Predictive Model for Patient-Reported Outcomes Scores following Cervical Spine Deformity Surgical Correction

Study Design: Retrospective cohort study. Objectives: This study aimed to address the prevalence, distribution, and clinical significance of cervical high-intensity zones (HIZs) on magnetic resonance imaging (MRI) with respect to pain and other patient-reported outcomes in the setting of patients that will undergo an anterior cervical discectomy and fusion (ACDF) procedure. Methods: A retrospective cohort study of ACDF patients surgically treated at a single center from 2008 to 2015. Based on preoperative MRI, HIZ subtypes were identified as either traditional T2-hyperintense, T1-hypointense (“single-HIZs”), or combined T1- and T2-hyperintense (“dual-HIZs”), and their level-specific prevalence was assessed. Preoperative symptoms, patient-reported outcomes, and disc degeneration pathology were assessed in relation to HIZs and HIZ subtypes. Results: Of 861 patients, 58 demonstrated evidence of HIZs in the cervical spine (6.7%). Single-HIZs and dual-HIZs comprised 63.8% and 36.2% of the overall HIZs, respectively. HIZs found outside of the planned fusion segment reported better preoperative Neck Disability Index (NDI; P = .049) and Visual Analogue Scale (VAS) Arm ( P = .014) scores relative to patients without HIZs. Furthermore, patients with single-HIZs found inside the planned fusion segment had worse VAS Neck ( P = .045) and VAS Arm ( P = .010) scores. In general, dual-HIZ patients showed no significant differences across all clinical outcomes. Conclusions: This is the first study to evaluate the clinical significance of HIZs in the cervical spine, noting level-specific and clinical outcome–specific variations. Single-HIZs were associated with significantly more pain when located inside the fusion segment, while dual-HIZs showed no associations with patient-reported outcomes. The presence of single-HIZs may correlate with concurrent spinal pathologies and should be more closely evaluated.

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Generating the American Shoulder and Elbow Surgeons Score Using Multivariable Predictive Models and Computer Adaptive Testing to Reduce Survey Burden

The American Journal of Sports Medicine ◽

10.1177/0363546520987240 ◽

2021 ◽

Vol 49 (3) ◽

pp. 764-772

Author(s):

Matthew S. Tenan ◽

Joseph W. Galvin ◽

Timothy C. Mauntel ◽

John M. Tokish ◽

James R. Bailey ◽

...

Keyword(s):

Physical Function ◽

Predictive Model ◽

Predictive Models ◽

Patient Reported Outcomes ◽

Patient Survey ◽

Patient Reported Outcome ◽

Pain Interference ◽

Measurement Information ◽

Level Of Evidence ◽

Patient Reported

Background: The preferred patient-reported outcome measure for the assessment of shoulder conditions continues to evolve. Previous studies correlating the Patient-Reported Outcomes Measurement Information System (PROMIS) computer adaptive tests (CATs) to the American Shoulder and Elbow Surgeons (ASES) score have focused on a singular domain (pain or physical function) but have not evaluated the combined domains of pain and physical function that compose the ASES score. Additionally, previous studies have not provided a multivariable prediction tool to convert PROMIS scores to more familiar legacy scores. Purpose: To establish a valid predictive model of ASES scores using a nonlinear combination of PROMIS domains for physical function and pain. Study Design: Cohort study (Diagnosis); Level of evidence, 3. Methods: The Military Orthopaedics Tracking Injuries and Outcomes Network (MOTION) database is a prospectively collected repository of patient-reported outcomes and intraoperative variables. Patients in MOTION research who underwent shoulder surgery and completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at varying time points were included in the present analysis. Nonlinear multivariable predictive models were created to establish an ASES index score and then validated using “leave 1 out” techniques and minimal clinically important difference /substantial clinical benefit (MCID/SCB) analysis. Results: A total of 909 patients completed the ASES, PROMIS Physical Function, and PROMIS Pain Interference at presurgery, 6 weeks, 6 months, and 1 year after surgery, providing 1502 complete observations. The PROMIS CAT predictive model was strongly validated to predict the ASES (Pearson coefficient = 0.76-0.78; R2 = 0.57-0.62; root mean square error = 13.3-14.1). The MCID/SCB for the ASES was 21.7, and the best ASES index MCID/SCB was 19.4, suggesting that the derived ASES index is effective and can reliably re-create ASES scores. Conclusion: The PROMIS CAT predictive models are able to approximate the ASES score within 13 to 14 points, which is 7 points more accurate than the ASES MCID/SCB derived from the sample. Our ASES index algorithm, which is freely available online ( https://osf.io/ctmnd/ ), has a lower MCID/SCB than the ASES itself. This algorithm can be used to decrease patient survey burden by 11 questions and provide a reliable ASES analog to clinicians.

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Effects of Psychiatric Factors on Patient-Reported Outcomes after Surgical Correction of Lumbar Degenerative Kyphosis

Asian Spine Journal ◽

10.4184/asj.2018.12.1.126 ◽

2018 ◽

Vol 12 (1) ◽

pp. 126-131 ◽

Cited By ~ 2

Author(s):

Tae Sik Goh ◽

Jong Ki Shin ◽

Myung Soo Youn ◽

Jung Sub Lee

Keyword(s):

Patient Reported Outcomes ◽

Short Form ◽

Surgical Correction ◽

Osteotomy Site ◽

Corrective Surgery ◽

Mineral Density ◽

Patient Reported ◽

Psychiatric Problems ◽

Component Scores

<sec><title>Study Design</title>A prospective study.</sec><sec><title>Purpose</title>To identify associations between psychiatric factors and patient-reported outcomes after corrective surgery in patients with lumbar degenerative kyphosis (LDK).</sec><sec><title>Overview of Literature</title>Thus far, to the best of our knowledge, patient factors that may help predict patient-reported outcomes after corrective surgery for LDK have not been studied.</sec><sec><title>Methods</title>We prospectively investigated 46 patients with LDK who underwent surgical correction with a minimum follow-up of 2 years. Demographic data were collected. Short form-36, mental component scores (MCS), physical component scores (PCS), Scoliosis Research Society-22 (SRS-22) scores, and Roland-Morris Disability Questionnaire (RMDQ) scores were determined before the surgery and after 2 years of follow-up. Psychiatric conditions were preoperatively evaluated using the Zung depression scale (ZDS) and Zung anxiety scale (ZAS). Patients were divided into two groups (with or without psychiatric issues), according to baseline ZDS and ZAS scores.</sec><sec><title>Results</title>Patients included 43 women and 3 men. Twelve patients were deemed to have psychiatric problems (P group) and 34 patients had no psychiatric problems (NP group). No significant intergroup differences were found in MCS, PCS, SRS-22, and RMDQ scores preoperatively. However, at the 2-year follow-up, a significant intergroup difference was observed between PCS and RMDQ scores. Multiple regression analysis revealed that only the presence of a preoperative psychiatric problem can predict PCS and RMDQ scores. Other factors, such as, gender, age, body mass index, bone mineral density, osteotomy site, number of fusion segments, and instrumented levels did not affect PCS or RMDQ scores.</sec><sec><title>Conclusions</title>The presence of a psychiatric factor may be an important risk factor underlying poor physical and pain scores after corrective surgery in patients with LDK. The findings presented here suggest that psychiatric factors should be evaluated prior to surgery for determining the risk of a poor outcome.</sec>

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P109. Tobacco use is associated with worse patient-reported outcomes following elective cervical spine surgery

The Spine Journal ◽

10.1016/j.spinee.2019.05.534 ◽

2019 ◽

Vol 19 (9) ◽

pp. S208

Author(s):

Jose H. Jimenez-Almonte ◽

Ifeanyi N. Nzegwu ◽

Boshen Liu ◽

Jonathan D. Grabau ◽

Zeeshan Akhtar ◽

...

Keyword(s):

Cervical Spine ◽

Tobacco Use ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Cervical Spine Surgery ◽

Patient Reported

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Development and Validation of Cervical Prediction Models for Patient-Reported Outcomes at 1 Year After Cervical Spine Surgery for Radiculopathy and Myelopathy

Spine ◽

10.1097/brs.0000000000003610 ◽

2020 ◽

Vol 45 (22) ◽

pp. 1541-1552

Author(s):

Kristin R. Archer ◽

Mohamad Bydon ◽

Inamullah Khan ◽

Hui Nian ◽

Jacquelyn S. Pennings ◽

...

Keyword(s):

Cervical Spine ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Prediction Models ◽

Cervical Spine Surgery ◽

Patient Reported ◽

Development And Validation

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Patient-Reported Outcomes and Costs Associated With Revision Surgery for Degenerative Cervical Spine Diseases

Spine ◽

10.1097/brs.0000000000002361 ◽

2018 ◽

Vol 43 (7) ◽

pp. E423-E429 ◽

Cited By ~ 3

Author(s):

Elliott J. Kim ◽

Silky Chotai ◽

Joseph B. Wick ◽

David P. Stonko ◽

Ahilan Sivaganesan ◽

...

Keyword(s):

Cervical Spine ◽

Revision Surgery ◽

Patient Reported Outcomes ◽

Patient Reported ◽

Spine Diseases ◽

Degenerative Cervical Spine

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Factors associated with chronic opioid use after cervical spine surgery for degenerative conditions

Journal of Neurosurgery Spine ◽

10.3171/2019.7.spine19563 ◽

2020 ◽

Vol 32 (1) ◽

pp. 1-8 ◽

Cited By ~ 1

Author(s):

Marjorie C. Wang ◽

Andrew M. Lozen ◽

Purushottam W. Laud ◽

Ann B. Nattinger ◽

Erin E. Krebs

Keyword(s):

Cervical Spine ◽

Pain Relief ◽

Spine Surgery ◽

Patient Reported Outcomes ◽

Opioid Use ◽

Duration Of Symptoms ◽

Cervical Spine Surgery ◽

Sf 36 ◽

Patient Reported ◽

Chronic Opioid Use

OBJECTIVEOpioids are commonly prescribed after surgery for painful spinal conditions, yet little is known about postoperative opioid use. The relationship between chronic opioid use and patient-reported outcomes and satisfaction with surgery is also unclear. The purpose of this study was to evaluate factors associated with opioid use 1 year after elective cervical spine surgery for degenerative conditions causing radiculopathy and myelopathy. The authors hypothesized that patients with preoperative opioid use would be more likely to report postoperative opioid use at 1 year, and that postoperative opioid use would be associated with patient-reported outcomes and dissatisfaction with surgery.METHODSThe authors performed a retrospective study of a prospective cohort of adult patients who underwent elective cervical spine surgery for degenerative changes causing radiculopathy or myelopathy. Patients were prospectively and consecutively enrolled from a single academic center after the decision for surgery had been made. Postoperative in-hospital pain management was conducted using a standardized protocol. The primary outcome was any opioid use 1 year after surgery. Secondary outcomes were the Neck Disability Index (NDI); 36-Item Short-Form Health Survey (SF-36) physical function (PF), bodily pain (BP), and mental component summary (MCS) scores; the modified Japanese Orthopaedic Association (mJOA) score among myelopathy patients; and patient expectations surveys. Patients with and without preoperative opioid use were compared using the chi-square and Student t-tests, and multiple logistic regression was used to study the associations between patient and surgical characteristics and postoperative opioid use 1 year after surgery.RESULTSTwo hundred eleven patients were prospectively and consecutively enrolled, of whom 39 were lost to follow-up for the primary outcome; 43.6% reported preoperative opioid use. Preoperative NDI and SF-36 PF and BP scores were significantly worse in the preoperative opioid cohort. More than 94% of both cohorts rated expectations of pain relief as extremely or somewhat important. At 1 year after surgery, 50.7% of the preoperative-opioid-use cohort reported ongoing opioid use, and 17.5% of patients in the no-preoperative-opioid-use cohort reported ongoing opioid use. Despite this, both cohorts reported similar improvements in NDI as well as SF-36 PF, BP, and MCS scores. More than 70% of both cohorts also reported being extremely or somewhat satisfied with pain relief after surgery. Predictors of 1-year opioid use included preoperative opioid use, duration of symptoms for more than 9 months before surgery, tobacco use, and higher comorbidity index.CONCLUSIONSOne year after elective cervical spine surgery, patients with preoperative opioid use were significantly more likely to report ongoing opioid use. However, patients in both groups reported similar improvements in patient-reported outcomes and satisfaction with pain relief. Interventions targeted at decreasing opioid use may need to focus on patient factors such as preoperative opioid use or duration of symptoms before surgery.

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