• Mitsuru Yagi, Kenshi Daimon, Naobumi Hosogane, Eijiro Okada, Satoshi Suzuki, Osahiko Tsuji, Narihito Nagoshi, Nobuyuji Fujita, Masaya Nakamura, Morio Matsumoto, Kota Watanabe, and Keio Spine Research Group.
• Department of Orthopedic Surgery, Keio University School of Medicine, Tokyo, Japan.
• Spine. 2021 Jan 15; 46 (2): E80-E86.

Study DesignThis is a multicenter retrospective review of 257 surgically treated consecutive ASD patients who had a minimum of five fused segments, completed a 2-year follow-up (53 ± 19 yrs, females: 236 [92%]).ObjectiveThis study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort.Summary Of Background DataThe GAP score is a recently established risk stratification model for MF following ASD surgery. However, the predictive ability of the GAP score is not well studied. This study aimed to validate the predictive probability of the GAP score in an Asian ASD patient cohort.MethodsComparisons of the immediate postoperative GAP scores between MF the and MF-free groups were performed. We evaluated the discriminative ability of the GAP score based on the area under the receiver operating characteristic curve (AUROC). The Cuzick test was performed to determine whether there is a trend between the GAP score and the incidence of MF or revision surgery. Univariate logistic regression analyses were performed to explore the associations between the GAP score and the incidence of MF or revision surgery.ResultsNo difference was observed in the GAP score between the MF and MF-free groups (MF vs. MF-free; GAP: 5.9 ± 3.3 vs. 5.2 ± 2.7, P = 0.07). The Cuzick analysis showed no trend between the GAP score and the risk for MF or revision surgery. Likewise, the MF rate was not correlated with the GAP score, as shown by the ROC curve (AUC of 0.56 [95% CI 0.48-0.63], P = 0.124). Univariate logistic regression confirmed no associations between the GAP score and the incidence of MF or revision surgery (MF; moderately disproportioned [MD]: OR: 0.6 [95% CI: 0.3-1.2], P = 0.17, severely disproportioned [SD]: OR: 1.2 [95% CI: 0.6-2.3], P = 0.69, revision surgery; MD: OR: 0.8 [95% CI: 0.2-2.8], P = 0.71, SD: OR: 1.2 [95% CI: 0.9-8.7], P = 0.08).ConclusionIn this multicenter study, in an Asian ASD patient cohort, the GAP score was not associated with the incidence of MF or revision surgery. Additional studies on the predictive ability of the GAP score in different patient cohorts are warranted.Level of Evidence: 3.Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.

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