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Lee CH, Jo DJ, Oh JK, Hyun SJ, Park JH, Kim KH, Bae JS, Moon BJ, Lee CK, Shin MH, Jang HJ, Han MS, Kim CH, Chung CK, Moon SM. Development and Validation of an Online Calculator to Predict Proximal Junctional Kyphosis After Adult Spinal Deformity Surgery Using Machine Learning. Neurospine 2023; 20:1272-1280. [PMID: 38171294 PMCID: PMC10762414 DOI: 10.14245/ns.2342434.217] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/10/2023] [Revised: 08/16/2023] [Accepted: 08/29/2023] [Indexed: 01/05/2024] Open
Abstract
OBJECTIVE Although adult spinal deformity (ASD) surgery aims to restore and maintain alignment, proximal junctional kyphosis (PJK) may occur. While existing scoring systems predict PJK, they predominantly offer a generalized 3-tier risk classification, limiting their utility for nuanced treatment decisions. This study seeks to establish a personalized risk calculator for PJK, aiming to enhance treatment planning precision. METHODS Patient data for ASD were sourced from the Korean spinal deformity database. PJK was defined a proximal junctional angle (PJA) of ≥ 20° at the final follow-up, or an increase in PJA of ≥ 10° compared to the preoperative values. Multivariable analysis was performed to identify independent variables. Subsequently, 5 machine learning models were created to predict individualized PJK risk post-ASD surgery. The most efficacious model was deployed as an online and interactive calculator. RESULTS From a pool of 201 patients, 49 (24.4%) exhibited PJK during the follow-up period. Through multivariable analysis, postoperative PJA, body mass index, and deformity type emerged as independent predictors for PJK. When testing machine learning models using study results and previously reported variables as hyperparameters, the random forest model exhibited the highest accuracy, reaching 83%, with an area under the receiver operating characteristics curve of 0.76. This model has been launched as a freely accessible tool at: (https://snuspine.shinyapps.io/PJKafterASD/). CONCLUSION An online calculator, founded on the random forest model, has been developed to gauge the risk of PJK following ASD surgery. This may be a useful clinical tool for surgeons, allowing them to better predict PJK probabilities and refine subsequent therapeutic strategies.
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Affiliation(s)
- Chang-Hyun Lee
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Dae-Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
| | - Jae Keun Oh
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Kyung Hyun Kim
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | | | - Bong Ju Moon
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Chang-Kyu Lee
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Myoung Hoon Shin
- Department of Neurosurgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
| | - Hyun Jun Jang
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Moon-Soo Han
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, Gwangju, Korea
| | - Chi Heon Kim
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Chun Kee Chung
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Seung-Myung Moon
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
| | - for the Korean Spinal Deformity Society
- Department of Neurosurgery, Seoul National University Hospital, Seoul National University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Seoul, Korea
- Department of Neurosurgery, Hallym University Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Korea
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
- Department of Neurosurgery, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Wooridul Spine Hospital, Seoul, Korea
- Department of Neurosurgery, Chonnam National University Research Institute of Medical Sciences, Chonnam National University Hospital & Medical School, Gwangju, Korea
- Department of Neurosurgery, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
- Department of Neurosurgery, Incheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Incheon, Korea
- Department of Neurosurgery, Kangnam Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea
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Lee SH, Kim TH, Kim SW, Rim HT, Lee HS, Kim JH, Chang IB, Song JH, Hong YK, Oh JK. The Sagittal Balance of Cervical Spine : Comprehensive Review of Recent Update. J Korean Neurosurg Soc 2023; 66:611-617. [PMID: 37583244 PMCID: PMC10641420 DOI: 10.3340/jkns.2023.0146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 08/17/2023] Open
Abstract
The cervical spine plays a critical role in supporting the skull, maintaining horizontal gaze, and facilitating walking. Its unique characteristics, including the widest range of motion among spinal segments, have led to extensive research on cervical sagittal alignment. Various parameters have been proposed to evaluate cervical alignment, with studies investigating their clinical significance, correlation with symptoms, and implications for surgical interventions. Recent findings suggest that cervical sagittal alignment not only impacts the cervical spine but also influences global spine-pelvic alignment through compensatory mechanisms. This comprehensive review examines classical and new parameters of cervical sagittal alignment and considers the dynamic and muscular factors associated with it.
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Affiliation(s)
- Sang Hoon Lee
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Tae Hwan Kim
- Departments of Orthopedics, Hallym University Sacred Heart Hospital, Anyang, Korea
- Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Seok Woo Kim
- Departments of Orthopedics, Hallym University Sacred Heart Hospital, Anyang, Korea
- Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Hyun Take Rim
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Heui Seung Lee
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Ji Hee Kim
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - In Bok Chang
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Joon Ho Song
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Yong Kil Hong
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
| | - Jae Keun Oh
- Departments of Neurosurgery, Hallym University Sacred Heart Hospital, Anyang, Korea
- Spine Center, Hallym University Sacred Heart Hospital, Anyang, Korea
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Cho Y, Jo DJ, Hyun SJ, Park JH, Yang NR. From the Spinopelvic Parameters to Global Alignment and Proportion Scores in Adult Spinal Deformity. Neurospine 2023; 20:467-477. [PMID: 37401065 PMCID: PMC10323335 DOI: 10.14245/ns.2346374.187] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/31/2023] [Revised: 05/16/2023] [Accepted: 05/16/2023] [Indexed: 07/05/2023] Open
Abstract
In the last 20 years, sagittal alignment and balance of the spine have become one of the most important issues in the field of spine surgery. Recent studies emphasize that sagittal balance and alignment are more important for health-related quality of life. The understanding of normal and abnormal sagittal alignment of the spine is necessary for the diagnosis and appropriate treatment of adult spinal deformity (ASD), and we will discuss the currently used classification of ASD, the parameters of sagittal alignment that are essential for the diagnosis of spinal deformity, compensatory actions to maintain sagittal balance, and the relationship between sagittal alignment and clinical symptoms. Furthermore, we will also discuss the recently introduced Global Alignment and Proportion scores. The Korean Spinal Deformity Society is publishing a series of review articles on spinal deformities to help spine surgeons better understand spinal deformities.
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Affiliation(s)
- Yongjae Cho
- Department of Neurosurgery, Ewha Womans University, School of Medicine, Seoul, Korea
| | - Dae Jean Jo
- Department of Neurosurgery, Kyung Hee University Hospital at Gangdong, Kyung Hee University College of Medicine, Seoul, Korea
| | - Seung-Jae Hyun
- Department of Neurosurgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jin Hoon Park
- Department of Neurosurgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Na Rae Yang
- Department of Neurosurgery, Ewha Womans University College of Medicine, Seoul, Korea
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