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Research ArticleOther and Special Categories

External Validation of the European Spine Study Group-International Spine Study Group Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery

Peter G. Passias, Sara Naessig, Ashok Para, Katherine Pierce, Waleed Ahmad, Bassel G. Diebo, Renaud Lafage, Virginie Lafage, Justin S. Smith and Burhan Janjua
International Journal of Spine Surgery August 2022, 16 (4) 760-766; DOI: https://doi.org/10.14444/8245
Peter G. Passias
1 Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
MD
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Sara Naessig
1 Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
BS
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Ashok Para
1 Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
MD
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Katherine Pierce
1 Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
BS
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Waleed Ahmad
1 Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
MS
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Bassel G. Diebo
2 Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA
MD
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Renaud Lafage
3 Department of Orthopedic Surgery Hospital for Special Surgery, New York, NY, USA
MS
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Virginie Lafage
4 Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY, USA
PhD
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Justin S. Smith
5 Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, NC, USA
MD, PhD
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Burhan Janjua
1 Division of Spinal Surgery/Departments of Orthopaedic and Neurosurgery, NYU Langone Medical Center, NY Spine Institute, New York, USA
MD
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  • Article
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Article Figures & Data

Figures

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  • Figure 1
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    Figure 1

    Basic demographics of a sample patient utilizing the European Spine Study Group-International Spine Study Group calculator.

  • Figure 2
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    Figure 2

    Radiographic alignment of a sample patient utilizing the European Spine Study Group-International Spine Study Group calculator.

  • Figure 3
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    Figure 3

    Health-related quality of life metrics of a sample patient utilizing the European Spine Study Group-International Spine Study Group calculator.

  • Figure 4
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    Figure 4

    Planned surgical characteristics of a sample patient utilizing theEuropean Spine Study Group-International Spine Study Group calculator.

  • Figure 5
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    Figure 5

    (A) Case example: baseline full standing coronal radiograph, (B) case example: baseline full standing lateral radiograph.

  • Figure 6
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    Figure 6

    (A) Case example: follow-up coronal radiograph, (B) case example: follow-up lateral radiograph.

Tables

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    Table 1

    Factors used to create the Modified Frailty Index.

    Frailty Factors
    Body mass index <18.5 or >30
    Heart disease
    Work status
    Depression
    Diabetes
    Hypertension
    Osteoporosis
    Blood clots
    Bladder incontinence
    Bowel incontinence
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    Table 2

    Brier scores for the European Spine Study Group calculator.

    PredictedObservedBrier Score
    Likelihood of improvement in ODI89.2%79.2%0.0013
    Likelihood of improvement in SRS-22 mental health71.1%66.7%0.0019
    Likelihood of improvement in SRS-22 subtotal87.6%83.3%0.0018
    Major complication at 2 y53.4%34.8%0.034
    • Abbreviations: ODI, Oswestry Disability Index; SRS, Scoliosis Research Society.

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    Table 3

    Comparing the ESSG-ISSG calculator with other commonly used risk stratification tools.

    Predictive ToolFactors Used to Predict OutcomesMeasured Outcome
    ESSG-ISSG calculatorTwelve basic patient demographics: gender, age, height, weight, smoking history, prior spine surgery, heel walk, toe walk, leg weakness, ASA grade, NRS back pain, NRS leg pain
    Nine radiographic parameters: major curve location, Cobb angle, coronal balance, leg length discrepancy, L1-S1 angle, pelvic tilt, sacral slope, sagittal balance, global alignment
    8 HRQL questions
    Nine surgical characteristics: number of stages, use of bone graft, use of antifibrinolytics, number of levels fused, upper instrumented vertebra, lower instrumented vertebra, implant density, posterior rod material, posterior rod diameter
    Major complications, reinterventions, readmissions, and patient-reported outcomes including SRS-22, Oswestry Disability Index, SF36v2
    Charlson Comorbidity IndexAge, history of MI, CHF, PVD, DM, CKD, CVA/TIA, AIDS, liver disease, connective tissue disease, peptic ulcer disease, hemiplegia, solid tumor, leukemia, lymphomaEstimated 10-y survival based on medical comorbidities
    ACS-NSQIP CalculatorAge, BMI, functional status, ASA class
    History of HTN, DM, CHF, COPD, acute kidney injury, CKD requiring dialysis, smoking, ascites, sepsis, disseminated cancer
    Postoperative risk of any complications, severe complications, cardiac complications, and death
    SpineSageT Age, BMI, gender, diagnosis
    Level (cervical, thoracic, lumbar),
    Approach (anterior, lateral, posterior)
    Previous spine surgery, revision surgery, previous cardiac complications
    History of CVA/TIA, COPD, asthma, HTN, rheumatoid arthritis, kidney disease, cancer, syncope/seizure, anemia, bleeding disorder, DM, CHF
    Expected complication rates after various types of spine surgery
    ASAPatients clinically classified into 1 of the following categories based on multiple factors:
    I: normal healthy patient
    II: mild systemic disease
    III: severe systemic disease
    IV: severe systemic disease constant threat to life
    V: moribund patient not expected to survive without the operation
    Preoperative risk of undergoing anesthesia
    mFI-5CHF within 30 d of surgery
    Partially or totally dependent functional health status at time of surgery
    History of DM, COPD or pneumonia, HTN
    Occurrence of adverse postoperative outcomes
    mFI-11Functional status, history of HTN, DM, MI, PVD, CVD, cerebrovascular disease ± neurologic deficit, impaired sensorium, respiratory problems, other cardiac problemsOccurrence of adverse postoperative outcomes
    • Abbreviations: ASA, American Society of Anesthesiology; BMI, body mass index; CHF, congestive heart failure; CKD, chronic kidney disease; COPD, chronic obstructive pulmonary disease; CVA, cerebrovascular accident; CVD, cardiovascular disease; DM, diabetes mellitus; ESSG, European Spine Study Group; HTN, hypertension; ISSG, International Spine Study Group; mFI, modified frailty index; MI, myocardial infarction; NRS, numeric rating scale; PVD, peripheral vascular disease; TIA, transient ischemic attack.

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International Journal of Spine Surgery
Vol. 16, Issue 4
1 Aug 2022
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External Validation of the European Spine Study Group-International Spine Study Group Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery
Peter G. Passias, Sara Naessig, Ashok Para, Katherine Pierce, Waleed Ahmad, Bassel G. Diebo, Renaud Lafage, Virginie Lafage, Justin S. Smith, Burhan Janjua
International Journal of Spine Surgery Aug 2022, 16 (4) 760-766; DOI: 10.14444/8245

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External Validation of the European Spine Study Group-International Spine Study Group Calculator Utilizing a Single Institutional Experience for Adult Spinal Deformity Corrective Surgery
Peter G. Passias, Sara Naessig, Ashok Para, Katherine Pierce, Waleed Ahmad, Bassel G. Diebo, Renaud Lafage, Virginie Lafage, Justin S. Smith, Burhan Janjua
International Journal of Spine Surgery Aug 2022, 16 (4) 760-766; DOI: 10.14444/8245
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Keywords

  • adult spinal deformity (ASD)
  • risk calculator
  • Brier scores
  • International Spine Study Group (ISSG)
  • European Spine Study Group (ESSG)
  • Oswestry Disability Index (ODI)
  • Scoliosis Research Society (SRS) questionnaire
  • complication risk

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