PROMIS physical health domain scores are related to cervical deformity severity

Abstract

Introduction:The aim of this study was to evaluate the association of available cervical alignment components through the Ames cervical deformity (CD) classification parameters with the Patient-Reported Outcomes Measurement Information System (PROMIS) physical health domain metrics.Methods:Surgical CD patients (C2–C7 Cobb >10° or C2–C7 sagittal vertical axis [cSVA] >4 cm or T1 slope minus cervical lordosis (TS-CL) >15°) ≥18 years with available baseline (BL) radiographic and PROMIS were isolated in a single-center spine database. Patients were classified according to the Ames CD modifiers for cSVA and TS-CL (low deformity [Low], moderate deformity [Mod], and severe deformity [Sev]). Descriptives and univariate analyses compared population-weighted PROMIS scores for Pain Intensity (PI), Physical Function (PF), and Pain Interference (Int) across CD modifiers. Conditional tree analysis with logistic regression sampling determined the threshold of PROMIS scores for which the correlation with Ames radiographic cutoffs was most significant. Reported cutoff values for Mod (cSVA: 4–8 cm; TS-CL: 15–20°) and Sev (cSVA: >8 cm; TS-CL: >20°) disabilities were used.Results:Two hundred and eight patients (58.8 years, female: 51%, 29.6 kg/m2, Charlson Comorbidity Index: 1.19). BL cSVA modifier by severity: 83.2% Low, 16.8% Mod. No patients met criteria for severe cSVA. BL TS-CL modifier by severity: 18.8% Low, 22.1% Mod, 59.1% Sev. Mean baseline PROMIS scores were as follows: PI score: 89.6 ± 15.4, PF score: 11.9 ± 13.1, Int score: 56.9 ± 6.8. PI did not differ between cSVA and TS-CL severity. Mod cSVA patients and Mod/Sev TS-CL modifier groups trended toward lower PF scores and higher Int scores. A PI score of >96 (odds ratio [OR]: 0.658 [0.303–1.430]), a PF score of <14 (OR: 1.864 [0.767–4.531]), and an Int score of > 57.4 (OR: 1.878 [0.889–3.967]) were predictors of Mod cSVA. A PI score of >87 (OR: 1.428 [0.767–2.659]), a PF score of <14 (OR: 1.551 [0.851–2.827]), and an Int score of >56.5 (OR: 1.689 [0.967–2.949]) were predictors of Sev TS-CL.Conclusions:PROMIS physical health domains were related to the Ames CD classification. Certain BL PROMIS thresholds can be connected to the severity of CD.

Evolution of Adult Cervical Deformity Surgery Clinical and Radiographic Outcomes Based on a Multicenter Prospective Study: Are Behaviors and Outcomes Changing With Experience?

“…Advancements in CD research over the past several years has broadly improved our basic understanding of sagittal deformity and compensatory mechanisms within the cervical spine. 18,19 We now recognize the contributions of the global chain of correlation and the efforts of the cervical spine to maintain horizontal gaze with its wide range of motion. 20 As the literature on CD grows, it is important to investigate whether these improvements in understanding translated into better surgical outcomes for patients.…”

Association of Spinal Alignment Correction With Patient-Reported Outcomes in Adult Cervical Deformity: Review of the Literature

“…Cervical C2-C7 sagittal vertical axis (C2-C7 SVA) was investigated in 9 of the included studies 4,16,19,21,24,[26][27][28][29] , including 3 studies by the ISSG 16,19,30 . Meta-analyses of correlation coefficients showed that C2-C7 SVA and NDI correlated fairly [Random Effect; Zr = 0.31 [95% CI: -0.03, 0.58]; P < .001) 16,24,27,28,31 .…”

“…Only one study investigated the relationship between C2-C7 SVA categories in CD Ames-ISSG severity groups (Score 0, C2-7 SVA < 4 cm; Score 1, C2-7 SVA 4-8 cm; Score 2, C2-7 SVA > 8 cm), and PROMIS domains showing no difference in PROMIS scores between C2-C7 SVA categories 4 . The authors used conditional tree analysis to determine thresholds for PROMIS domains that were independent of C2-C7 SVA severities, but did not reach statistical significance 4 .…”

“…Eight studies investigated the relationship between cervical lordosis minus T1 slope (TS-CL) and PROs 4,16,19,22,24,25,27,28 . Meta-analyses of correlation coefficients showed that NDI and EQ-5D correlated poorly with TS-CL [NDI Random Effect; Zr = 0.04 [95% CI: -0.23, 0.30]; P =.001] and EQ-5D Random Effect; r = 0.07 [95% CI: -0.24, 0.37]; P =0.02) (Figure 3 25 at baseline.…”

“…However, assessing PROs and HRQoL measures are necessary to understand the full impact of deformity and correction on patients' A c c e p t e d A r t i c l e health and daily functioning. As such, considerable efforts have been made by special study groups including but not limited to the ISSG and other study groups in North America, Europe, and Asia [4][5][6] .…”