PROMIS physical health domain scores are related to cervical deformity severity

Katherine E Pierce; Haddy Alas; Avery E Brown; Cole A Bortz; Brooke O'Connell; Dennis Vasquez-Montes; Bassel G Diebo; Renaud Lafage; Virginie Lafage; Aaron J Buckland; Peter G Passias

doi:10.4103/jcvjs.JCVJS_52_19

PROMIS physical health domain scores are related to cervical deformity severity

J Craniovertebr Junction Spine. 2019 Jul-Sep;10(3):179-183. doi: 10.4103/jcvjs.JCVJS_52_19.

Affiliations

¹ Departments of Orthopaedic and Neurosurgery, Division of Spinal Surgery, NYU Medical Center, NY Spine Institute, New York, NY, USA.
² Department of Orthopaedic Surgery, NYU Langone Orthopedic Hospital, New York, NY, USA.
³ Department of Orthopedic Surgery, SUNY Downstate, New York, NY, USA.
⁴ Department of Orthopaedics, Hospital for Special Surgery, New York, NY, USA.

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.

Keywords: Ames classification; Patient-Reported Outcomes Measurement Information System; cervical deformity; health-related quality of life.