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Alvaro Ibaseta, Rafa Rahman, Nicholas S. Andrade, Richard L. Skolasky, Khaled M. Kebaish, Daniel M. Sciubba, and Brian J. Neuman

P atient-reported outcomes (PROs) are tools to assess patients’ health-related quality of life. PROs have become an important measure of treatment success. 1 Valid and responsive PROs, with adequate discriminant ability, are needed to evaluate and compare treatments. Clinicians have traditionally used disease-specific PROs. In adult spinal deformity (ASD), legacy (i.e., traditional) PROs such as the Scoliosis Research Society 22-item questionnaire (SRS-22r) are commonly used. Although legacy PROs are validated and reliable, they are static, disease

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Parthasarathy D. Thirumala, Donald J. Crammond, Yoon K. Loke, Hannah L. Cheng, Jessie Huang, and Jeffrey R. Balzer

OBJECTIVE

The goal of this study was to evaluate the efficacy of intraoperative transcranial motor evoked potential (TcMEP) monitoring in predicting an impending neurological deficit during corrective spinal surgery for patients with idiopathic scoliosis (IS).

METHODS

The authors searched the PubMed and Web of Science database for relevant lists of retrieved reports and/or experiments published from January 1950 through October 2014 for studies on TcMEP monitoring use during IS surgery. The primary analysis of this review fit the operating characteristic into a hierarchical summary receiver operating characteristic curve model to determine the efficacy of intraoperative TcMEP-predicted change.

RESULTS

Twelve studies, with a total of 2102 patients with IS were included. Analysis found an observed incidence of neurological deficits of 1.38% (29/2102) in the sample population. Of the patients who sustained a neurological deficit, 82.8% (24/29) also had irreversible TcMEP change, whereas 17.2% (5/29) did not. The pooled analysis using the bivariate model showed TcMEP change with sensitivity (mean 91% [95% CI 34%–100%]) and specificity (mean 96% [95% CI 92–98%]). The diagnostic odds ratio indicated that it is 250 times more likely to observe significant TcMEP changes in patients who experience a new-onset motor deficit immediately after IS correction surgery (95% CI 11–5767). TcMEP monitoring showed high discriminant ability with an area under the curve of 0.98.

CONCLUSIONS

A patient with a new neurological deficit resulting from IS surgery was 250 times more likely to have changes in TcMEPs than a patient without new deficit. The authors' findings from 2102 operations in patients with IS show that TcMEP monitoring is a highly sensitive and specific test for detecting new spinal cord injuries in patients undergoing corrective spinal surgery for IS. They could not assess the value of TcMEP monitoring as a therapeutic adjunct owing to the limited data available and their study design.

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Andrew T. Hale, David P. Stonko, Li Wang, Megan K. Strother, and Lola B. Chambless

on this pattern recognition. 9 , 10 , 15 ANNs are often more useful than conventional statistics because 1) ANNs can take an arbitrary number of input variables and predict any number of target variables of either continuous or discrete nature, 2) ANNs are able to continue to “learn” or improve their predictive ability as they are exposed to new data, 3) ANNs benefit from internal validation and testing, and 4) ANNs tend to have stronger discriminant ability than conventional statistics. 6–9 Logistic regression is a common method used for capturing and expressing

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Andrew B. Harris, Floreana Kebaish, Lee H. Riley III, Khaled M. Kebaish, and Richard L. Skolasky

presenting for anterior cervical spine surgery . Spine (Phila Pa 1976) 42 : E1357 – E1365 , 2017 19 Purvis TE , Neuman BJ , Riley LH III , Skolasky RL : Discriminant ability, concurrent validity, and responsiveness of PROMIS health domains among patients with lumbar degenerative disease undergoing decompression with or without arthrodesis . Spine (Phila Pa 1976) 43 : 1512 – 1520 , 2018 20 Remmers C , Hibbard J , Mosen DM , Wagenfield M , Hoye RE , Jones C : Is patient activation associated with future health outcomes and healthcare

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Andrew T. Hale, David P. Stonko, Jaims Lim, Oscar D. Guillamondegui, Chevis N. Shannon, and Mayur B. Patel

clinical medicine. 5 , 6 , 9 They are often more useful than conventional statistical methods because: 1) ANNs can take any number of input variables and predict any number of outcomes; 2) they are capable of improving their predictive ability over time as they are exposed to new data; 3) they benefit from internal validation and testing; and 4) they tend to have stronger discriminant ability compared to conventional statistics. 1 , 13 , 31 , 40 Leveraging this technology, we created a model that combines clinical and radiologist-interpreted CT data to predict whether

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Dil V. Patel, Mundeep S. Bawa, Brittany E. Haws, Benjamin Khechen, Andrew M. Block, Sailee S. Karmarkar, Eric H. Lamoutte, and Kern Singh

, Skolasky RL : Concurrent validity and responsiveness of PROMIS health domains among patients presenting for anterior cervical spine surgery . Spine (Phila Pa 1976) 42 : E1357 – E1365 , 2017 23 Purvis TE , Neuman BJ , Riley LH III , Skolasky RL : Discriminant ability, concurrent validity, and responsiveness of PROMIS health domains among patients with lumbar degenerative disease undergoing decompression with or without arthrodesis . Spine (Phila Pa 1976) 43 : 1512 – 1520 , 2018 29621093 10.1097/BRS.0000000000002661 24 Sabatino MJ , Kunkel ST

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Jawad M. Khalifeh, Christopher F. Dibble, Ammar H. Hawasli, and Wilson Z. Ray

presenting for anterior cervical spine surgery . Spine (Phila Pa 1976) 42 : E1357 – E1365 , 2017 31 Purvis TE , Neuman BJ , Riley LH III , Skolasky RL : Discriminant ability, concurrent validity, and responsiveness of PROMIS health domains among patients with lumbar degenerative disease undergoing decompression with or without arthrodesis . Spine (Phila Pa 1976) 43 : 1512 – 1520 , 2018 32 Terwee CB , Bot SD , de Boer MR , van der Windt DA , Knol DL , Dekker J , : Quality criteria were proposed for measurement properties of health

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Taylor E. Purvis, Brian J. Neuman, Lee H. Riley III, and Richard L. Skolasky

specificity. The area under the curve (AUC), a measure of discriminant ability, was also calculated for the PROMIS Anxiety and Depression CATs. All analyses were conducted using SAS software (version 9.4, SAS Institute) or Stata software (version 14, Stata Corp LP). Statistical significance was accepted as p < 0.05. Results Patient Characteristics During the period of observation, 629 patients presented for spine surgery. Of these, 512 patients (81%) provided assessments of anxiety and depression: 54% women with a mean age of 56 ± 15 years met the inclusion criteria. There