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Depression is higher among spine patients than among the general population. Some small studies, but not others, have suggested that depression may be a predictor of worse outcome after surgery.Determination whether there is an association between depression and worse response to surgery among spine patients.The national, prospective, Canadian Spine Outcome Research Network (CSORN) surgical outcome registry.All patients in the CSORN registry who received surgery for thoracic or lumbar degenerative deformity, stenosis, spondylolisthesis, disc disease, or disc herniation with a minimum of 12 months follow-up postoperation (n = 2310).Oswestry Disability Index (ODI), SF12 Physical Component Score (PCS), European Quality of Life (EuroQoL), and pain scales.Change in preoperative to 12-month postoperative ODI, and secondary measures, were compared to assess if there was an association between preoperative depression, as measured by PHQ9, and smaller response to surgery. Multivariate regression analysis was used to search for preoperative factors which might interact with PHQ9 to predict ODI outcome.Patients with PHQ95, associated with minimal to no depression, had the smallest ODI improvement (-16.8 [95%CI -18.1 to -15.3]) and patients with severe preoperative depression (PHQ9 ≥ 10) had the largest ODI improvement (-22.8 [95%CI -24.1 to -21.5]; p.00001). Similar findings were found in the EQ5D and PCS. Pain improvement was not different between depression levels. Multivariate modeling found worse baseline PHQ9 and ODI, greater age, nicotine use, more operative levels, and worse American Society of Anesthesiology score was predictive of worse ODI outcomes.Depressed patients have similar or better relative improvements in disability, quality of life, and pain, when compared to nondepressed patients, although their preoperative and postoperative levels of disability are higher. Surgeons should not be concerned that depression will reduce the patient-reported beneficial response to surgical intervention.

BACKGROUND CONTEXT Spine patients have a higher rate of depression then the general population which may be caused in part by levels of pain and disability from their spinal disease. PURPOSE Determination whether improvements in health-related quality of life (HRQOL) resulting from successful spine surgery leads to improvements in mental health. STUDY DESIGN/SETTING The Canadian Spine Outcome Research Network prospective surgical outcome registry. OUTCOME MEASURES Change between preoperative and postoperative SF12 Mental Component Score (MCS). Secondary outcomes include European Quality of Life (EuroQoL) Healthstate, SF-12 Physical Component Score (PCS), Oswestry Disability Index (ODI), Patient Health Questionaire-9 (PHQ9), and pain scales. METHODS The Canadian Spine Outcome Research Network registry was queried for all patients receiving surgery for degenerative thoracolumbar spine disease. Exclusion criteria were trauma, tumor, infection, and previous spine surgery. SF12 Mental Component Scores (MCS) were compared between those with and without significant improvement in postoperative disability (ODI) and secondary measures. Multivariate analysis examined factors predictive of MCS improvement. RESULTS Eighteen hospitals contributed 3222 eligible patients. Worse ODI, EuroQoL, PCS, back pain and leg pain correlated with worse MCS at all time points. Overall, patients had an improvement in MCS that occurred within 3 months of surgery and was still present 24 months after surgery. Patients exceeding Minimally Clinically Important Differences in ODI had the greatest improvements in MCS. Major depression prevalence decreased up to 48% following surgery, depending on spine diagnosis. CONCLUSIONS Large scale, real world, registry data suggests that successful surgery for degenerative lumbar disease is associated with reduction in the prevalence of major depression regardless of the specific underlaying diagnosis. Worse baseline MCS was associated with worse baseline HRQOL and improved postoperatively with coincident improvement in disability, emphasizing that mental wellness is not a static state but may improve with well-planned spine surgery.

BACKGROUND Understanding patient expectations is a critical component of patient-centered care; however, little is known about which expectation(s) are most important to patients as they relate to their sense of post-operative success. PURPOSE To investigate patient's preoperative expectations of change in symptoms, function and well-being resulting from surgical intervention and to examine the associations between socio-demographic, lifestyle, health status and clinical characteristics with patient outcome expectations. STUDY DESIGN Observational cross-sectional study. SAMPLE Pre-operative data from the Canadian Spine Outcomes and Research Network national registry of patients of patients (n=4333) undergoing surgery for degenerative spinal conditions between 2012 and 2017. OUTCOME MEASURES Patients reported their expectations as a result of the surgery (0 (no change), 1 (somewhat better), 2 (better) or 3 (much better)) for seven items: leg/arm pain, back/neck pain, independence in everyday activities, sporting activities/recreation, general physical capacity, frequency and quality of social contacts and mental well-being. Patients also reported the single most important change expected. METHODS Data on demographic, lifestyles, health status, clinical factors and reasons for having surgery were also collected. Factor analysis was used to examine the multidimensionality of expectations. Multivariate linear regression was used to examine factors associated with expectations. RESULTS Over 80% of patients reported expectation for improvements (at least somewhat better) in all items with the exception of social contacts (75.8%). Expectations are multidimensional; a two factor structure emerged indicating two expectation dimensions (pain relief and overall functional well-being). Two expectation scores were calculated corresponding to the two dimensions (0-100), with higher scores reflecting higher expectations. The mean ± standard deviation pain relief expectation score was 78.5 ± 24.7 and the mean overall functional well-being expectation score was 69.7 ± 24.4. In multivariate analysis, the variables associated with these dimensions either differed or differed in degree of influence. For example, higher pain and disability scores, thoraco-lumbar location and diagnosis of spondylolisthesis were associated with higher expectations in both dimensions, while longer disease duration was only associated with lower overall functional well-being expectations. The top three most important expected change items were pain (improvement of leg or arm pain (29.1%) / improvement in back/neck pain (26.0%)), improvement in general capacity/function (21.0%), and improvement of independence in everyday activities (15.9%). Rankings of the most important expected change were similar across socio-demographic, lifestyle, health status and clinical variables examined. CONCLUSIONS Our findings highlight the need to identify and address specific individual expectations as part of the shared decision-making and pre-surgery education process.

BACKGROUND CONTEXT Traumatic spinal cord injury can have a dramatic effect on a patient's life. The degree of neurologic recovery greatly influences a patient's treatment and expected quality of life. This has resulted in the development of machine learning algorithms (MLA) that use acute demographic and neurologic information to prognosticate recovery. The van Middendorp et al. (2011) (vM) logistic regression (LR) model has been established as a reference model for the prediction of walking recovery following spinal cord injury as it has been validated within many different countries. However, an examination of the way in which these prediction models are evaluated is warranted. The area under the receiver operators curve (AUROC) has been consistently used when evaluating model performance, but it has been shown that AUROC overemphasizes the most common event resulting in an inaccurate assessment when the data are imbalanced. Furthermore, there is evidence that the use of more advanced MLA, such as an unsupervised k-means model, may show superior performance compared to LR as they can handle a larger number of features. PURPOSE The first objective of the study was to assess the performance of both an unsupervised MLA and LR model with complete admission neurologic information against the vM and Hicks models. Second, a comparison between the accuracy of the AUROC and the F1-score will be made to determine which method is superior for the assessment of diagnostic performance of prediction models on large-scale datasets. STUDY DESIGN Retrospective review of a prospective cohort study. PATIENT SAMPLE The Rick Hansen Spinal Cord Injury Registry (RHSCIR) was used in this study. All patients enrolled between 2004 and 2017 with complete neurologic examination and Functional Independence Measure outcome data at ≥1 year follow-up or who could walk at discharge were included. The prognostic variables included age (dichotomized at ≥65 years old); American Spinal Injury Association Impairment Scale (AIS) grade; and individual motor, light touch, and pinprick score from L2 to S1. OUTCOME MEASURES The Functional Independence Measure locomotor score was used to assess independent walking ability at discharge or 1-year follow-up. METHODS An unsupervised MLA with k=2 was chosen in order to identify a “walk” cluster and a “not walk” cluster. Model performance was assessed through the development of a receiver operating characteristic curve with associated AUROC and a precision-recall curve with associated F1-score. The study and the RHSCIR are supported by funding from Health Canada, Western Economic Diversification Canada, and the Governments of Alberta, British Columbia, Manitoba, and Ontario. These funders had no role in the study or study reporting and the authors have no conflicts of interest to report. RESULTS No clinically relevant differences were found between with the use of an unsupervised MLA with a greater amount of initial neurologic information compared to the established standards for any AIS classification. Although demonstrated for all separate AIS classifications, most notably, the AUROC for the vM (0.78) and Hicks models (0.76) were found to be superior to that of the new LR model (0.72); however, the vM and Hicks models had more than double the amount of false negative classifications compared to the LR. The F1-scores between these three models were also found to be different but with the vM and Hicks models being lower than the LR (0.85, 0.81, and 0.89, respectively). CONCLUSIONS No clinically relevant differences were found between the use of an unsupervised MLA with complete admission neurologic information compared to the previously validated standards; however, when comparing the performance of the AUROC and F1-score, the AUROC showed inaccurate prognostic performance when there was an imbalance toward a greater amount of false negatives. Importantly, the F1-score did not succumb to this imbalance. As AUROC has been used as the standard when evaluating performance of prediction models, consideration as to whether this is the most appropriate method is warranted. Future work should focus on comparing AUROC and F1-scores with other previously validated models.

BACKGROUND Degenerative lumbar spinal stenosis is a common condition, predominantly affecting middle-aged and elderly people. This study focused on patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity. PURPOSE To determine whether the addition of fusion to decompression resulted in improved clinical outcomes at 3, 12, and 24 months postsurgery. STUDY DESIGN/SETTING The Canadian Spine Outcomes and Research Network (CSORN) prospective database that includes pre- and postoperative data from tertiary care hospitals. PATIENT SAMPLE The CSORN database was queried for consecutive spine surgery cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Neurogenic claudication patients with baseline and 2-year follow-up data, from four sites, formed the study sample (n=306). The sample was categorized into two groups: (1) those that had decompression alone, and (2) those that underwent decompression plus fusion. OUTCOME MEASURES Change in modified Oswestry Disability Index (ODI), numerical rating scale for back/leg pain, the EuroQol EQ5D, the SF-12 physical, and mental component scores. The primary outcome measure was the ODI at 2 years postoperative. METHODS We conducted a multicenter, ambispective review of consecutive spine surgery patients enrolled between October 2012 and January 2018. RESULTS Baseline characteristics were comparable between groups except for female sex and multilevel pathology (both with greater proportion in the decompression plus fusion group). The decompression plus fusion group had clinically meaningfully more operative time, blood loss, rate of perioperative complication, and length of hospital stay (p Both decompression and decompression plus fusion had a large clinically meaningful impact on generic and disease-specific patient-reported outcome measures within 3 months of surgery which was maintained out to 24-month follow-up. At any follow-up time point, there was no statistical evidence of a difference in these effects favoring decompression plus fusion over decompression alone. CONCLUSIONS The addition of fusion to decompression did not result in improved outcomes at 3-, 12-, or 24-month follow-up. The addition of fusion to decompression provides no advantage to decompression alone for the treatment of patients with neurogenic claudication secondary to lumbar stenosis without spondylolisthesis or deformity.

BACKGROUND CONTEXT Lumbar degenerative stenosis is one of the most common spine pathologies for which surgical intervention is indicated. There is some evidence that a prolonged duration of neurological compression could lead to a failure of surgery to alleviate symptoms. PURPOSE Determination of whether longer symptom duration was associated with worse postoperative disability outcomes after decompressive surgery for lumbar degenerative stenosis. STUDY DESIGN/SETTING The Canadian Spine Outcomes and Research Network (CSORN) prospective database includes pre- and postoperative data from 18 tertiary care hospitals. PATIENT SAMPLE The CSORN database was queried for all cases of degenerative lumbar stenosis receiving surgical decompression for neurogenic claudication or radiculopathy. Patients with tumor, infection, fracture, or previous surgery were excluded. Patients were divided into groups based on symptom duration ( 2 years). OUTCOME MEASURES Change between preoperative and 12-month postoperative Oswestry Disability Index (ODI) was compared between symptom duration groups. Secondary outcomes included SF12 physical component score (PCS), and numeric rating scales for leg and back pain. Outcomes were also assessed at 3 months and 24 months postoperatively. METHODS Change in ODI, and secondary outcome measures, were compared between different symptom duration groups. Multiple regression analysis was used to identify factors interacting with symptom duration to predict change in ODI. RESULTS Four hundred and seventy-eight cases of lumbar stenosis with 12-month postoperative data were identified. Longer symptom duration correlated with less improvement in ODI (p 1 year of symptoms were less likely to achieve a Minimal Clinically Significant Difference in ODI (54.4% vs. 66.1%; p=.03) and were more likely to experience no improvement or worse disability, postoperatively (22.1% vs. 11.3%; p=.008). Similar results were found at 3- and 24-month timepoints. Smaller postoperative improvements in SF12 PCS and leg pain scales were also correlated with longer symptom duration (p CONCLUSIONS Multicenter registry data provides important real-world evidence to guide consent, surgical planning, and health resource management. Longer symptom duration was found to correlate with less improvement in pain and disability after lumbar stenosis surgery suggesting that these patients may benefit from earlier treatment.

Retrospective review of results from a prospectively collected Canadian cohort in comparison to published literature.(1) To investigate whether patients in a universal health care system have different outcomes than those in a multitier health care system in surgical management of degenerative spondylolisthesis (DS). (2) To identify independent factors predictive of outcome in surgical DS patients.Canada has a national health insurance program with unique properties. It is a single-payer system, coverage is universal, and access to specialist care requires referral by the primary care physician. The United States on the other hand is a multitier public/private payer system with more rapid access for insured patients to specialist care.Surgical DS patients treated between 2013 and 2016 in Canada were identified through the Canadian Spine Outcome Research Network (CSORN) database, a national registry that prospectively enrolls consecutive patients with spinal pathology from 16 tertiary care academic hospitals. This population was compared with the surgical DS arm of patients treated in the Spine Patients Outcome Research Trial (SPORT) study. We compared baseline demographics, spine-related, and health-related quality of life (HRQOL) outcomes at 3 months and 1 year. Multivariate analysis was used to identify factors predictive of outcome in surgical DS patients.The CSORN cohort of 213 patients was compared with the SPORT cohort of 248 patients. Patients in the CSORN cohort were younger (mean age 60.1 vs. 65.2; p.001), comprised fewer females (60.1% vs. 67.7%; p=.09), and had a higher proportion of smokers (23.3% vs. 8.9%; p.001). The SPORT cohort had more patients receiving compensation (14.6% vs. 7.7%; p.001). The CSORN cohort consisted of patients with slightly greater baseline disability (Oswestry disability index scores: 47.7 vs. 44.0; p=.008) and had more patients with symptom duration of greater than 6 months (93.7% vs. 62.1%; p.001). The CSORN cohort showed greater satisfaction with surgical results at 3 months (91.1% vs. 66.1% somewhat or very satisfied; p.01) and 1 year (88.2% vs. 71.0%, p.01). Improvements in back and leg pain were similar comparing the two cohorts. On multivariate analysis, duration of symptoms, treatment group (CSORN vs. SPORT) or insurance type (public/Medicare/Medicaid vs. Private/Employer) predicted higher level of postoperative satisfaction. Baseline depression was also associated with worse Oswestry disability index at 1-year postoperative follow-up in both cohorts.Surgical DS patients treated in Canada (CSORN cohort) reported higher levels of satisfaction than those treated in the United States (SPORT cohort) despite similar to slightly worse baseline HRQOL measures. Symptom duration and insurance type appeared to impact satisfaction levels. Improvements in other patient-reported health-related quality of life measures were similar between the cohorts.

Objective To analyze relations among injury, demographic, and environmental factors on function, health-related quality of life (HRQoL), and life satisfaction in individuals with traumatic spinal cord injury (SCI). Design Prospective observational registry cohort study. Setting Specialized acute and rehabilitation SCI centers. Participants Participants (N=340) from the Rick Hansen Spinal Cord Injury Registry (RHSCIR) who were prospectively recruited from 2004 to 2014 were included. The model cohort participants were 79.1% men, with a mean age of 41.6±17.3 years. Of the participants, 34.7% were motor/sensory complete (ASIA Impairment Scale [AIS] grade A). Interventions None. Main Outcome Measures Path analysis was used to determine relations among SCI severity (AIS grade and anatomic level [cervical/thoracolumbar]), age at injury, education, number of health conditions, functional independence (FIM motor score), HRQoL (Medical Outcomes Study 36-Item Short-Form Health Survey [Version 2] Physical Component Score [PCS] and Mental Component Score [MCS]), and life satisfaction (Life Satisfaction-11 [LiSat-11]). Model fit was assessed using recommended published indices. Results Goodness of fit of the model was supported by all indices, indicating the model results closely matched the RHSCIR data. Higher age, higher severity injuries, cervical injuries, and more health conditions negatively affected FIM motor score, whereas employment had a positive effect. Higher age, less education, more severe injuries (AIS grades A–C), and more health conditions negatively correlated with PCS (worse physical health). More health conditions were negatively correlated with a lower MCS (worse mental health), however were positively associated with reduced function. Being married and having higher function positively affected Lisat-11, but more health conditions had a negative effect. Conclusions Complex interactions and enduring effects of health conditions after SCI have a negative effect on function, HRQoL, and life satisfaction. Modeling relations among these types of concepts will inform clinicians how to positively effect outcomes after SCI (eg, development of screening tools and protocols for managing individuals with traumatic SCI who have multiple health conditions).

Traumatic spinal cord injury (SCI) is a debilitating condition with limited treatment options for neurologic or functional recovery. The ability to predict the prognosis of walking post injury with emerging prediction models could aid in rehabilitation strategies and reintegration into the community.To revalidate an existing clinical prediction model for independent ambulation (van Middendorp et al., 2011) using acute and long-term post-injury follow-up data, and to investigatethe accuracy of a simplified model using prospectively collected data from a Canadian multicenter SCI database, the Rick Hansen Spinal Cord Injury Registry (RHSCIR).Prospective cohort study.The analysis cohort consisted of 278 adult individuals with traumatic SCI enrolled in the RHSCIR for whom complete neurologic examination data and Functional Independence Measure (FIM) outcome data were available.The FIM locomotor score was used to assess independent walking ability (defined as modified or complete independence in walk or combined walk and wheelchair modality) at 1-year follow-up for each participant.A logistic regression (LR) model based on age and four neurologic variables was applied to our cohort of 278 RHSCIR participants. Additionally, a simplified LR model was created. The Hosmer-Lemeshow goodness of fit test was used to check if the predictive model is applicable to our data set. The performance of the model was verified by calculating the area under the receiver operating characteristic curve (AUC). The accuracy of the model was tested using a cross-validation technique. This study was supported by a grant from The Ottawa Hospital Academic Medical Organization ($50,000 over 2 years). The RHSCIR is sponsored by the Rick Hansen Institute and is supported by funding from Health Canada, Western Economic Diversification Canada, and the provincial governments of Alberta, British Columbia, Manitoba, and Ontario. ET and JP report receiving grants from the Rick Hansen Institute (approximately $60,000 and $30,000 per year, respectively). DMR reports receiving remuneration for consulting services provided to Palladian Health, LLC and Pacira Pharmaceuticals, Inc ($20,000-$30,000 annually), although neither relationship presents a potential conflict of interest with the submitted work. KEH received a grant for involvement in the present study from the Government of Canada as part of the Canada Summer Jobs Program ($3,000). JP reports receiving an educational grant from Medtronic Canada outside of the submitted work ($75,000 annually). TM reports receiving educational fellowship support from AO Spine, AO Trauma, and Medtronic; however, none of these relationships are financial in nature. All remaining authors have no conflicts of interest to disclose.The fitted prediction model generated 85% overall classification accuracy, 79% sensitivity, and 90% specificity. The prediction model was able to accurately classify independent walking ability (AUC 0.889, 95% confidence interval [CI] 0.846-0.933, p.001) compared with the existing prediction model, despite the use of a different outcome measure (FIM vs. Spinal Cord Independence Measure) to qualify walking ability. A simplified, three-variable LR model based on age and two neurologic variables had an overall classification accuracy of 84%, with 76% sensitivity and 90% specificity, demonstrating comparable accuracy with its five-variable prediction model counterpart. The AUC was 0.866 (95% CI 0.816-0.916, p.01), only marginally less than that of the existing prediction model.A simplified predictive model with similar accuracy to a more complex model for predicting independent walking was created, which improves utility in a clinical setting. Such models will allow clinicians to better predict the prognosis of ambulation in individuals who have sustained a traumatic SCI.

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is the leading cause of spinal cord impairment worldwide. Recent evidence suggests that patients with CSM benefit from surgical intervention regardless of their preoperative disease severity. PURPOSE The goals of this study are (1) to validate previous results and (2) to assess the impact of surgery on neurologic and health-related quality of life (HRQoL) outcome measures at 12 months after surgery in a prospective cohort of patients. STUDY DESIGN/SETTING In this multicenter, prospective cohort study, patients were recruited by 35 surgeons from seven Canadian centers between 2015 and 2018. PATIENT SAMPLE Eligible patients had a clinical diagnosis of CSM with evidence of spinal cord compression and had completed at least 12 months of follow-up. OUTCOME MEASURES Outcome measures included the modified Japanese Orthopaedic Association (mJOA) score, neck disability index (NDI), EQ-5D and SF-12. These were assessed at baseline and at 12 months after surgery for the whole cohort and were further analyzed based on pre-operative disease severity: mild (mJOA ≥15), moderate (mJOA 12 – 14), and severe (mJOA METHODS N/A RESULTS Of 378 patients who underwent surgical decompression, disease severity and outcomes measures at 12 months were available for 364. Mean age is 59 years, and females comprise 37% of the cohort. A total of 104 patients (29%) were classified as having mild myelopathy, 153 (42%) as moderate, and 107 severe (29%). At baseline, patients with severe myelopathy were older, were more disabled, and had lower HRQoL scores. For the whole cohort, there was significant improvement in all outcome measures at 12 months (p CONCLUSIONS This study validates the results of previous studies that demonstrated improved outcomes with surgical decompression in cervical myelopathy. When stratified by disease severity, however, patients with mild myelopathy did not improve significantly from an mJOA or HRQoL perspective compared to patients with moderate and severe disease. These findings highlight the controversy of how to manage a patient with mild cervical myelopathy and support a more conservative approach with close clinical follow-up in neurologically stable patients. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Cervical spondylotic myelopathy (CSM) is the most common cause of spinal cord dysfunction internationally; however, few studies have evaluated return to work (RTW) after CSM surgery. PURPOSE Our goals were to determine rates and predictors of postoperative RTW and to compare postoperative rates to a lumbar spondylolisthesis cohort. STUDY DESIGN/SETTING Retrospective review of prospectively-collected data. PATIENT SAMPLE Non-retired patients undergoing surgical decompression for CSM. OUTCOME MEASURES Return to work (ie, active employment) at 1-year following surgery. METHODS Data were derived from the CSORN prospective, multi-center surgical CSM registry. From this cohort, we included all non-retired patients with at least 1-year follow-up. RTW rate was defined as the proportion of patients with active employment at 1-year from the time of surgery. Bivariable and multivariable logistic regression were used to identify patient, disease and treatment variables predicting RTW. RESULTS Of 211 surgically treated CSM patients with 1-year follow-up, 102 (48.3%) were considered non-retired preoperatively, with 54.5% working and 45.5% not working in the immediate period before surgery. At 1-year, 60 patients (58.8%) had returned to work, while 42 (41.2%) were not working. In bivariable analyses, while working preoperatively predicted postoperative RTW(p 0.05). In multivariable analyses, only preoperative employment status predicted RTW, with those working pre-op having 12 times greater odds of working at 12 months postoperative (OR:12.1,95%CI:2.2,66.5). For comparison, the 1-year post-surgical RTW rate in the CSORN lumbar spondylolisthesis study cohort was 70.0%. CONCLUSIONS The majority (58.8%) of non-retired patients undergoing surgery for CSM had returned to work 12 months postoperative; preoperative work status was the only significant predictor of RTW in this analysis. RTW rates appear to be lower in CSM compared to lumbar spondylolisthesis. These results will help to inform preoperative patient counseling, enable economic analyses and serve as a focus for future quality improvement efforts. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT Recent evidence suggests that sagittal alignment may play a role in the presentation and management of patients with cervical spondylotic myelopathy (CSM) but its importance has not been fully established. PURPOSE Our objectives were to evaluate the extent to which (1) preoperative sagittal alignment is associated with baseline function and symptoms, (2) surgery leads to changes in sagittal alignment, and (3) postoperative sagittal alignment is associated with function and symptoms at follow-up. STUDY DESIGN/SETTING We performed an observational cohort study using prospectively collected data from the Canadian Spine Outcomes and Research Network (CSORN). PATIENT SAMPLE We included consecutive patients who were diagnosed with CSM by participating surgeons at seven centers between 2015 and 2017. OUTCOME MEASURES mJOA, NDI, VAS, SF12 and EQ5D. METHODS We measured sagittal alignment using two methods: surgeon classification and Ishihara's Cervical Curvature Index (ICCI). We measured function and symptoms with multiple Patient Reported Outcome Measures (PROMs), and we adjusted for age, gender, severity, and comorbidities using multiple linear regression. RESULTS Among 474 patients, baseline alignment was neutral in 196 (41%), lordotic in 190 (40%), and kyphotic in 88 (19%). In unadjusted analyses, baseline kyphosis was associated with significantly worse EuroQol 5D (p CONCLUSIONS In patients with CSM, baseline alignment is not associated with differences in impairment of health-related quality of life after adjusting for potential confounders. Surgery for CSM increases lordosis and improves symptoms and function regardless of baseline alignment, but postoperative sagittal alignment does not seem to be associated with final patient-reported outcomes. Our findings suggest that sagittal alignment restoration may not be critical for improving PROMs in the surgical management of patients with CSM, and that surgeons may prioritize the technical goals of neurological decompression and stabilization. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.

BACKGROUND CONTEXT The importance of sagittal balance and spinopelvic parameters are recognized in the management and outcomes of adult spinal deformity and isthmic spondylolisthesis, but less is known regarding their role in degenerative lumbar spondylolisthesis (DLS). The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. PURPOSE The purpose of this study is to determine the influence of baseline sagittal balance and spinopelvic parameters on pain, function, and health-related quality of life (HRQOL) of patients presenting with DLS. STUDY DESIGN/SETTING Prospective, multi-center study from the Canadian Spine Outcome and Research Network (CSORN). PATIENT SAMPLE Patients with DLS were enrolled in a prospective, multi-center study between 2015 and 2017. Inclusion into this study required DLS at 1 or 2 levels and symptoms of neurogenic claudication or radicular pain with our without back pain. Patients were excluded if they had previous lumbar spine surgery or the presence of another condition which significantly affected function OUTCOME MEASURES Patient-rated outcome measures included the Numeric Pain Rating Scale (NPRS) for back pain and leg pain, Oswestry Disability Index (ODI), SF-12 Physical Component Summary score (PCS) and Mental Component Summary score (MCS), EQ-5D. Pelvic parameter measurements included: sacral slope (SS), pelvic tilt (PT), pelvic incidence (PI), sagittal vertical axis (SVA), lumbar lurdosis (LL), thoracic kyphosis (TK), T1 spino-pelvic inclination (T1 SPI), and T9 spino-pelvic inclination (T9 SPI). METHODS Baseline patient demographics, radiographic spinopelvic parameters, and sagittal alignment were analyzed for possible correlation to HRQOL using Pearson correlations. RESULTS A total of 154 patients were analyzed (mean age: 65.8, BMI: 29.1) with grade I (72%) or II (28%) DLS, of which 95 were females. Primary symptoms were related to neurogenic claudication (80%), radiculopathy (15.3%) or back pain (4.7%). On average, symptom duration was greater than 2 years in 71% of patients. Patients had moderate to severe symptoms and disability (mean NRS back: 7.2, NRS leg: 7.3, ODI: 45.6, PCS-12: 33.2, MCS-12: 49.6, EQ-5D: 0.54). Baseline measurements of radiographic alignment included sacral slope (SS=34.9±16.7°), pelvic tilt (PT=24.8±9.5°), pelvic incidence (PI=57.4±13.8°), sagittal vertical axis (SVA=35.8±40.8mm), lumbar lordosis (LL=45.7±13.6°), thoracic kyphosis (TK=36.8±13.0°), T9-spinopelvic inclination (T9SPI=9.62±4.0°), and T1-spinopelvic inclination (T1SPI=4.43±10.4°). There were 54% of patients who had an insufficient lumbar lordosis based on the relationship between PI and LL (LL CONCLUSIONS Patients with DLS have global sagittal misalignment compared to published normative controls, highlighted by less lumbar lordosis, a PI to LL mismatch, and increased PT. Spinopelvic alignment was not associated with patient outcomes, although positive sagittal balance may also be influenced by spinal stenosis. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.