Association Between Neighborhood-Level Socioeconomic Disadvantage and Patient-Reported Outcomes in Lumbar Spine Surgery

Zhang, Justin K.; Greenberg, Jacob K.; Javeed, Saad; Khalifeh, Jawad M.; Dibble, Christopher F.; Park, Yikyung; Jain, Deeptee; Buchowski, Jacob M.; Dorward, Ian G.; Santiago, Paul; Molina, Camilo A.; Pennicooke, Brenton; Ray, Wilson Z.

doi:10.1227/neu.0000000000002181

Cited by 15 publications

(19 citation statements)

References 33 publications

(44 reference statements)

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“…In addition, this cluster comprised the highest percentage of non-Caucasian race (Table 1). Although this result is an uncontrolled bivariate statistic, it raises important questions as to whether symptom severity upon presentation is related to inequitable access to health care or whether those with less socioeconomic disadvantage have higher health awareness and present earlier 34…”

Section: Discussionmentioning

confidence: 98%

Diffusion Basis Spectrum Imaging Identifies Clinically Relevant Disease Phenotypes of Cervical Spondylotic Myelopathy

Zhang

Javeed

Greenberg

et al. 2023

Clinical Spine Surgery: A Spine Publication

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Objective: Apply a machine learning clustering algorithm to baseline imaging data to identify clinically relevant cervical spondylotic myelopathy (CSM) patient phenotypes.Summary of Background Data: A major shortcoming in improving care for CSM patients is the lack of robust quantitative imaging tools to guide surgical decision-making. Advanced diffusion-weighted magnetic resonance imaging (MRI) techniques, such as diffusion basis spectrum imaging (DBSI), may help address this limitation by providing detailed evaluations of white matter injury in CSM.Methods: Fifty CSM patients underwent comprehensive clinical assessments and diffusion-weighted MRI, followed by DBSI modeling. DBSI metrics included fractional anisotropy, axial and radial diffusivity, fiber fraction, extra-axonal fraction, restricted fraction, and nonrestricted fraction. Neurofunctional status was assessed by the modified Japanese Orthopedic Association, myelopathic disability index, and disabilities of the arm, shoulder, and hand. Quality-of-life was measured by the 36-Item Short Form Survey physical component summary and mental component summary. The neck disability index was used to measure self-reported neck pain. K-means clustering was applied to baseline DBSI measures to identify 3 clinically relevant CSM disease phenotypes. Baseline demographic, clinical, radiographic, and patient-reported outcome measures were compared among clusters using one-way analysis of variance (ANOVA).Results: Twenty-three (55%) mild, 9 (21%) moderate, and 10 (24%) severe myelopathy patients were enrolled. Eight patients were excluded due to MRI data of insufficient quality. Of the remaining 42 patients, 3 groups were generated by k-means clustering. When compared with clusters 1 and 2, cluster 3 performed significantly worse on the modified Japanese Orthopedic Association and all patient-reported outcome measures (P < 0.001), except the 36-Item Short Form Survey mental component summary (P > 0.05). Cluster 3 also possessed the highest proportion of non-Caucasian patients (43%, P = 0.04), the worst hand dynamometer measurements (P < 0.05), and significantly higher intra-axonal axial diffusivity and extraaxonal fraction values (P < 0.001).Conclusions: Using baseline imaging data, we delineated a clinically meaningful CSM disease phenotype, characterized by worse neurofunctional status, quality-of-life, and pain, and more severe imaging markers of vasogenic edema.Level of Evidence: II.

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Section: Discussionmentioning

confidence: 98%

Diffusion Basis Spectrum Imaging Identifies Clinically Relevant Disease Phenotypes of Cervical Spondylotic Myelopathy

Zhang

Javeed

Greenberg

et al. 2023

Clinical Spine Surgery: A Spine Publication

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confidence: 84%

“…4 Much of the work out of the Dartmouth Atlas, which has downplayed the impact of poverty on health outcomes, comes from work examining Hospital Referral Regions. Meanwhile, neighborhoodbased ADI allows a more granular examination of the influence of area deprivation, which is shown in this study by Zhang et al 1 Demonstrating that socioeconomic status (SES), as measured through ADI, affects outcomes in neurosurgery is especially important in the context of the continued shift toward value-based reimbursements. The standard risk-adjustment formulas do not adequately adjust for SES.…”

mentioning

confidence: 88%

“…The use of ADI is relatively new in assessing outcomes in neurosurgery, but studies have shown that it is associated with recovery after surgery for subdural hematoma 2 and after ACDF. 3 The paper by Zhang et al 1 adds to this literature, showing, like the 2 aforementioned studies, that outcomes after lumbar spine surgery also correlate with a patient's ADI. It is important to note that, despite having worse Patient-Reported Outcomes Measurement Information System after surgery, lower ADI patients still improved when compared with their preoperative scores.…”

mentioning

confidence: 89%

“…T he paper by Zhang et al 1 examines how neighborhood socioeconomic factors, as measured by Area Deprivation Index (ADI), correlate with outcomes in patients undergoing lumbar spine surgery.…”

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confidence: 99%

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Commentary: Association Between Neighborhood-Level Socioeconomic Disadvantage and Patient-Reported Outcomes in Lumbar Spine Surgery

DiGiorgio

Mummaneni

2022

Neurosurgery

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Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

Javeed,

Benedict,

Yakdan

et al. 2024

JAMA Netw Open

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ImportanceComorbid depression is common among patients with degenerative lumbar spine disease. Although a well-researched topic, the evidence of the role of depression in spine surgery outcomes remains inconclusive.ObjectiveTo investigate the association between preoperative depression and patient-reported outcome measures (PROMs) after lumbar spine surgery.Data SourcesA systematic search of PubMed, Cochrane Database of Systematic Reviews, Embase, Scopus, PsychInfo, Web of Science, and ClinicalTrials.gov was performed from database inception to September 14, 2023.Study SelectionIncluded studies involved adults undergoing lumbar spine surgery and compared PROMs in patients with vs those without depression. Studies evaluating the correlation between preoperative depression and disease severity were also included.Data Extraction and SynthesisAll data were independently extracted by 2 authors and independently verified by a third author. Study quality was assessed using Newcastle-Ottawa Scale. Random-effects meta-analysis was used to synthesize data, and I2 was used to assess heterogeneity. Metaregression was performed to identify factors explaining the heterogeneity.Main Outcomes and MeasuresThe primary outcome was the standardized mean difference (SMD) of change from preoperative baseline to postoperative follow-up in PROMs of disability, pain, and physical function for patients with vs without depression. Secondary outcomes were preoperative and postoperative differences in absolute disease severity for these 2 patient populations.ResultsOf the 8459 articles identified, 44 were included in the analysis. These studies involved 21 452 patients with a mean (SD) age of 57 (8) years and included 11 747 females (55%). Among these studies, the median (range) follow-up duration was 12 (6-120) months. The pooled estimates of disability, pain, and physical function showed that patients with depression experienced a greater magnitude of improvement compared with patients without depression, but this difference was not significant (SMD, 0.04 [95% CI, −0.02 to 0.10]; I2 = 75%; P = .21). Nonetheless, patients with depression presented with worse preoperative disease severity in disability, pain, and physical function (SMD, −0.52 [95% CI, −0.62 to −0.41]; I2 = 89%; P &lt; .001), which remained worse postoperatively (SMD, −0.52 [95% CI, −0.75 to −0.28]; I2 = 98%; P &lt; .001). There was no significant correlation between depression severity and the primary outcome. A multivariable metaregression analysis suggested that age, sex (male to female ratio), percentage of comorbidities, and follow-up attrition were significant sources of variance.Conclusions and RelevanceResults of this systematic review and meta-analysis suggested that, although patients with depression had worse disease severity both before and after surgery compared with patients without depression, they had significant potential for recovery in disability, pain, and physical function. Further investigations are needed to examine the association between spine-related disability and depression as well as the role of perioperative mental health treatments.

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Association Between Neighborhood-Level Socioeconomic Disadvantage and Patient-Reported Outcomes in Lumbar Spine Surgery

Cited by 15 publications

References 33 publications

Diffusion Basis Spectrum Imaging Identifies Clinically Relevant Disease Phenotypes of Cervical Spondylotic Myelopathy

Diffusion Basis Spectrum Imaging Identifies Clinically Relevant Disease Phenotypes of Cervical Spondylotic Myelopathy

Commentary: Association Between Neighborhood-Level Socioeconomic Disadvantage and Patient-Reported Outcomes in Lumbar Spine Surgery

Implications of Preoperative Depression for Lumbar Spine Surgery Outcomes

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