Novel Method Using Baseline Normalization and Area Under the Curve to Evaluate Differences in Outcome Between Treatment Groups and Application to Patients With Cervical Spondylotic Myelopathy Undergoing Anterior Versus Posterior Surgery

被引：12

作者：

Liu, Shian ^{[1
]}

Tetreault, Lindsay ^{[2
]}

Fehlings, Michael G. ^{[2
]}

Challier, Vincent ^{[1
]}

Smith, Justin S. ^{[3
]}

Shaffrey, Christopher I. ^{[3
]}

Arnold, Paul M. ^{[4
]}

Scheer, Justin K. ^{[5
]}

Chapman, Jens R. ^{[6
]}

Kopjar, Branko ^{[7
]}

Protopsaltis, Themistocles S. ^{[1
]}

Lafage, Virginie ^{[1
]}

Schwab, Frank ^{[1
]}

Massicotte, Eric M. ^{[8
]}

Yoon, Sangwook T. ^{[9
]}

Ames, Christopher P. ^{[10
]}

机构：

[1] NYU, Hosp Joint Dis, Dept Orthopaed Surg, New York, NY USA

[2] Univ Toronto, Toronto Western Hosp, Univ Hlth Network, Toronto, ON M5T 2S8, Canada

[3] Univ Virginia Hlth Syst, Dept Neurosurg, Charlottesville, VA USA

[4] Univ Kansas, Dept Neurosurg, Kansas City, KS USA

[5] Northwestern Univ, Feinberg Sch Med, Dept Neurol Surg, Chicago, IL 60611 USA

[6] Univ Washington, Dept Orthopaed Surg, Seattle, WA 98195 USA

[7] Univ Washington, Dept Hlth Serv, Seattle, WA 98195 USA

[8] Toronto Western Hosp, Div Neurosurg, Toronto, ON M5T 2S8, Canada

[9] Emory Univ, Dept Orthopaed, Atlanta, GA 30322 USA

[10] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA 94143 USA

来源：

SPINE | 2015年 / 40卷 / 24期

关键词：

area under curve; cervical; cervical spondylotic myelopathy; HRQOL; recovery;

D O I：

10.1097/BRS.0000000000001152

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

Study Design. Retrospective review of a prospective database. Objective. To describe a novel method that uses baseline normalization and area under the curve (AUC) to compare surgical outcomes between patients surgically treated anteriorly versus posteriorly for cervical spondylotic myelopathy (CSM). Summary and Background Data. It is important to control for baseline characteristics, especially disease severity, when evaluating differences in outcomes between 2 treatment groups. However, current methods of reporting outcomes are limited perhaps diminish the health impact of the entire postoperative recovery experience. Methods. In the prospective, multicenter AO Spine North America CSM database, 147 patients had complete modified Japanese Orthopaedic Association (mJOA) data at baseline and at 6-, 12-, and 24-months postoperatively and were either treated anteriorly (n = 94) or posteriorly (n = 53). Each patient's follow-up mJOA scores were normalized by dividing them by the patient's baseline value. A graph was then plotted with the time point on the x-axis and the normalized score or "recovery index'' on the y-axis. The AUC was calculated and then compared between the anterior and posterior surgical approach groups. Results. The non-normalized recovery profile of the anterior group was better than that of the posterior group, as the patients treated anteriorly had less functional impairment at baseline. After normalization, patients in the anterior and posterior group had similar recovery indices and AUCs at 6-months following surgery. At 24-months, patients treated posteriorly had a significantly higher recovery index (1.32) and a larger AUC (16.3) than those treated anteriorly (1.11, 14.5, P = 0.004 and P = 0.006, respectively). Conclusion. This is the first study to apply AUC analysis to patients with CSM. In surgical patients with CSM, those treated anteriorly achieved a higher mJOA score at all time points than those treated posteriorly. The recovery indices, however, were not significantly different between approach groups at 6 months.

引用

页码：E1299 / E1304

页数：6