Redefining cervical spine deformity classification through novel cutoffs: An assessment of the relationship between radiographic parameters and functional neurological outcomes

Peter Gust Passias, Katherine E. Pierce, Avery E. Brown, Cole A. Bortz, Haddy Alas, Renaud Lafage, Virginie Lafage, Breton Line, Eric O. Klineberg, Douglas C. Burton, Robert Hart, Alan H. Daniels, Shay Bess, Bassel Diebo, Themistocles Protopsaltis, Robert Eastlack, Christopher I. Shaffrey, Frank J. Schwab, Justin S. Smith, Christopher Ames

Research output: Contribution to journalArticlepeer-review

Abstract

Purpose: The aim is to investigate the relationship between cervical parameters and the modified Japanese Orthopedic Association scale (mJOA). Materials and Methods: Surgical adult cervical deformity (CD) patients were included in this retrospective analysis. After determining data followed a parametric distribution through the Shapiro-Wilk Normality (P = 0.15, P > 0.05), Pearson correlations were run for radiographic parameters and mJOA. For significant correlations, logistic regressions were performed to determine a threshold of radiographic measures for which the correlation with mJOA scores was most significant. mJOA score of 14 and <12 reported cut-off values for moderate (M) and severe (S) disability. New modifiers were compared to an existing classification using Spearman's rho and logistic regression analyses to predict outcomes up to 2 years. Results: A total of 123 CD patients were included (60.5 years, 65%F, 29.1 kg/m2). For significant baseline factors from Pearson correlations, the following thresholds were predicted: MGS (M:-12 to-9° and 0°-19°, P = 0.020; S: >19° and <-12°, χ2= 4.291, P = 0.036), TS-CL (M: 26°to 45°, P = 0.201; S: >45°, χ2= 7.8, P = 0.005), CL (M:-21° to 3°, χ2= 8.947, P = 0.004; S: <-21°, χ2= 9.3, P = 0.009), C2-T3 (M:-35° to-25°, χ2= 5.485, P = 0.046; S: <-35°, χ2= 4.1, P = 0.041), C2 Slope (M: 33° to 49°, P = 0.122; S: >49°, χ2= 5.7, P = 0.008), and Frailty (Mild: 0.18-0.27, P = 0.129; Severe: >0.27, P = 0.002). Compared to existing Ames-International Spine Study Group classification, the novel thresholds demonstrated significant predictive value for reoperation and mortality up to 2 years. Conclusions: Collectively, these radiographic values can be utilized in refining existing classifications and developing collective understanding of severity and surgical targets in corrective surgery for adult CD.

Original languageEnglish (US)
Pages (from-to)157-164
Number of pages8
JournalJournal of Craniovertebral Junction and Spine
Volume12
Issue number2
DOIs
StatePublished - Apr 1 2021

Keywords

  • Adult cervical deformity
  • cervical spine
  • thresholds of severity

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Fingerprint

Dive into the research topics of 'Redefining cervical spine deformity classification through novel cutoffs: An assessment of the relationship between radiographic parameters and functional neurological outcomes'. Together they form a unique fingerprint.

Cite this