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Coskun E, Wellington IJ, Chaudhary C, Crea K, Cote MP, Rhee JM, Mallozzi S, Moss IL, Singh H. Clinical and radiologic outcomes of posterior column extension, pedicle subtraction, and vertebral column resection osteotomies in adult chin on chest deformity: A systematic review. NORTH AMERICAN SPINE SOCIETY JOURNAL 2024; 18:100324. [PMID: 38765779 PMCID: PMC11101968 DOI: 10.1016/j.xnsj.2024.100324] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/18/2024] [Revised: 04/08/2024] [Accepted: 04/09/2024] [Indexed: 05/22/2024]
Abstract
Background Chin-on-chest deformity is a rare and severely disabling condition characterized by kyphotic deformity in the cervicothoracic spine. To treat this deformity, various osteotomy techniques were described. Methods A comprehensive literature search of biomedical databases including MEDLINE (via PubMed), Scopus (via Elsevier), Embase (via Elsevier), and Cochrane Library in English from 1/1/1990 to 3/31/2022 was conducted using a combination of text and Medical Subject Headings (MeSH). Results The final analysis included 16 studies. All the studies were assigned a level of evidence of four. Except for two articles, all of the articles were non-comparative studies. A total of 288 patients were included in this review. Of the 288 patients, 107 underwent posterior column extension osteotomy (PCEO), 108 underwent pedicle subtraction osteotomy (PSO), and 33 underwent vertebral column resection osteotomy (VCRO). The most common osteotomy level in fifteen of the studies was C7/T1. The studies included in this review described several techniques for cervical sagittal balance correction. The range of preoperative and postoperative visual analogue scale (VAS) scores was 5.5-8.6 to 1.7-4.91, respectively. The range of preoperative and postoperative neck disability index (NDI) was 34.2-65.4 to 22.1-51.3, respectively. The most common complications were upper extremity paresthesia and hand numbness through the C8 dermatome distribution. Conclusions Corrective osteotomies provide satisfactory results in patients with chin-on-chest deformity; however, the quality of the included studies limits the evidence.
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Affiliation(s)
- Ergin Coskun
- Riley Hospital for Children, Indiana University Health, 705 Riley Hospital Dr, Indianapolis, IN 46202, United States
| | - Ian J. Wellington
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Chirag Chaudhary
- Insight Surgical Hospital, 21230 Dequindre Rd Warren, MI 4809, United States
| | - Kathleen Crea
- Lyman Maynard Stowe Library, UConn Health, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Mark P. Cote
- Massachusetts General Brigham Sports Medicine, Harvard Medical School, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - John M. Rhee
- Department of Orthopedic Surgery, Emory Spine Center, Emory University, 59 Executive Park South, Atlanta, GA 30327, United States
| | - Scott Mallozzi
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Isaac L. Moss
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
| | - Hardeep Singh
- Department of Orthopedics, The University of Connecticut, 120 Dowling Way, Farmington, CT 06032, United States
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Feng J, Zhang K, Dou L, Shi Z, Chen G, Li S. Health state utility values in patients with Ankylosing Spondylitis: a systematic review and meta-analysis. Qual Life Res 2024:10.1007/s11136-024-03670-8. [PMID: 38824212 DOI: 10.1007/s11136-024-03670-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/19/2024] [Indexed: 06/03/2024]
Abstract
INTRODUCTION Ankylosing spondylitis (AS) is a chronic condition that requires lifelong treatment and results in a serious disease burden. Health state utility values (HSUVs) are a valuable tool for quantifying this burden and conducting cost-utility analysis. OBJECTIVE We conducted a systematic review and meta-analysis to obtain estimates of HSUVs in patients with AS, explored potential sources of heterogeneity, and compared pooled patient HSUVs with population norms. METHOD We searched PubMed, Embase, Web of science, Cochrane database and Scopus until July, 2023 to obtain eligible studies. The methodological quality of the included studies was assessed using the ROBINS-I checklist. RESULTS Forty-two publications involving 11,354 participants were included in this systematic review. The most commonly used instrument is the EQ-5D (38 studies). The estimated HSUVs for patients with AS from all available studies was pooled as 0.62 (95% CI 0.59 to 0.65). The pooled mean utility estimates from the random effects meta-analysis for SF-6D, EQ-5D-3L, EQ-5D-5L, and HUI3 were 0.65 (95% CI 0.62,0.68), 0.63 (95% CI 0.59,0.66), 0.60 (95% CI 0.42,0.79), and 0.48 (95% CI 0.43,0.53), respectively. For the EQ-5D-3L we conducted stratified meta-analyses and meta-regression based on key subgroups. The pooled estimates of EQ-5D-3L were lower for patients published before 2010, with high disease activity, long duration of disease, and in developed countries. CONCLUSION Pooled estimates of HSUVs for people with AS were substantially lower than population norms. These estimates provide robust evidence that can inform the economic evaluation of new therapies for individuals with AS.
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Affiliation(s)
- JunChao Feng
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | | | - Lei Dou
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Zhao Shi
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China
- Center for Health Preference Research, Shandong University, Jinan, 250012, China
| | - Gang Chen
- Centre for Health Economics, Monash University, Melbourne, VIC, 3145, Australia
| | - Shunping Li
- Centre for Health Management and Policy Research, School of Public Health, Cheeloo College of Medicine, Shandong University, Jinan, 250012, China.
- NHC Key Lab of Health Economics and Policy Research, Shandong University, Jinan, 250012, China.
- Center for Health Preference Research, Shandong University, Jinan, 250012, China.
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Henao Romero S, Sierra Peña JA, Diaz Orduz RC, Berbeo-Calderon ME. Horizontal Gaze Assessment: An Extensive Narrative Review. World Neurosurg 2024:S1878-8750(24)00788-5. [PMID: 38750886 DOI: 10.1016/j.wneu.2024.05.035] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/30/2024] [Accepted: 05/07/2024] [Indexed: 06/09/2024]
Abstract
OBJECTIVE Bipedalism was a significant milestone in the evolutionary development of Homo sapiens sapiens, influencing neocortical evolution and subsequent behavioral changes. Coordinated visual and sensory inputs are crucial for posture, environmental interaction, and surgical planning, with horizontal gaze being a pivotal parameter. This narrative review aims to explore various geometric measures used to assess horizontal gaze in patients, highlighting their applications in surgical planning. METHODS A literature review was conducted in indexed databases using Mesh terms like "Cervical Vertebrae" and "Visual Fields" along with keywords such as "horizontal gaze" and "sagittal spine parameters." Among 477 initially identified articles, 41 were selected for inclusion after rigorous filtering. RESULTS The most recognized method for assessing horizontal gaze is the Chin Brow Vertical Angle (CBVA), initially described in patients with ankylosing spondylitis. Clinical photography is employed as a tool for CBVA calculation, while other measures like McGregor slope and Slope of the Line of Sight have been considered as alternatives to CBVA. Each method presents its unique advantages and limitations. CONCLUSIONS This review highlights the need for further research into horizontal gaze measurement methods. Developing novel approaches to determine horizontal gaze can significantly enhance surgical planning and, consequently, improve patient outcomes. The ongoing exploration of these geometric measures offers promising prospects for advancing the field and optimizing patient care.
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Affiliation(s)
- Sara Henao Romero
- Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia; Neurosurgery research seedbed, Pontificia Universidad Javeriana, Bogotá, Colombia.
| | | | - Roberto Carlos Diaz Orduz
- Department of Neurosurgery, Hospital Universitario San Ignacio, Pontificia Universidad Javeriana, Bogotá, Colombia
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Wang W, Lee YH, Wei JCC. Correspondence on 'Efficacy of a tight-control and treat-to-target strategy in axial spondyloarthritis: results of the open-label, pragmatic, cluster-randomised TICOSPA trial'. Ann Rheum Dis 2023; 82:e223. [PMID: 34226191 DOI: 10.1136/annrheumdis-2021-220938] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 06/08/2021] [Indexed: 11/03/2022]
Affiliation(s)
- Weijie Wang
- Department of Rheumatology, The Second Affiliated Hospital of Zhejiang Chinese Medical University, Hangzhou, China
| | - Yung-Heng Lee
- Department of senior services industry management, Minghsin University of Science and Technology, Hsinchu, Taiwan
- Department of Recreation and Sport Management, Shu-Te University, Kaohsiung, Taiwan
- Department of Orthopedics, Cishan Hospital, Ministry of Health and Welfare, Kaohsiung, Taiwan
| | - James Cheng Chung Wei
- Institute of Medicine, Chung Shan Medical University, Taichung, Taiwan
- Department of Allergy, Immunology & RheumatologyTaiwan, Chung Shan Medical University Hospital, Taichung, Taiwan
- Graduate Institute of Integrated Medicine, China Medical University, Taichung, Taiwan
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Hey HWD, Lim JXY, Tan CS, Liu GKP, Wong HK. Audit and Comparison Between Radiographic Markers of Gaze Direction Using EOS Imaging - An Essential Step to Streamline Existing Methods. Spine (Phila Pa 1976) 2021; 46:E1202-E1210. [PMID: 34474453 DOI: 10.1097/brs.0000000000004213] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Retrospective cohort study on prospectively implemented EOS protocol. OBJECTIVE This study aims to audit and compare existing radiological definitions of gaze direction-chin brow vertical angle (CBVA), McGregor slope (McGS), slope of line of sight (SLS), orbital-internal occipital protuberance (OIOP) slope angle, and Tangent to the hard palate (THP) in a neutral, healthy, and asymptomatic cohort. SUMMARY OF BACKGROUND DATA The ability to accurately define direction of gaze is the first step when striving for horizontal gaze restoration in any affected individual with rigid sagittal deformity. Yet, the radiological definition of gaze direction remains poorly standardized. METHODS Hundred healthy subjects who could achieve horizontal gaze underwent whole-body standing EOS radiographs taken under a strictly standardized protocol. Radiographic measurements of global spinal sagittal parameters and surrogate measures of horizontal gaze were analyzed and compared. RESULTS The mean age was 45 ± 15.9 years, with a balanced male-to-female-ratio. Their C7 SVA was -7.7 mm ± 24.8 mm, PI was 51.0o ± 11.4o, PI-LL was -0.9o ± 13.0o and T1-slope was 21.2o ± 9.2o. Measured horizontal gaze parameters were as follows: CBVA (1.07o ± 5.48o), McGS (-3.23o ± 5.63o), SLS (0.45o ± 5.34o), OIOP (5.03o ± 4.66o), THP (-0.17o ± 6.27o). CBVA correlated strongly with McGS (r = 0.679, P < 0.001), SLS (r = 0.592, P < 0.001), OIOP (r = 0.697, P < 0.001), and THP (r = -0.504, P < 0.001). OIOP had the lowest variance amongst all parameters and showed less variability compared to CBVA (SD 4.66 Var 21.69 vs. SD 5.48 Var 30.08, P = .012). Multivariate analysis showed that C2-7 angle was the only parameter found to be associated with OIOP values (P = 0.006). CONCLUSION OIOP is the least variable, and most robust radiological method in determining gaze direction. It uses easily recognizable anatomical landmarks and an angular criterion, which makes it advantageous both with x-rays or slot scanners.Level of Evidence: 3.
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Affiliation(s)
| | - Joel Xue Yi Lim
- Department of Orthopedic Surgery, National University Health System, Singapore
| | - Chuen Seng Tan
- Saw Swee Hock School of Public Health, National University of Singapore, Singapore
| | - Gabriel Ka Po Liu
- Department of Orthopedic Surgery, National University Health System, Singapore
| | - Hee Kit Wong
- Department of Orthopedic Surgery, National University of Singapore, Singapore
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Passias PG, Passfall L, Horn SR, Pierce KE, Lafage V, Lafage R, Smith JS, Line BG, Mundis GM, Eastlack R, Diebo BG, Protopsaltis TS, Kim HJ, Scheer J, Burton DC, Hart RA, Schwab FJ, Bess S, Ames CP, Shaffrey CI. Risk-benefit assessment of major versus minor osteotomies for flexible and rigid cervical deformity correction. JOURNAL OF CRANIOVERTEBRAL JUNCTION AND SPINE 2021; 12:263-268. [PMID: 34728993 PMCID: PMC8501816 DOI: 10.4103/jcvjs.jcvjs_35_21] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 04/30/2021] [Indexed: 11/30/2022] Open
Abstract
Introduction: Osteotomies are commonly performed to correct sagittal malalignment in cervical deformity (CD). However, the risks and benefits of performing a major osteotomy for cervical deformity correction have been understudied. The objective of this retrospective cohort study was to investigate the risks and benefits of performing a major osteotomy for CD correction. Methods: Patients stratified based on major osteotomy (MAJ) or minor (MIN). Independent t-tests and Chi-squared tests were used to assess differences between MAJ and MIN. A sub-analysis compared patients with flexible versus rigid CL. Results: 137 CD patients were included (62 years, 65% F). 19.0% CD patients underwent a MAJ osteotomy. After propensity score matching for cSVA, 52 patients were included. About 19.0% CD patients underwent a MAJ osteotomy. MAJ patients had more minor complications (P = 0.045), despite similar surgical outcomes as MIN. At 3M, MAJ and MIN patients had similar NDI, mJOA, and EQ5D scores, however by 1 year, MAJ patients reached MCID for NDI less than MIN patients (P = 0.003). MAJ patients with rigid deformities had higher rates of complications (79% vs. 29%, P = 0.056) and were less likely to show improvement in NDI at 1 year (0.95 vs. 0.54, P = 0.027). Both groups had similar sagittal realignment at 1 year (all P > 0.05). Conclusions: Cervical deformity patients who underwent a major osteotomy had similar clinical outcomes at 3-months but worse outcomes at 1-year as compared to minor osteotomies, likely due to differences in baseline deformity. Patients with rigid deformities who underwent a major osteotomy had higher complication rates and worse clinical improvement despite similar realignment at 1 year.
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Affiliation(s)
- Peter Gust Passias
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Lara Passfall
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Samantha R Horn
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Katherine E Pierce
- Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Langone Medical Center, NY Spine Institute, New York, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Breton G Line
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, CO, USA
| | | | - Robert Eastlack
- Division of Orthopaedic Surgery, Scripps Clinic, La Jolla, USA
| | - Bassel G Diebo
- Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
| | | | - Han Jo Kim
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Justin Scheer
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, NY, USA
| | - Shay Bess
- Department of Spine Surgery, Denver International Spine Center, Presbyterian St. Luke's, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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Lin G, Wang S, Yang Y, Su Z, Du Y, Xu X, Chai X, Wang Y, Yu B, Zhang J. The effect of pedicle subtraction osteotomy for the correction of severe Scheuermann thoracolumbar kyphosis on sagittal spinopelvic alignment. BMC Musculoskelet Disord 2021; 22:165. [PMID: 33568117 PMCID: PMC7877028 DOI: 10.1186/s12891-020-03942-7] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/08/2020] [Accepted: 12/04/2020] [Indexed: 12/23/2022] Open
Abstract
Purpose To analyze how pedicle subtraction osteotomy (PSO) treatment of severe Scheuermann thoracolumbar kyphosis (STLK) using pedicle screw instrumentation affects sagittal spinopelvic parameters. Background The medical literature on the post-surgical effects of treatments such as Ponte osteotomy is limited, but suggests few effects on spinopelvic profiles. Currently, there is no research regarding changes in sagittal spinopelvic alignment upon PSO treatment in STLK patients. Methods We performed a retrospective study on 11 patients with severe STLK. These patients underwent posterior-only correction surgeries with PSO and pedicle screw instrumentation between 2012 to 2017 in a single institute. Patients were measured for the following spinopelvic parameters: global kyphosis (GK), thoracic kyphosis (TK), thoracolumbar kyphosis (TL), lumbar lordosis (LL), sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tile (PT), sacral slope (SS), and administered a Scoliosis Research Society-22 questionnaire (SRS-22) pre-operation, post-operation and at final follow-up. Results GK improved from a median of 74.1° to 40.0° after surgery, achieving a correction rate of 48.8% with a median correction loss of 0.8°. TK, TL and LL all showed significant difference (P < 0.05) and SVA improved 22.7 (11.6, 30.9) mm post operation. No significant difference was found in pelvic parameters (PI, PT, SS, all P < 0.05). The absolute value of LL- PI significantly improved from a median of 26.5° pre-operation to 6.1° at the final follow-up. 72.7% in this series showed an evident trend of thoracic and lumbar apices migrating closer to ideal physiological segments after surgery. Self-reported scores of pain, self-image, and mental health from SRS-22 revealed significant improvement at final follow-up (all P < 0.05). Conclusions PSO treatment of severe STLK with pedicle screw instrumentation can improve spine alignment and help obtain a proper alignment of the spine and the pelvis.
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Affiliation(s)
- Guanfeng Lin
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Shengru Wang
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Yang Yang
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Zhe Su
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - You Du
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Xiaolin Xu
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Xiran Chai
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Yipeng Wang
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Bin Yu
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China
| | - Jianguo Zhang
- Departments of Orthopaedic Surgery, Peking Union Medical College Hospital (PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences; State Key Laboratory of Complex Severe and Rare Diseases, Peking Union Medical College Hospital(PUMCH), Peking Union Medical College and Chinese Academy of Medical Sciences, No. 1 Shuaifuyuan Hutong, Beijing, 100730, People's Republic of China.
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Benoist M. The Michel Benoist and Robert Mulholland Yearly European Spine Journal Review: A survey of the "medical" articles in the European Spine Journal, 2018. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2019; 28:10-20. [PMID: 30604295 DOI: 10.1007/s00586-018-5857-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/08/2018] [Accepted: 12/08/2018] [Indexed: 06/09/2023]
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Horn SR, Passias PG, Hockley A, Lafage R, Lafage V, Hassanzadeh H, Horowitz JA, Bortz CA, Segreto FA, Brown AE, Smith JS, Sciubba DM, Mundis GM, Kelley MP, Daniels AH, Burton DC, Hart RA, Schwab FJ, Bess S, Shaffrey CI, Hostin RA, Ames CP. Cost-utility of revisions for cervical deformity correction warrants minimization of reoperations. JOURNAL OF SPINE SURGERY 2018; 4:702-711. [PMID: 30714001 DOI: 10.21037/jss.2018.10.02] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Background Cervical deformity (CD) surgery has become increasingly more common and complex, which has also led to reoperations for complications such as distal junctional kyphosis (DJK). Cost-utility analysis has yet to be used to analyze CD revision surgery in relation to the cost-utility of primary CD surgeries. The aim of this study was to determine the cost-utility of revision surgery for CD correction. Methods Retrospective review of a multicenter prospective CD database. CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin-brow vertical angle (CBVA) >25°. Quality-adjusted life year (QALY) were calculated by EuroQol Five-Dimensions questionnaire (EQ-5D) and Neck Disability Index (NDI) mapped to SF-6D index and utilized a 3% discount rate to account for residual decline to life expectancy (men: 76.9 years, women: 81.6 years). Medicare reimbursement at 30 days assigned costs for index procedures (9+ level posterior fusion, 4-8 level posterior fusion with anterior fusion, 2-3 level posterior fusion with anterior fusion, 4-8 level anterior fusion) and revision fusions (2-3 level, 4-8 level, or 9+ level posterior refusion). Cost per QALY gained was calculated. Results Eighty-nine CD patients were included (61.6 years, 65.2% female). CD correction for these patients involved a mean 7.7±3.7 levels fused, with 34% combined approach surgeries, 49% posterior-only and 17% anterior-only, 19.1% three-column osteotomy. Costs for index surgeries ranged from $20,001-55,205, with the average cost for this cohort of $44,318 and cost per QALY of $27,267. Eleven revision surgeries (mean levels fused 10.3) occurred up to 1-year, with an average cost of $41,510. Indications for revisions were DJK (5/11), neurologic impairment [4], infection [1], prominent/painful instrumentation [1]. Average QALYs gained was 1.62 per revision patient. Cost was $28,138 per QALY for reoperations. Conclusions CD revisions had a cost of $28,138 per QALY, in addition to the $27,267 per QALY for primary CD surgeries. For primary CD patients, CD surgery has the potential to be cost effective, with the caveats that a patient livelihood extends long enough to have the benefits and durability of the surgery is maintained. Efforts in research and surgical technique development should emphasize minimization of reoperation causes just as DJK that significantly affect cost utility of these surgeries to bring cost-utility to an acceptable range.
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Affiliation(s)
- Samantha R Horn
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Peter G Passias
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Aaron Hockley
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Renaud Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Virginie Lafage
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Hamid Hassanzadeh
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Jason A Horowitz
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Cole A Bortz
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Frank A Segreto
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Avery E Brown
- Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY, USA
| | - Justin S Smith
- Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Daniel M Sciubba
- Department of Orthopaedic Surgery, The Johns Hopkins Hospital, Baltimore, Maryland, USA
| | - Gregory M Mundis
- Department of Orthopaedic Surgery, Scripps Spine Center, La Jolla, California, USA
| | - Michael P Kelley
- Department of Orthopaedic Surgery, Washington University Orthopedics, Chesterfield, MO, USA
| | - Alan H Daniels
- Department of Orthopaedic Surgery, Brown University Medical Center, Providence, Rhode Island, USA
| | - Douglas C Burton
- Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas, USA
| | - Robert A Hart
- Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, WA, USA
| | - Frank J Schwab
- Department of Orthopaedic Surgery, Hospital for Special Surgery, New York City, NY, USA
| | - Shay Bess
- Department of Orthopaedic Surgery, Presbyterian/St. Luke's Medical Center, Rocky Mountain Hospital for Children, Denver, CO, USA
| | - Christopher I Shaffrey
- Department of Orthopedic Surgery, University of Virginia Medical Center, Charlottesville, VA, USA
| | - Richard A Hostin
- Department of Orthopaedic Surgery, Baylor Scoliosis Center, Dallas, Texas, USA
| | - Christopher P Ames
- Department of Neurological Surgery, University of California, San Francisco, San Francisco, CA, USA
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