative and postoperative ODI, VAS, and SRS -22 scores were similar between groups. Complication rates between groups were similar as well (57.4% LLIF vs 57.7% ACR; p=0.98), including neurologic (16.8% vs 15.4%; p=0.859) and vascular (0% for both groups) injuries. CONCLUSIONS: Use of ACR via lateral approach for correction of adult spinal deformity results in no increase in neurologic, vascular, or other overall complications rates, when compared to using LLIF alone, but is a more complex procedure and should be performed by highly experienced
surgeons. Optimization of spino-pelvic parameters was achieved regardless of the technique employed. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.221
207. Two- and three-year outcomes of minimally invasive and hybrid correction of adult spinal deformity Robert K. Eastlack, MD1, Richard G. Fessler, MD, PhD2, Khoi D. Than, MD3, Stacie Tran, MPH4, Dean Chou, MD5, Andrew K. Chan, MD6, Kai-Ming G. Fu, MD, PhD7, Paul Park, MD8, Michael Y. Wang, MD9, Adam S. Kanter, MD10, David O. Okonkwo, MD11, Pierce D. Nunley, MD12, Juan S. Uribe, MD13, Gregory M. Mundis Jr., MD14, International Spine Study Group 15; 1 Scripps Clinic, San Diego, CA, US; 2 Rush University Medical Center, Dept of Neuro Surgery, Chicago, IL, US; 3 Oregon Health & Science University, Portland, OR, US; 4 San Diego Spine Foundation, San Diego, CA, US; 5 University of California San Francisco, San Francisco, CA, US; 6 Department of Neurological Surgery, UCSF, San Francisco, CA, US; 7 Weill Cornell Medicine/ NewYork Presbyterian, New York, NY, US; 8 University Of Michigan Dept of Neurosurgery, Ann Arbor, MI, US; 9 University of Miami, Dept of Neurosurgery, Miami, FL, US; 10 UPMC-Presbyterian/Dept of Neurological Surgery, Pittsburgh, PA, US; 11 Pittsburgh, PA, US; 12 Spine Institute of Louisiana, Shreveport, LA, US; 13 Barrow Neurological Institute, Phoenix, AZ, US; 14 Scripps Clinic Medical Group, Department of Orthopedics, La Jolla, CA, US; 15 Brighton, CO, US BACKGROUND CONTEXT: Previous research has demonstrated short term benefit in radiographic and clinical outcomes using minimally invasive (cMIS) and Hybrid techniques to correct adult spinal deformity (ASD). However, it is not known if these benefits are maintained over longer periods of time. PURPOSE: Evaluate the durability of radiologic and clinical outcomes in cMIS and Hybrid correction of ASD. STUDY DESIGN/SETTING: Multicenter retrospective review of ASD database PATIENT SAMPLE: A total of 197 (99%) patients were evaluated at 2 years and 96 (49%) patients had 3 year data available. Inclusion criteria were age ≥18 years, and one of the following: coronal cobb>20˚, SVA>5cm, PT>20˚, PI-LL >10˚. OUTCOME MEASURES: Adjusting for age and preoperative Cobb angle, radiographic, clinical outcomes and complications were assessed at 2 and 3 years postoperatively. METHODS: A retrospective data base was analyzed using paired t-test and Mann-Whitney U analysis for continuous variables and Chi-Square analysis for categorical variables RESULTS: A total of 197 (99%) patients were evaluated at 2 years and 96 (49%) patients had 3-year data available. When analyzing the latest data available, cMIS corrected the Cobb angle greater than Hybrid technique (18.3 vs 15.2, p<.029). At 2 years postoperatively cMIS improved back pain (3.8 vs 2.7, p<.002) and ODI (35.6 vs 25.5, p<.002) more than Hybrid technique. CMIS had greater overall change in back pain from baseline (3.8 vs 2.7 p<.023) and as a percentage of baseline (58% vs 35%, p<.01). These were no longer significant at 3 years. Consistent with this, between the 2 and 3 year data points, cMIS had greater loss of improvement in
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.
S102
Proceedings of the 34th Annual Meeting of the North American Spine Society / The Spine Journal 19 (2019) S101−S140
overall ODI score (p<.017) and as a percentage (p<.028). cMIS technique had significantly fewer complications than Hybrid technique in overall complications, major and minor complications, infections, neurologic and cardiopulmonary categories. CONCLUSIONS: In this retrospective review of a large database of patients undergoing minimally invasive and Hybrid surgery for ASD, both techniques significantly improved radiographic parameters, and this was maintained through 2 and 3 years. When controlling for age and pre-operative Cobb angle, cMIS improved Cobb angle slightly more than Hybrid technique. Although back pain and ODI were significantly more improved using cMIS technique at 2 years, this difference was no longer significant by 3 years. Complications were significantly less frequent using cMIS than Hybrid technique. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs. https://doi.org/10.1016/j.spinee.2019.05.222
208. Predictors of superior recovery kinetics in adult cervical deformity correction: an analysis using a novel area under the curve methodology Katherine E. Pierce, BS1, Peter G. Passias, MD2, Renaud Lafage, MSc3, Virginie Lafage, PhD3, Douglas C. Burton, MD4, Robert A. Hart, MD5, D. Kojo Hamilton, MD6, Jeffrey L. Gum, MD7, Justin K. Scheer, MD8, Alan H. Daniels, MD9, Shay Bess, MD10, Daniel M. Sciubba, MD16, Alexandra Soroceanu, MD, MPH11, Eric O. Klineberg, MD12, Christopher I. Shaffrey, MD13, Breton Line, BS14, Frank J. Schwab, MD3, Justin S. Smith, MD, PhD15, Christopher P. Ames, MD8, International Spine Study Group 16,17; 1 New York, NY, US; 2 NY Spine Institute, NYU Langone Health, New York, NY, US; 3 Hospital for Special Surgery, New York, NY, US; 4 University of Kansas Medical Center, Kansas City, KS, US; 5 Swedish Neuroscience Institute, Seattle, WA, US; 6 University of Pittsburgh School of Medicine, Pittsburgh, PA, US; 7 Norton Leatherman Spine Center, Louisville, KY, US; 8 University of California, San Francisco, San Francisco, CA, US; 9 Warren Alpert Medical School of BU/ RI Hospital, Providence, RI, US; 10 Denver, CO, US; 11 University of Calgary, Calgary, Canada; 12 UC, Davis School of Medicine, Sacramento, CA, US; 13 University of Virginia, Charlottesville, VA, US; 14 Denver International Spine Center, Denver, CO, US; 15 UVA Health System, Charlottesville, VA, US; 16 Brighton, CO, US; 16 John Hopkins University, School of Medicine BACKGROUND CONTEXT: Novel analyses of clinical outcomes following cervical deformity (CD) corrective surgery use an area-under-thecurve (AUC) method to assess health-related quality of life (HRQL) metrics throughout the surgical recovery process. It remains unclear how demographics, preop parameters, and surgical decisions are associated with superior recovery. PURPOSE: Identify demographic, surgical and radiographic factors that predict superior recovery kinetics. STUDY DESIGN/SETTING: Retrospective review of a prospective CD database. PATIENT SAMPLE: A total of 98 CD patients. OUTCOME MEASURES: Baseline (BL) to 1-year (1Y) HRQL Instruments: Neck Disability Index (NDI). METHODS: CD database criteria:C2-7 Cobb angle>10˚, coronal Cobb angle >10˚, cSVA>4cm or TS-CL>10˚, or CBVA>25˚. Following univariate analyses, the AUC normalization method was utilized by dividing all reported BL and postoperative(3M, 1Y) outcome measures by the BL score. Normalized scores(y-axis) were plotted against follow-up time interval(x-axis). Total area was calculated for all follow-up, divided by cumulative follow-up length, determining overall, time-adjusted HRQL recovery (Integrated Health State[IHS]). IHS NDI scores were stratified by quartile, the uppermost 25% were categorized as having “superior” recovery kinetics (SRK) vs “normal” recovery kinetics (NRK). BL demographic, clinical
and surgical information were used to predict SRK using generalized linear modeling. RESULTS: A total of 98 patients included(62§10yrs, 28§6kg/m2, 65%F). Mean CCI: 0.95, 6% smokers, and 31% history of smoking. Surgical approach: combined(33%), posterior(49%), anterior(18%). Average posterior levels fused: 8.7, anterior levels fused: 3.6, EBL: 915.9ccs, op time: 495min. According to the Ames CD classification at BL: cSVA (53.2% minor deformity and 46.8% moderate), TS-CL (9.8% minor, 4.3% moderate, 85.9% marked), and horizontal gaze (27.4% minor, 46.6% moderate, 26% marked). Relative to BL NDI scores (mean: 47), normalized postop NDI scores showed decrease in disability at 3M(0.9§0.5, p=0.260) and a further decrease at 1Y (0.78§0.41, p<0.001). As assessed with normalized NDI scores, patients showed significant improvement in neck disability from BL to 1Y postoperative (p<0.001). NDI IHS scores demonstrated correlation with age (p=0.011), gender (p=0.042), anterior approach only (p=0.042), posterior approach (p=0.042). After grouping by quartile, patients with greater BL PT (SRK:25.6˚, NRK:17˚, p=0.002), PILL (SRK:8.4˚, NRK:-2.8˚, p=0.009), and anterior approach (SRK:34.8%, NRK:13.3%; p=0.020) correlated strongly with SRK. A total of 69.4% of patients met MCID for NDI (
209. Global spinal deformity from the upper cervical perspective: what is “abnormal” in the upper cervical spine? Peter G. Passias, MD1, Haddy Alas, BS2, Renaud Lafage, MSc3, Bassel G. Diebo, MD4, Christopher P. Ames, MD5, Paul Park, MD6, Khoi D. Than, MD7, Alan H. Daniels, MD8, D. Kojo Hamilton, MD9, Douglas C. Burton, MD10, Robert A. Hart, MD11, Shay Bess, MD12, Breton Line, BS13, Eric O. Klineberg, MD14, Christopher I. Shaffrey, MD15, Justin S. Smith, MD, PhD16, Frank J. Schwab, MD3, Virginie Lafage, PhD3, International Spine Study Group 17; 1 NY Spine Institute, NYU Langone Health, New York, NY, US; 2 Department of Orthopedic Surgery, NYU Langone Orthopedic Hospital, NYU Langone Health, New York, NY, US; 3 Hospital for Special Surgery, New York, NY, US; 4 Department of Orthopaedic Surgery, SUNY Downstate Medical Center, Brooklyn, NY, US; 5 University of California, San Francisco, San Francisco, CA, US; 6 University Of Michigan - Dept of Neurosurgery, Ann Arbor, MI, US; 7 Oregon Health & Science University, Portland, OR, US; 8 Warren Alpert Medical School of BU/RI Hospital, Providence, RI, US; 9 University of Pittsburgh School of Medicine, Pittsburgh, PA, US; 10 University of Kansas Medical Center, Kansas City, KS, US; 11 Swedish Neuroscience Institute, Seattle, WA, US; 12 Denver, CO, US; 13 Denver International Spine Center, Denver, CO, US; 14 UC, Davis School of Medicine, Sacramento, CA, US; 15 University of Virginia, Charlottesville, VA, US; 16 UVA Health System, Charlottesville, VA, US; 17 Brighton, CO, US BACKGROUND CONTEXT: Reciprocal changes in cervical alignment occur with incremental degrees of adult spinal deformity (ASD) severity, or across different sagittal morphotypes as described respectively by Schwab and Roussouly systems. The extent to which these systems relate changes in the upper cervical spine remains underexplored.
Refer to onsite annual meeting presentations and postmeeting proceedings for possible referenced figures and tables. Authors are responsible for accurately reporting disclosure and FDA device/drug status at time of abstract submission.