TY - JOUR
T1 - Unsupervised Clustering of Adult Spinal Deformity Patterns Predicts Surgical and Patient-Reported Outcomes
AU - on behalf of International Spine Study Group
AU - Lafage, Renaud
AU - Song, Junho
AU - Elysee, Jonathan
AU - Fourman, Mitchell S.
AU - Smith, Justin S.
AU - Ames, Christopher
AU - Bess, Shay
AU - Daniels, Alan H.
AU - Gupta, Munish
AU - Hostin, Richard
AU - Kim, Han Jo
AU - Klineberg, Eric
AU - Mundis, Gregory
AU - Diebo, Bassel G.
AU - Shaffrey, Christopher
AU - Schwab, Frank
AU - Lafage, Virginie
AU - Burton, Douglas
N1 - Publisher Copyright:
© The Author(s) 2024.
PY - 2024
Y1 - 2024
N2 - Study Design: Retrospective cohort study. Objectives: To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes. Methods: Patients were classified based on the results of a previously conducted analysis that examined clusters of deformity, including Moderate Sagittal (Mod Sag), Severe Sagittal (Sev Sag), Coronal, and Hyper-Thoracic Kyphosis (Hyper-TK). The surgical data, HRQOL, and complication outcomes of these clusters were then compared. Results: The final analysis included 1062 patients. Similar to published results on a different patient sample, Mod Sag and Sev Sag patients were older, more likely to have a history of previous spine surgery, and more disabled. By 2-year, all clusters improved in HRQOL and reached a similar rate of minimal clinically important difference (MCID). The Sev Sag cluster had the highest rate major complications (53% vs 34-40%), and complications leading to reoperation (29% vs 17-23%), implant failures (20% vs 8-11%), and operative complications (27% vs 10-17%). Coronal patients had the highest rate of pulmonary complications (9% vs 3-6%) but the lowest rate of X-ray imbalance (10% vs 19-21%). No significant differences were found in neurological complications, infection rate, gastrointestinal, or cardiac events (all P >.1). Kaplan-Meier survival curves demonstrated a lower time to first complications for the Sev Sag cluster. Conclusions: All clusters of adult spinal deformity benefit similarly from surgery as they all achieved similar rates of MCID. Although the rates of complications varied among the clusters, the types of complications were not significantly different.
AB - Study Design: Retrospective cohort study. Objectives: To evaluate whether different radiographic clusters of adult spinal deformity identified using artificial intelligence-based clustering are associated with distinct surgical outcomes. Methods: Patients were classified based on the results of a previously conducted analysis that examined clusters of deformity, including Moderate Sagittal (Mod Sag), Severe Sagittal (Sev Sag), Coronal, and Hyper-Thoracic Kyphosis (Hyper-TK). The surgical data, HRQOL, and complication outcomes of these clusters were then compared. Results: The final analysis included 1062 patients. Similar to published results on a different patient sample, Mod Sag and Sev Sag patients were older, more likely to have a history of previous spine surgery, and more disabled. By 2-year, all clusters improved in HRQOL and reached a similar rate of minimal clinically important difference (MCID). The Sev Sag cluster had the highest rate major complications (53% vs 34-40%), and complications leading to reoperation (29% vs 17-23%), implant failures (20% vs 8-11%), and operative complications (27% vs 10-17%). Coronal patients had the highest rate of pulmonary complications (9% vs 3-6%) but the lowest rate of X-ray imbalance (10% vs 19-21%). No significant differences were found in neurological complications, infection rate, gastrointestinal, or cardiac events (all P >.1). Kaplan-Meier survival curves demonstrated a lower time to first complications for the Sev Sag cluster. Conclusions: All clusters of adult spinal deformity benefit similarly from surgery as they all achieved similar rates of MCID. Although the rates of complications varied among the clusters, the types of complications were not significantly different.
KW - adult spinal deformity
KW - artificial intelligence
KW - clustering
KW - machine learning
KW - minimum clinically important difference
KW - patient-reported outcomes
KW - sagittal alignment
KW - sagittal balance
KW - scoliosis
KW - surgical outcomes
UR - http://www.scopus.com/inward/record.url?scp=85207501205&partnerID=8YFLogxK
U2 - 10.1177/21925682241296481
DO - 10.1177/21925682241296481
M3 - Article
C2 - 39442502
AN - SCOPUS:85207501205
SN - 2192-5682
JO - Global Spine Journal
JF - Global Spine Journal
ER -