@article{6997a96f38d94626a8911f80bb471d31,
title = "Recovery Kinetics: Comparison of Patients Undergoing Primary or Revision Procedures for Adult Cervical Deformity Using a Novel Area under the Curve Methodology",
abstract = "Limited data are available to objectively define what constitutes a {"}good{"} versus a {"}bad{"} recovery for operative cervical deformity (CD) patients. Furthermore, the recovery patterns of primary versus revision procedures for CD is poorly understood. OBJECTIVE: To define and compare the recovery profiles of CD patients undergoing primary or revision procedures, utilizing a novel area-under-the-curve normalization methodology. METHODS: CD patients undergoing primary or revision surgery with baseline to 1-yr health-related quality of life (HRQL) scores were included. Clinical symptoms and HRQL were compared among groups (primary/revision). Normalized HRQL scores at baseline and follow-up intervals (3M, 6M, 1Y) were generated. Normalized HRQLs were plotted and area under the curve was calculated, generating one number describing overall recovery (Integrated Health State). Subanalysis identified recovery patterns through 2-yr follow-up. RESULTS: Eighty-three patients were included (45 primary, 38 revision). Age (61.3 vs 61.9), gender (F: 66.7% vs 63.2%), body mass index (27.7 vs 29.3), Charlson Comorbidity Index, frailty, and osteoporosis (20% vs 13.2%) were similar between groups (P >. 05). Primary patients were more preoperatively neurologically symptomatic (55.6% vs 31.6%), less sagittally malaligned (cervical sagittal vertical axis [cSVA]: 32.6 vs 46.6; T1 slope: 28.8 vs 36.8), underwent more anterior-only approaches (28.9% vs 7.9%), and less posterior-only approaches (37.8% vs 60.5%), all P <. 05. Combined approaches, decompressions, osteotomies, and construct length were similar between groups (P >. 05). Revisions had longer op-times (438.0 vs 734.4 min, P =. 008). Following surgery, complication rate was similar between groups (66.6% vs 65.8%, P =. 569). Revision patients remained more malaligned (cSVA, TS-CL; P <. 05) than primary patients until 1-yr follow-up (P >. 05). Normalized HRQLs determined primary patients to exhibit less neck pain (numeric rating scale [NRS]) and myelopathy (modified Japanese Orthopaedic Association) symptoms through 1-yr follow-up compared to revision patients (P <. 05). These differences subsided when following patients through 2 yr (P >. 05). Despite similar 2-yr HRQL outcomes, revision patients exhibited worse neck pain (NRS) Integrated Health State recovery (P <. 05). CONCLUSION: Despite both primary and revision patients exhibiting similar HRQL outcomes at final follow-up, revision patients were in a greater state of postoperative neck pain for a greater amount of time.",
keywords = "Cervical deformity, HRQL, Primary surgery, Recovery kinetics, Revision surgery, Sagittal alignment, Salvage surgery",
author = "Segreto, {Frank A.} and Virginie Lafage and Renaud Lafage and Smith, {Justin S.} and Line, {Breton G.} and Eastlack, {Robert K.} and Scheer, {Justin K.} and Dean Chou and Frangella, {Nicholas J.} and Horn, {Samantha R.} and Bortz, {Cole A.} and Diebo, {Bassel G.} and Neuman, {Brian J.} and Protopsaltis, {Themistocles S.} and Kim, {Han Jo} and Klineberg, {Eric O.} and Burton, {Douglas C.} and Hart, {Robert A.} and Schwab, {Frank J.} and Shay Bess and Shaffrey, {Christopher I.} and Ames, {Christopher P.} and Passias, {Peter G.}",
note = "Funding Information: The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations, and supported the current work. The authors have the following disclosures: Dr Lafage, Depuy Synthes paid lectures, Nuvasive paid lectures, K2M paid lectures, Medtronic paid lectures, Nemaris board member and shareholder. Dr Smith, grants from DePuy Synthes during the conduct of the study, personal fees from Zimmer-Biomet, personal fees from Nuvasive, personal fees from Cerapedics, personal fees from K2M, grants from AOSpine, and grants from NREF outside the submitted work. Dr Eastlack and Dr Chou, grants to the institution from DePuy Synthes. Dr Protop-saltis, consulting fees from Medicrea, NuVasive, Globis, and Innovasis, grants to the institution from Zimmerbiomet and CSRS. Dr Kim, grants from DePuy Synthes during the conduct of the study, personal fees from K2M, personal fees from Zimmer-Biomet, grants from DePuy Synthes, grants from CSRS, other from HSS Journal, other from Asian Spine Journal, and other from Global Spine Journal outside the submitted work. Dr Klineberg, consulting for DePuy and Styker, paid speaker and fellowship support from AOSpine, and paid speaker for K2M. Dr Burton, consultant, royalties, and research support from DePuy Synthes. Dr Hart, personal fees from Globus, grants from Medtronic, personal fees from Seaspine, personal fees from DePuy Synthes, board member for CSRS, Executive Committee for ISSG, board member for ISSLS, and patent with OHSU. Dr Schwab, grants from SRS, DePuy Spine (through ISSGF), Speaking/teaching arrangements and consulting for Zimmer-Biomet, NuVasive, K2M, MSD, and Medicrea, Board of Directors, Shareholder with Nemaris Inc, Royalties from K2M and MSD. Dr Bess, consultant, royalties, research support from K2 Medical, consultant for Allosource, royalties from Pioneer, royalties and research support from Innovasis and Nuvasive, and research support from Stryker and DePuy Synthes Spine. Dr Shaffrey, royalties, patents, consultant with Medtronic, royalties, patents, consultant, stock holder with Nuvasive, royalties, patents, consultant for Zimmer Biomet, consultant for Stryker, K2M, and In Vivo, grants from the NIH, Department of Defense, ISSG, DePuy Synthes, and AO. Dr Ames, DePuy Synthes consulting fees, Medtronic consulting fees, Stryker consulting fees, Zimmer Biomet royalties, Fish & Richardson, PC patents. Dr Passias, consultant to Zimmer Biomet, Medicrea, and Spinewave. Publisher Copyright: Copyright {\textcopyright} 2018 by the Congress of Neurological Surgeons.",
year = "2019",
month = jul,
day = "1",
doi = "10.1093/neuros/nyy435",
language = "English (US)",
volume = "85",
pages = "E40--E51",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",
number = "1",
}