Development of a Novel Cervical Deformity Surgical Invasiveness Index
Bibliographic record
Abstract
STUDY DESIGN: Retrospective review. OBJECTIVE: The aim of this study was to develop a novel surgical invasiveness index for cervical deformity (CD) surgery that incorporates CD-specific parameters. SUMMARY OF BACKGROUND DATA: There has been a surgical invasiveness index for general spine surgery and adult spinal deformity, but a CD index has not been developed. METHODS: CD was defined as at least one of the following: C2-C7 Cobb >10°, cervical lordosis (CL) >10°, cervical sagittal vertical axis (cSVA) >4 cm, chin brow vertical angle >25°. Consensus from experienced spine and neurosurgeons selected weightings for each variable that went into the invasiveness index. Binary logistic regression predicted high operative time (>338 minutes), estimated blood loss (EBL) (>600 mL), or length of stay (LOS) >5 days) based on the median values of operative time, EBL, and LOS. Multivariable regression modeling was utilized to construct a final model incorporating the strongest combination of factors to predict operative time, LOS, and EBL. RESULTS: Eighty-five CD patients were included (61 years, 66% females). The variables in the newly developed CD invasiveness index with their corresponding weightings were: history of previous cervical surgery (3), anterior cervical discectomy and fusion (2/level), corpectomy (4/level), levels fused (1/level), implants (1/level), posterior decompression (2/level), Smith-Peterson osteotomy (2/level), three-column osteotomy (8/level), fusion to upper cervical spine (2), absolute change in T1 slope minus cervical lordosis, cSVA, T4-T12 thoracic kyphosis (TK), and sagittal vertical axis (SVA) from baseline to 1-year. The newly developed CD-specific invasiveness index strongly predicted long LOS (R = 0.310, P < 0.001), high EBL (R = 0.170, P = 0.011), and extended operative time (R = 0.207, P = 0.031). A second analysis used multivariable regression modeling to determine which combination of factors in the newly developed index were the strongest determinants of operative time, LOS, and EBL. The final predictive model included: number of corpectomies, levels fused, decompression, combined approach, and absolute changes in SVA, cSVA, and TK. This model predicted EBL (R = 0.26), operative time (R = 0.12), and LOS (R = 0.13). CONCLUSION: Extended LOS, operative time, and high blood loss were strongly predicted by the newly developed CD invasiveness index, incorporating surgical factors and radiographic parameters clinically relevant for patients undergoing CD corrective surgery. LEVEL OF EVIDENCE: 4.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.008 | 0.014 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.001 |
| Bibliometrics | 0.006 | 0.004 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.001 |
| Open science | 0.001 | 0.001 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".