Forskning
Udskriv Udskriv
Switch language
Region Hovedstaden - en del af Københavns Universitetshospital
Udgivet

Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

Harvard

Kwan, KYH, Lenke, LG, Shaffrey, CI, Carreon, LY, Dahl, BT, Fehlings, MG, Ames, CP, Boachie-Adjei, O, Dekutoski, MB, Kebaish, KM, Lewis, SJ, Matsuyama, Y, Mehdian, H, Qiu, Y, Schwab, FJ, Cheung, KMC & AO Spine Knowledge Forum Deformity 2021, 'Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation', Clinical Orthopaedics and Related Research, bind 479, nr. 2, s. 312-320. https://doi.org/10.1097/CORR.0000000000001521

APA

Kwan, K. Y. H., Lenke, L. G., Shaffrey, C. I., Carreon, L. Y., Dahl, B. T., Fehlings, M. G., Ames, C. P., Boachie-Adjei, O., Dekutoski, M. B., Kebaish, K. M., Lewis, S. J., Matsuyama, Y., Mehdian, H., Qiu, Y., Schwab, F. J., Cheung, K. M. C., & AO Spine Knowledge Forum Deformity (2021). Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation. Clinical Orthopaedics and Related Research, 479(2), 312-320. https://doi.org/10.1097/CORR.0000000000001521

CBE

Kwan KYH, Lenke LG, Shaffrey CI, Carreon LY, Dahl BT, Fehlings MG, Ames CP, Boachie-Adjei O, Dekutoski MB, Kebaish KM, Lewis SJ, Matsuyama Y, Mehdian H, Qiu Y, Schwab FJ, Cheung KMC, AO Spine Knowledge Forum Deformity. 2021. Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation. Clinical Orthopaedics and Related Research. 479(2):312-320. https://doi.org/10.1097/CORR.0000000000001521

MLA

Vancouver

Author

Kwan, Kenny Yat Hong ; Lenke, Lawrence G ; Shaffrey, Christopher I ; Carreon, Leah Y ; Dahl, Benny T ; Fehlings, Michael G ; Ames, Christopher P ; Boachie-Adjei, Oheneba ; Dekutoski, Mark B ; Kebaish, Khaled M ; Lewis, Stephen J ; Matsuyama, Yukihiro ; Mehdian, Hossein ; Qiu, Yong ; Schwab, Frank J ; Cheung, Kenneth Man Chee ; AO Spine Knowledge Forum Deformity. / Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery? An External Validation. I: Clinical Orthopaedics and Related Research. 2021 ; Bind 479, Nr. 2. s. 312-320.

Bibtex

@article{d97367fdbc4d41e09723e5b51d92369b,
title = "Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery?: An External Validation",
abstract = "BACKGROUND: The Global Alignment and Proportion (GAP) score, based on pelvic incidence-based proportional parameters, was recently developed to predict mechanical complications after surgery for spinal deformities in adults. However, this score has not been validated in an independent external dataset.QUESTIONS/PURPOSES: After adult spinal deformity surgery, is a higher GAP score associated with (1) an increased risk of mechanical complications, defined as rod fractures, implant-related complications, proximal or distal junctional kyphosis or failure; (2) a higher likelihood of undergoing revision surgery to treat a mechanical complication; and (3) is a lower (more proportioned) GAP score category associated with better validated outcomes scores using the Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) and the Short Form-36 questionnaires?METHODS: A total of 272 patients who had undergone corrective surgeries for complex spinal deformities were enrolled in the Scoli-RISK-1 prospective trial. Patients were included in this secondary analysis if they fulfilled the original inclusion criteria by Yilgor et al. From the original 272 patients, 14% (39) did not satisfy the radiographic inclusion criteria, the GAP score could not be calculated in 14% (37), and 24% (64) did not have radiographic assessment at postoperative 2 years, leaving 59% (159) for analysis in this review of data from the original trial. A total of 159 patients were included in this study,with a mean age of 58 ± 14 years at the time of surgery. Most patients were female (72%, 115 of 159), the mean number of levels involved in surgery was 12 ± 4, and three-column osteotomy was performed in 76% (120 of 159) of patients. The GAP score was calculated using parameters from early postoperative radiographs (between 3 and 12 weeks) including pelvic incidence, sacral slope, lumbar lordosis, lower arc lordosis and global tilt, which were independently obtained from a computer software based on centralized patient radiographs. The GAP score was categorized as proportional (scores of 0 to 2), moderately disproportional (scores of 3 to 6), or severely disproportional (scores higher than 7 to 13). Receiver operating characteristic area under curve (AUC) was used to assess associations between GAP score and risk of mechanical complications and risk of revision surgery. An AUC of 0.5 to 0.7 was classified as {"}no or low associative power{"}, 0.7 to 0.9 as {"}moderate{"} and greater than 0.9 as {"}high{"}. We analyzed differences in validated outcome scores between the GAP categories using Wilcoxon rank sum test.RESULTS: At a minimum of 2 years' follow-up, a higher GAP score was not associated with increased risks of mechanical complications (AUC = 0.60 [95% CI 0.50 to 0.70]). A higher GAP score was not associated with a higher likelihood of undergoing a revision surgery to treat a mechanical complication (AUC = 0.66 [95% 0.53 to 0.78]). However, a moderately disproportioned GAP score category was associated with better SF-36 physical component summary score (36 ± 10 versus 40 ± 11; p = 0.047), better SF-36 mental component summary score (46 ± 13 versus 51 ± 12; p = 0.01), better SRS-22 total score (3.4 ± 0.8 versus 3.7 ± 0.7, p = 0.02) and better ODI score (35 ± 21 versus 25 ± 20; p = 0.003) than severely disproportioned GAP score category.CONCLUSION: Based on the findings of this external validation study, we found that alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. Parameters not included in the original GAP score needed to be considered to reduce the likelihood of mechanical complications.LEVEL OF EVIDENCE: Level III, diagnostic study.",
keywords = "Adolescent, Adult, Aged, Aged, 80 and over, Disability Evaluation, Female, Humans, Male, Middle Aged, Postoperative Complications/diagnosis, Predictive Value of Tests, Reoperation, Retrospective Studies, Risk, Spinal Curvatures/diagnostic imaging, Surveys and Questionnaires",
author = "Kwan, {Kenny Yat Hong} and Lenke, {Lawrence G} and Shaffrey, {Christopher I} and Carreon, {Leah Y} and Dahl, {Benny T} and Fehlings, {Michael G} and Ames, {Christopher P} and Oheneba Boachie-Adjei and Dekutoski, {Mark B} and Kebaish, {Khaled M} and Lewis, {Stephen J} and Yukihiro Matsuyama and Hossein Mehdian and Yong Qiu and Schwab, {Frank J} and Cheung, {Kenneth Man Chee} and {AO Spine Knowledge Forum Deformity}",
note = "Copyright {\textcopyright} 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of Bone and Joint Surgeons.",
year = "2021",
month = feb,
day = "1",
doi = "10.1097/CORR.0000000000001521",
language = "English",
volume = "479",
pages = "312--320",
journal = "Clinical Orthopaedics and Related Research",
issn = "0009-921X",
publisher = "Springer New York LLC",
number = "2",

}

RIS

TY - JOUR

T1 - Are Higher Global Alignment and Proportion Scores Associated With Increased Risks of Mechanical Complications After Adult Spinal Deformity Surgery?

T2 - An External Validation

AU - Kwan, Kenny Yat Hong

AU - Lenke, Lawrence G

AU - Shaffrey, Christopher I

AU - Carreon, Leah Y

AU - Dahl, Benny T

AU - Fehlings, Michael G

AU - Ames, Christopher P

AU - Boachie-Adjei, Oheneba

AU - Dekutoski, Mark B

AU - Kebaish, Khaled M

AU - Lewis, Stephen J

AU - Matsuyama, Yukihiro

AU - Mehdian, Hossein

AU - Qiu, Yong

AU - Schwab, Frank J

AU - Cheung, Kenneth Man Chee

AU - AO Spine Knowledge Forum Deformity

N1 - Copyright © 2020 The Author(s). Published by Wolters Kluwer Health, Inc. on behalf of the Association of Bone and Joint Surgeons.

PY - 2021/2/1

Y1 - 2021/2/1

N2 - BACKGROUND: The Global Alignment and Proportion (GAP) score, based on pelvic incidence-based proportional parameters, was recently developed to predict mechanical complications after surgery for spinal deformities in adults. However, this score has not been validated in an independent external dataset.QUESTIONS/PURPOSES: After adult spinal deformity surgery, is a higher GAP score associated with (1) an increased risk of mechanical complications, defined as rod fractures, implant-related complications, proximal or distal junctional kyphosis or failure; (2) a higher likelihood of undergoing revision surgery to treat a mechanical complication; and (3) is a lower (more proportioned) GAP score category associated with better validated outcomes scores using the Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) and the Short Form-36 questionnaires?METHODS: A total of 272 patients who had undergone corrective surgeries for complex spinal deformities were enrolled in the Scoli-RISK-1 prospective trial. Patients were included in this secondary analysis if they fulfilled the original inclusion criteria by Yilgor et al. From the original 272 patients, 14% (39) did not satisfy the radiographic inclusion criteria, the GAP score could not be calculated in 14% (37), and 24% (64) did not have radiographic assessment at postoperative 2 years, leaving 59% (159) for analysis in this review of data from the original trial. A total of 159 patients were included in this study,with a mean age of 58 ± 14 years at the time of surgery. Most patients were female (72%, 115 of 159), the mean number of levels involved in surgery was 12 ± 4, and three-column osteotomy was performed in 76% (120 of 159) of patients. The GAP score was calculated using parameters from early postoperative radiographs (between 3 and 12 weeks) including pelvic incidence, sacral slope, lumbar lordosis, lower arc lordosis and global tilt, which were independently obtained from a computer software based on centralized patient radiographs. The GAP score was categorized as proportional (scores of 0 to 2), moderately disproportional (scores of 3 to 6), or severely disproportional (scores higher than 7 to 13). Receiver operating characteristic area under curve (AUC) was used to assess associations between GAP score and risk of mechanical complications and risk of revision surgery. An AUC of 0.5 to 0.7 was classified as "no or low associative power", 0.7 to 0.9 as "moderate" and greater than 0.9 as "high". We analyzed differences in validated outcome scores between the GAP categories using Wilcoxon rank sum test.RESULTS: At a minimum of 2 years' follow-up, a higher GAP score was not associated with increased risks of mechanical complications (AUC = 0.60 [95% CI 0.50 to 0.70]). A higher GAP score was not associated with a higher likelihood of undergoing a revision surgery to treat a mechanical complication (AUC = 0.66 [95% 0.53 to 0.78]). However, a moderately disproportioned GAP score category was associated with better SF-36 physical component summary score (36 ± 10 versus 40 ± 11; p = 0.047), better SF-36 mental component summary score (46 ± 13 versus 51 ± 12; p = 0.01), better SRS-22 total score (3.4 ± 0.8 versus 3.7 ± 0.7, p = 0.02) and better ODI score (35 ± 21 versus 25 ± 20; p = 0.003) than severely disproportioned GAP score category.CONCLUSION: Based on the findings of this external validation study, we found that alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. Parameters not included in the original GAP score needed to be considered to reduce the likelihood of mechanical complications.LEVEL OF EVIDENCE: Level III, diagnostic study.

AB - BACKGROUND: The Global Alignment and Proportion (GAP) score, based on pelvic incidence-based proportional parameters, was recently developed to predict mechanical complications after surgery for spinal deformities in adults. However, this score has not been validated in an independent external dataset.QUESTIONS/PURPOSES: After adult spinal deformity surgery, is a higher GAP score associated with (1) an increased risk of mechanical complications, defined as rod fractures, implant-related complications, proximal or distal junctional kyphosis or failure; (2) a higher likelihood of undergoing revision surgery to treat a mechanical complication; and (3) is a lower (more proportioned) GAP score category associated with better validated outcomes scores using the Oswestry Disability Index (ODI), Scoliosis Research Society-22 (SRS-22) and the Short Form-36 questionnaires?METHODS: A total of 272 patients who had undergone corrective surgeries for complex spinal deformities were enrolled in the Scoli-RISK-1 prospective trial. Patients were included in this secondary analysis if they fulfilled the original inclusion criteria by Yilgor et al. From the original 272 patients, 14% (39) did not satisfy the radiographic inclusion criteria, the GAP score could not be calculated in 14% (37), and 24% (64) did not have radiographic assessment at postoperative 2 years, leaving 59% (159) for analysis in this review of data from the original trial. A total of 159 patients were included in this study,with a mean age of 58 ± 14 years at the time of surgery. Most patients were female (72%, 115 of 159), the mean number of levels involved in surgery was 12 ± 4, and three-column osteotomy was performed in 76% (120 of 159) of patients. The GAP score was calculated using parameters from early postoperative radiographs (between 3 and 12 weeks) including pelvic incidence, sacral slope, lumbar lordosis, lower arc lordosis and global tilt, which were independently obtained from a computer software based on centralized patient radiographs. The GAP score was categorized as proportional (scores of 0 to 2), moderately disproportional (scores of 3 to 6), or severely disproportional (scores higher than 7 to 13). Receiver operating characteristic area under curve (AUC) was used to assess associations between GAP score and risk of mechanical complications and risk of revision surgery. An AUC of 0.5 to 0.7 was classified as "no or low associative power", 0.7 to 0.9 as "moderate" and greater than 0.9 as "high". We analyzed differences in validated outcome scores between the GAP categories using Wilcoxon rank sum test.RESULTS: At a minimum of 2 years' follow-up, a higher GAP score was not associated with increased risks of mechanical complications (AUC = 0.60 [95% CI 0.50 to 0.70]). A higher GAP score was not associated with a higher likelihood of undergoing a revision surgery to treat a mechanical complication (AUC = 0.66 [95% 0.53 to 0.78]). However, a moderately disproportioned GAP score category was associated with better SF-36 physical component summary score (36 ± 10 versus 40 ± 11; p = 0.047), better SF-36 mental component summary score (46 ± 13 versus 51 ± 12; p = 0.01), better SRS-22 total score (3.4 ± 0.8 versus 3.7 ± 0.7, p = 0.02) and better ODI score (35 ± 21 versus 25 ± 20; p = 0.003) than severely disproportioned GAP score category.CONCLUSION: Based on the findings of this external validation study, we found that alignment targets based on the GAP score alone were not associated with increased risks of mechanical complications and mechanical revisions in patients with complex adult spinal disorders. Parameters not included in the original GAP score needed to be considered to reduce the likelihood of mechanical complications.LEVEL OF EVIDENCE: Level III, diagnostic study.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Disability Evaluation

KW - Female

KW - Humans

KW - Male

KW - Middle Aged

KW - Postoperative Complications/diagnosis

KW - Predictive Value of Tests

KW - Reoperation

KW - Retrospective Studies

KW - Risk

KW - Spinal Curvatures/diagnostic imaging

KW - Surveys and Questionnaires

UR - http://www.scopus.com/inward/record.url?scp=85100280173&partnerID=8YFLogxK

U2 - 10.1097/CORR.0000000000001521

DO - 10.1097/CORR.0000000000001521

M3 - Journal article

C2 - 33079774

VL - 479

SP - 312

EP - 320

JO - Clinical Orthopaedics and Related Research

JF - Clinical Orthopaedics and Related Research

SN - 0009-921X

IS - 2

ER -

ID: 62386018