Scoli-Risk-1 study wins the Whitecloud Award for the second year in a row

An AO Spine Knowledge Forum Deformity study sponsored by AO Spine-SRS wins top award at the IMAST conference.

08 August 2016

Scoli-Risk-1 study wins the Whitecloud Award for the second year in a row

Dr. Amit Jain is presenting the award-winning abstract

The Scoli-Risk-1 study was designed to evaluate neurologic complications associated with surgical correction of “high risk” complex adult spinal deformity. This prospective, observational, multicenter study marks the first clinical trial collaboration between AO Spine and the Scoliosis Research Society (SRS). The study was executed by AO Clinical Investigation and Documentation (AOCID) on behalf of AO Spine and the SRS. The data are currently being analyzed.

At the recent International Meeting on Advanced Spinal Techniques (IMAST) held in Washington, D.C., from July 13-16, 2016, a paper based on the Scoli-Risk-1 study was awarded the prestigious Thomas E. Whitecloud Award for Best Clinical Paper. The study used the Scoli-Risk 1 dataset to investigate the incidence of proximal junction kyphosis (PJK) in adult spinal deformity patients fused to the pelvis, and compared the PJK rates in patients with long (upper instrumented vertebra (UIV) at or cranial to T8) vs. short (UIV caudal to T8) constructs.

Presenter of the abstract, Dr. Amit Jain, and the senior author of the study, Dr. Khaled Kebaish were thrilled to have won the Whitecloud award. Dr. Amit Jain declared, "This was a multicenter collaborative effort. This wouldn't have been possible without the cooperation of the Scoli-Risk investigators, support staff, and everyone who's been involved."

The Scoli-Risk-1 study's success comes as no surprise. This is the second year in a row it has been awarded the Whitecloud award—Best Clinical Paper at the 22nd IMAST meeting 2015. It has also been acknowledged at other meetings where it was the winner of the Best Paper Award at the Global Spine Congress 2015, and won the Russell A. Hibbs award for the best Clinical Research Paper at the SRS 48th Annual Meeting & Courses 2013.

Our congratulations go to Drs. Jain and Kebaish and the large team of people from around the world who are involved in this successful study.

The abstract of the winning presentation

Incidence of Proximal Junctional Kyphosis in Patients with Adult Spinal Deformity Fused to the Pelvis: A ScoliRisk-1 Subanalysis
Amit Jain, MD; Floreana Naef Kebaish, MD; Lawrence G. Lenke, MD; Yong Qiu, MD; Yukihiro Matsuyama, MD, PhD; Christopher P. Ames, MD; Michael G. Fehlings, MD, PhD, FRCSC; Benny T. Dahl, MD, PhD; Hossein Mehdian, MD; Kenneth MC Cheung, MD; Frank J. Schwab, MD; Ferran Pellisé, MD; Leah Yacat Carreon, MD, MSc; Christopher I. Shaffrey, MD; Khaled M. Kebaish, MD, FRCSC

Summary
The aim was to investigate the incidence of proximal junction kyphosis (PJK) in adult spinal deformity patients fused to the pelvis, and to compare PJK rates in patients with long (UIV at or cranial to T8) vs. short (UIV caudal to T8) constructs. The overall incidence of PJK in our study was 23.7%, with 9.6% patients requiring revision for PJK. Further, there was no significant difference in PJK rate in long vs. short fusion constructs anchored at the pelvis.

Hypothesis
In adult spinal deformity (ASD) patients fused to the pelvis, the incidence of proximal junctional kyphosis (PJK) would be significantly higher in short vs. long fusion constructs.

Design
Secondary analysis of a prospective cohort

Introduction
The aim of our study was to investigate the incidence of PJK in ASD patients fused to the pelvis, and to compare PJK rates in patients with long (defined as upper instrumented vertebrae “UIV” at or cranial to T8) vs. short (UIV caudal to T8) fusion constructs.

Methods
198 (73% of 272) patients who had long or short fusions anchored to the pelvis were identified from the AO Spine-SRS ScoliRisk-1 prospective study. At 2 years, 148 (75%) patients had radiographic and 159 (80%) patients had clinical follow-up. Patients who required revision surgery for PJK were classified as having “symptomatic PJK.” Patients who had a change from postoperative to a follow-up radiograph of >10° in kyphosis between the UIV and two levels above, but did not require revision were classified as “radiographic PJK.”

Results
Over the 2-year follow-up, PJK was noted in 47 of 198 (23.7%) patients. Of all patients, 19 (9.6%) underwent a revision surgery for PJK. Of 133 patients who did not undergo revision for PJK and had follow-up radiographic data available, 28 (21.1%) had radiographic evidence of PJK. The long vs. short fusion groups did not differ significantly with respect to rates of overall PJK (23.5% vs. 24.1%, P=0.933), symptomatic PJK (6.7% vs. 13.9%, P=0.092) or radiographic PJK (25.3% vs. 14.8%, P=0.145). Comparing health related quality of life outcomes in patients with radiographic PJK and those without PJK, there were no significant differences in: SF-36 physical component summary (P=0.986 and P=0.714), SF-36 mental component summary (P=0.705 and P=0.952), and SRS-22r total scores (P=0.993 and P=0.322) at baseline or at the 2-year follow-up, respectively.

Conclusion
The overall incidence of PJK in severe ASD patients with fusion to the pelvis was 23.7% with 9.6% undergoing revision. There was no increased rate of PJK or revision for PJK in long vs. short fusion constructs anchored at the pelvis.


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