TY - JOUR
T1 - Classifying Patients Operated for Spondylolisthesis
T2 - A K-Means Clustering Analysis of Clinical Presentation Phenotypes
AU - Chan, Andrew K.
AU - Wozny, Thomas A.
AU - Bisson, Erica F.
AU - Pennicooke, Brenton H.
AU - Bydon, Mohamad
AU - Glassman, Steven D.
AU - Foley, Kevin T.
AU - Shaffrey, Christopher I.
AU - Potts, Eric A.
AU - Shaffrey, Mark E.
AU - Coric, Domagoj
AU - Knightly, John J.
AU - Park, Paul
AU - Wang, Michael Y.
AU - Fu, Kai Ming
AU - Slotkin, Jonathan R.
AU - Asher, Anthony L.
AU - Virk, Michael S.
AU - Kerezoudis, Panagiotis
AU - Alvi, Mohammed A.
AU - Guan, Jian
AU - Haid, Regis W.
AU - Mummaneni, Praveen V.
N1 - Publisher Copyright:
© Congress of Neurological Surgeons 2021.
PY - 2021/12/1
Y1 - 2021/12/1
N2 - BACKGROUND: Trials of lumbar spondylolisthesis are difficult to compare because of the heterogeneity in the populations studied. OBJECTIVE: To define patterns of clinical presentation. METHODS: This is a study of the prospective Quality Outcomes Database spondylolisthesis registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means clustering analysis-an unsupervised machine learning algorithm-was used to identify clinical presentation phenotypes. RESULTS: Overall, 608 patients were identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (P > .05). Both clusters improved clinically (P < .001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the high-disease-burden cluster (adjusted-P < .001). However, the high-disease-burden cluster demonstrated greater 24-mo improvements for ODI, NRSBP, and EQ-5D (adjusted-P < .05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-P = .001). High-disease-burden cluster had lower satisfaction (adjusted-P = .02). CONCLUSION:We define 2 distinct phenotypes-those with high vs intermediate disease burden-operated for lumbar spondylolisthesis. Those with high disease burdenwere less satisfied, had a lower quality of life, andmore disability, more back pain, and more leg pain than thosewith intermediate disease burden, but had greatermagnitudes of improvement in disability, back pain, quality of life, and more often reached ODI MCID.
AB - BACKGROUND: Trials of lumbar spondylolisthesis are difficult to compare because of the heterogeneity in the populations studied. OBJECTIVE: To define patterns of clinical presentation. METHODS: This is a study of the prospective Quality Outcomes Database spondylolisthesis registry, including patients who underwent single-segment surgery for grade 1 degenerative lumbar spondylolisthesis. Twenty-four-month patient-reported outcomes (PROs) were collected. A k-means clustering analysis-an unsupervised machine learning algorithm-was used to identify clinical presentation phenotypes. RESULTS: Overall, 608 patients were identified, of which 507 (83.4%) had 24-mo follow-up. Clustering revealed 2 distinct cohorts. Cluster 1 (high disease burden) was younger, had higher body mass index (BMI) and American Society of Anesthesiologist (ASA) grades, and globally worse baseline PROs. Cluster 2 (intermediate disease burden) was older and had lower BMI and ASA grades, and intermediate baseline PROs. Baseline radiographic parameters were similar (P > .05). Both clusters improved clinically (P < .001 all 24-mo PROs). In multivariable adjusted analyses, mean 24-mo Oswestry Disability Index (ODI), Numeric Rating Scale Back Pain (NRS-BP), Numeric Rating Scale Leg Pain, and EuroQol-5D (EQ-5D) were markedly worse for the high-disease-burden cluster (adjusted-P < .001). However, the high-disease-burden cluster demonstrated greater 24-mo improvements for ODI, NRSBP, and EQ-5D (adjusted-P < .05) and a higher proportion reaching ODI minimal clinically important difference (MCID) (adjusted-P = .001). High-disease-burden cluster had lower satisfaction (adjusted-P = .02). CONCLUSION:We define 2 distinct phenotypes-those with high vs intermediate disease burden-operated for lumbar spondylolisthesis. Those with high disease burdenwere less satisfied, had a lower quality of life, andmore disability, more back pain, and more leg pain than thosewith intermediate disease burden, but had greatermagnitudes of improvement in disability, back pain, quality of life, and more often reached ODI MCID.
KW - Classification
KW - Clinical phenotypes
KW - Lumbar
KW - Patient-reported outcomes
KW - Presentation
KW - Quality Outcomes Database
KW - Spondylolisthesis
UR - http://www.scopus.com/inward/record.url?scp=85121990934&partnerID=8YFLogxK
U2 - 10.1093/neuros/nyab355
DO - 10.1093/neuros/nyab355
M3 - Article
C2 - 34634113
AN - SCOPUS:85121990934
SN - 0148-396X
VL - 89
SP - 1033
EP - 1041
JO - Neurosurgery
JF - Neurosurgery
IS - 6
ER -