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Fusion rate: a time-to-event phenomenon
Sagun K Tuli1, Jayshree Tuli, Peng Chen
1Department of Neurosurgery, Brigham and Women's Hospital, Harvard Medical School, Boston, Massachusetts 02445, USA.
Journal of Neurosurgery. Spine
|August 5, 2004
Summary
Fusion rate is best represented by median times using survival analysis, not just percentages. This study shows the Kaplan-Meier method accurately captures fusion as a time-to-event phenomenon in cervical corpectomy patients.
Area of Science:
- Spine surgery
- Orthopedic surgery
- Neurosurgery
Background:
- Traditional fusion rate reporting uses percentages, which may not fully represent the time-dependent nature of fusion.
- Cervical decompressive corpectomy and reconstruction are complex procedures where accurate fusion assessment is critical.
Purpose of the Study:
- To demonstrate that median times, calculated via survival analysis, provide a more accurate representation of fusion rate.
- To compare fusion times between one-level and multilevel cervical corpectomies.
Main Methods:
- Survival analysis, specifically the Kaplan-Meier method, was used to estimate the median time to fusion.
- Radiographs were independently assessed by neuroradiologists to confirm fusion (trabeculae bridging).
- Cox regression was used for multivariate analysis, adjusting for age, sex, and smoking history.
Main Results:
- The median time to fusion was 88 days (cephalad) and 85 days (caudal).
- This translates to fusion rates of 92% (by 2.1 years) and 93% (by 1.5 years), respectively.
- No statistically significant difference in median fusion time was found between one- and two-level corpectomies, even after adjusting for covariates.
Conclusions:
- Fusion rate is a time-to-event phenomenon.
- The Kaplan-Meier method offers a more accurate representation of fusion compared to traditional percentage-based rates.
- Median time to fusion is a valuable metric in assessing cervical corpectomy outcomes.