Kai-Ming Fu

OBJECTIVE It is not clear whether there is an additive effect of social factors in keeping patients with cervical spondylotic myelopathy (CSM) from achieving both a minimum clinically important difference (MCID) in outcomes and satisfaction after surgery. The aim of this study was to explore the effect of multiple social factors on postoperative outcomes and satisfaction. METHODS This was a multiinstitutional, retrospective study of the prospective Quality Outcomes Database (QOD) CSM cohort, which included patients aged 18 years or older who were diagnosed with primary CSM and underwent operative management. Social factors included race (White vs non-White), education (high school or below vs above), employment (employed vs not), and insurance (private vs nonprivate). Patients were considered to have improved from surgery if the following criteria were met: 1 …

METHODS:Adult spinal deformity (ASD) patients= 18 yr were queried from a multicenter, prospective database across the USA. To ensure equal cohorts for comparing the impact of MIS vs. open correction technique, propensity score matched gender, age, BMI, pelvic incidence-lumbar lordosis mismatch, and sagittal vertical axis. Of 190 patients with baseline surveys, 173 respondents (91.0%) had both baseline employment and 2-year follow-up. The open and cMIS cohorts were compared with a chi-squared test. The rate of return-to-work was calculated via discrete-time proportional hazards model—reporting an adjusted odds ratio (ORadj)—at three follow-up intervals: 6 weeks, 1-year, and 2-years.RESULTS:Of 173 patients, baseline employment status was nearly equal between open (n= 85) vs cMIS (n= 88) cohorts: employed (20.0% vs 21.5%), unemployed (3.5% vs 4.5%), disabled (4.7% vs 6.8%), and retired …

METHODS:This was a retrospective study of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort. Social risk factors included race, education, employment, and insurance. Patients were considered to have improved from surgery if 1) they reported a score of 1 or 2 on the NASS index and 2) met the MCID in patient-reported outcomes (VAS neck and arm pain, NDI, EQ5D, or mJOA score) at 24-month follow-up.RESULTS:Of the 1,141 patients included in the study, 205 (18.0%) had zero, 347 (30.4%) had one, 334 (29.3%) had two, and 255 (22.3%) had three social risk factors. The 24-month follow-up rate was 87.4% for patient-reported outcomes. After adjusting for all significant covariates, patients with one or more social risk factors were less likely to improve from surgery in all measured outcomes including VAS neck and arm pain, NDI, EQ-5D, and mJOA (all p< 0.05 …

OBJECTIVE The objective was to determine the degree of regional decompensation to pelvic tilt (PT) normalization after complex adult spinal deformity (ASD) surgery. METHODS Operative ASD patients with 1 year of PT measurements were included. Patients with normalized PT at baseline were excluded. Predicted PT was compared to actual PT, tested for change from baseline, and then compared against age-adjusted, Scoliosis Research Society–Schwab, and global alignment and proportion (GAP) scores. Lower-extremity (LE) parameters included the cranial-hip-sacrum angle, cranial-knee-sacrum angle, and cranial-ankle-sacrum angle. LE compensation was set as the 1-year upper tertile compared with intraoperative baseline. Univariate analyses were used to compare normalized and nonnormalized data against alignment outcomes. Multivariable logistic regression …

Study Design:Retrospective review of a prospectively maintained database.Objective:Assess differences in preoperative status and postoperative outcomes among patients of different educational backgrounds undergoing surgical management of cervical spondylotic myelopathy (CSM).Summary of Background Data:Patient education level (EL) has been suggested to correlate with health literacy, disease perception, socioeconomic status (SES), and access to health care.Methods:The CSM data set of the Quality Outcomes Database (QOD) was queried for patients undergoing surgical management of CSM. EL was grouped as high school or below, graduate-level, and postgraduate level. The association of EL with baseline disease severity (per patient-reported outcome measures), symptoms> 3 or≤ 3 months, and 24-month patient-reported outcome measures were evaluated.Results:Among 1141 patients with …

METHODS:This was an analysis of the prospective Quality Outcomes Database Cervical Spondylotic Myelopathy (QOD CSM) cohort which included adult patients who were diagnosed with primary CSM undergoing elective surgery. Patient-reported outcomes including VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction were collected at baseline and 24 months.RESULTS:Of the 239 patients with CSM who underwent PCF, 48 (20.1%) had UIV of C2 and 191 (79.9%) had UIV of C3/below. The 24-month follow-up rate was 87.4% for patient-reported outcomes. At baseline, C2 group had a higher frequency of motor deficit (83.3% vs 68.1%, p= 0.04) compared to the C3/below group; otherwise, there was no difference in pain, function, and quality of life. C2 group had greater number of treated levels (6.1±2.0 vs 4.5±1.3, p< 0.01) compared to the C3/below group. At 24-month follow-up, the two …

OBJECTIVE The aim of this study was to identify predictors of the best 24-month improvements in patients undergoing surgery for cervical spondylotic myelopathy (CSM). For this purpose, the authors leveraged a large prospective cohort of surgically treated patients with CSM to identify factors predicting the best outcomes for disability, quality of life, and functional status following surgery. METHODS This was a retrospective analysis of prospectively collected data. The Quality Outcomes Database (QOD) CSM dataset (1141 patients) at 14 top enrolling sites was used. Baseline and surgical characteristics were compared for those reporting the top and bottom 20th percentile 24-month Neck Disability Index (NDI), EuroQol-5D (EQ-5D), and modified Japanese Orthopaedic Association (mJOA) change scores. A multivariable logistic model was constructed and included candidate …

OBJECTIVE Depression has been implicated with worse immediate postoperative outcomes in adult spinal deformity (ASD) correction, yet the specific impact of depression on those patients undergoing minimally invasive surgery (MIS) requires further clarity. This study aimed to evaluate the role of depression in the recovery of patients with ASD after undergoing MIS. METHODS Patients who underwent MIS for ASD with a minimum postoperative follow-up of 1 year were included from a prospectively collected, multicenter registry. Two cohorts of patients were identified that consisted of either those affirming or denying depression on preoperative assessment. The patient-reported outcome measures (PROMs) compared included scores on the Oswestry Disability Index (ODI), numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society Outcomes Questionnaire …

METHODS:Operative ASD patients 18yrs with complete pre-(BL) and 2-year (2Y) data were assessed. Patients aged= 80years were isolated and compared by surgical technique: Open vs cMIS. BL and peri/post-operative factors were assessed using ANOVA and Bonferroni-adjusted ANCOVA while controlling for BL CCI and posterior levels fused. Propensity score matching (PSM) was used to align cMIS vs Open groups by BL CCI, C7-S1 SVA, PI-LL, and C7PL.RESULTS:174 ASD patients were included (62.85±13.93 years, 75.7% female), split evenly between cMIS and Open. 19.5%(n= 34) were octogenarians; 29.4% operated via cMIS vs 70.6% Open. At baseline, patients were comparable in gender, BMI, and history of spine surgery (all p>. 05). At BL, frailty scores were comparable (both p>. 05). Post-operatively, Open patients reported higher SRS-22 Appearance and Mental domain scores (both p<. 005), and …

OBJECTIVE The objective of this study was to compare clinical and patient-reported outcomes (PROs) between posterior foraminotomy and anterior cervical discectomy and fusion (ACDF) in patients presenting with cervical radiculopathy. METHODS The Quality Outcomes Database was queried for patients who had undergone ACDF or posterior foraminotomy for radiculopathy. To create two highly homogeneous groups, optimal individual matching was performed at a 5:1 ratio between the two groups on 29 baseline variables (including demographic characteristics, comorbidities, symptoms, patient-reported scores, underlying pathologies, and levels treated). Outcomes of interest were length of stay, reoperations, patient-reported satisfaction, increase in EQ-5D score, and decrease in Neck Disability Index (NDI) scores for arm and neck pain as long as 1 year after surgery …

OBJECTIVE Cervical spondylotic myelopathy (CSM) can cause significant difficulty with driving and a subsequent reduction in an individual’s quality of life due to neurological deterioration. The positive impact of surgery on postoperative patient-reported driving capabilities has been seldom explored. METHODS The CSM module of the Quality Outcomes Database was utilized. Patient-reported driving ability was assessed via the driving section of the Neck Disability Index (NDI) questionnaire. This is an ordinal scale in which 0 represents the absence of symptoms while driving and 5 represents a complete inability to drive due to symptoms. Patients were considered to have an impairment in their driving ability if they reported an NDI driving score of 3 or higher (signifying impairment in driving duration due to symptoms). Multivariable logistic regression models were fitted to …

METHODS:This was an analysis of the prospective Quality Outcomes Database CSM module. Patients of age= 18 years diagnosed with primary CSM who underwent elective surgery were included. PROs (VAS neck and arm pain, NDI, mJOA, EQ-5D, and NASS patient satisfaction) were collected at baseline and 24 months.RESULTS:Of the 1,141 patients with CSM, 202 (17.7%) were smokers and 939 (82.3%) were non-smokers. Compared to the non-smokers, smokers were younger (56.3±11.3 vs 61.5±11.7, p< 0.01) and had lower BMI (29.3±6.8 vs 30.3±6.3, p= 0.04). A higher number of smokers had depression, anxiety, and COPD (all p< 0.01). At baseline, smokers had worse pain (neck: 6.0±3.2 vs 5.1±3.3; arm: 5.7±3.2 vs 4.7±3.5), disability (NDI: 45.2±20.0 vs 37.1±20.6), myelopathy (mJOA: 11.5±2.9 vs 12.2±2.8), and quality of life (EQ-5D: 0.51±0.23 vs 0.57±0.22)(all p< 0.01). At 24-month follow-up, a higher …

This paper introduces an innovative approach to 3D environmental mapping through the integration of a compact, handheld sensor package with a two-stage sensor fusion pipeline. The sensor package, incorporating LiDAR, IMU, RGB, and thermal cameras, enables comprehensive and robust 3D mapping of various environments. By leveraging Simultaneous Localization and Mapping (SLAM) and thermal imaging, our solution offers good performance in conditions where global positioning is unavailable and in visually degraded environments. The sensor package runs a real-time LiDAR-Inertial SLAM algorithm, generating a dense point cloud map that accurately reconstructs the geometric features of the environment. Following the acquisition of that point cloud, we post-process these data by fusing them with images from the RGB and thermal cameras and produce a detailed, color-enriched 3D map that is useful and adaptable to different mission requirements. We demonstrated our system in a variety of scenarios, from indoor to outdoor conditions, and the results showcased the effectiveness and applicability of our sensor package and fusion pipeline. This system can be applied in a wide range of applications, ranging from autonomous navigation to smart agriculture, and has the potential to make a substantial benefit across diverse fields.

METHODS:We included patients with complex ASD with 6-week data. LE parameters were as follows: sacrofemoral angle, knee flexion angle, and ankle flexion angle. Each parameter was ranked, and upper tertile was deemed compensation. Patients compensating and not compensating postoperatively were propensity score matched for body mass index, frailty, and T1 pelvic angle. Linear regression assessed correlation between LE parameters and baseline deformity, demographics, and surgical details. Multivariate analysis controlling for baseline deformity and history of total knee/hip arthroplasty evaluated outcomes.RESULTS:Two hundred and ten patients (age: 61.3±14.1 years, body mass index: 27.4±5.8 kg/m 2, Charlson Comorbidity Index: 1.1±1.6, 72% female, 22% previous total joint arthroplasty, 24% osteoporosis, levels fused: 13.1±3.8) were included. At baseline, 59% were compensating in LE: 32 …

METHODS:This is a retrospective analysis of the multicenter, prospectively collected Quality Outcomes Database (QOD). Patients with surgically treated grade I lumbar spondylolisthesis with five years of follow-up were included. Patient reported outcomes (PROs) were recorded. Patients were grouped into baseline dependent or independent cohorts based on the Personal Care component of the ODI (0-2= independent; ³3= dependent). Minimum clinically important difference (MCID) was defined as a 30% reduction from baseline disability.RESULTS:Of the 602 patients, 535 (89%) were independent and 67 (11%) were dependent at baseline with mean age of 63 and 59, respectively (p= 0.01). 479 patients (80%) reported 60-month follow up Personal Care scores, with 59% reporting improvement and 41% having worse or no improvement. At 60-month follow-up, 87.5% of dependent patients had gained lasting …

METHODS:The CSM database of the QOD Study Group was utilized for this analysis. Patients were prospectively enrolled and followed for 24 months, with a follow-up rate of 85.2%. The MCIDs were computed for five standardized instruments: Neck Disability Index (NDI), five-dimension Euro-QoL (EQ-5D) in QALYs, neck and arm pain numeric rating scale (NRS), and modified Japanese Orthopedic Association score (mJOA) at both 3 and 24-month follow-up. Seven previously validated measures of MCID were compared using the area-under-the-curve (AUC). The North American Spine Society (NASS) satisfaction scale was the anchor, with scores of 1-2 meeting criteria for satisfaction.RESULTS:A total of 1,141 patients underwent surgery for CSM. Improvement of= 30% from baseline was the optimal MCID across time points for NDI and neck/arm NRS. At 24 months, 30% improvement for these three instruments …

OBJECTIVE Return to work (RTW) is an important surgical outcome for patients who are employed, yet a significant number of patients with cervical spondylotic myelopathy (CSM) who are employed undergo cervical spine surgery and fail to RTW. In this study, the authors investigated factors associated with failure to RTW in the CSM population who underwent cervical spine surgery and who were considered to have a good surgical outcome yet failed to RTW. METHODS This study retrospectively analyzed prospectively collected data from the cervical myelopathy module of a national spine registry, the Quality Outcomes Database. The CSM data set of the Quality Outcomes Database was queried for patients who were employed at the time of surgery and planned to RTW postoperatively. Distinct multivariable logistic regression models were fitted with 3-month RTW as an …

METHODS:The Quality Outcomes Database (QOD), a prospectively collected multi-institutional database, was used to analyze North American Spine Society (NASS) satisfaction, Neck Disability Index (NDI), Visual analog scale for neck pain (NP-VAS) and arm pain (AP-VAS), EuroQoL-Visual Analog Scale (EQ-VAS), and modified Japanese Orthopedic Association (mJOA) at 3, 12, and 24-month follow up.RESULTS:1141 patients were surgically treated (anterior approach n= 785, 69%; posterior approach n= 356, 31%) for cervical spondylotic myelopathy. Average demographics were 60.5 years old, 52.6% male, 92.4% non-Hispanic, BMI 30.2, and length of stay 2.1 days. At 3 month follow up, satisfaction was positively correlated with NP-VAS (R= 0.298, p<. 001), AP-VAS (R= 0.315, p<. 001), NDI (R= 0.362, p<. 001), and negatively correlated with EQ-VAS (R=-0.294, p<. 001) and mJOA (R=-0.287, p<. 001). At 12 …

OBJECTIVE The Quality Outcomes Database (QOD) was established in 2012 by the NeuroPoint Alliance, a nonprofit organization supported by the American Association of Neurological Surgeons. Currently, the QOD has launched six different modules to cover a broad spectrum of neurosurgical practice—namely lumbar spine surgery, cervical spine surgery, brain tumor, stereotactic radiosurgery (SRS), functional neurosurgery for Parkinson’s disease, and cerebrovascular surgery. This investigation aims to summarize research efforts and evidence yielded through QOD research endeavors. METHODS The authors identified all publications from January 1, 2012, to February 18, 2023, that were produced by using data collected prospectively in a QOD module without a prespecified research purpose in the context of quality surveillance and improvement. Citations were …

OBJECTIVE The aim of this study was to explore the preoperative patient characteristics that affect surgical decision-making when selecting an anterior or posterior operative approach in patients diagnosed with cervical spondylotic myelopathy (CSM). METHODS This was a multi-institutional, retrospective study of the prospective Quality Outcomes Database (QOD) Cervical Spondylotic Myelopathy module. Patients aged 18 years or older diagnosed with primary CSM who underwent multilevel (≥ 2-level) elective surgery were included. Demographics and baseline clinical characteristics were collected. RESULTS Of the 841 patients with CSM in the database, 492 (58.5%) underwent multilevel anterior surgery and 349 (41.5%) underwent multilevel posterior surgery. Surgeons more often performed a posterior surgical approach in older patients (mean …