Tag: cluster analysis

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Are there distinct patterns of clinical deficits in cervical deformity? A discriminant analysis of health-related quality of life measures

J Neurosurg Spine 44:242–252, 2026

This clinical study analyzes preoperative health-related quality of life (HRQOL) measures in 134 adults with cervical deformity (CD) to identify distinct clinical deficit patterns and their association with radiographic morphotypes. Using factor and cluster analyses on NDI, mJOA, and SWAL-QOL items, four patient clusters emerged: sleep/fatigue, low neck disability, dysphagia with severe neck disability, and myelopathy.

These HRQOL-derived clusters correlated with specific radiographic types among severe deformities: cervicothoracic, focal, and flat-neck morphotypes. The findings support integrating patient-reported clinical dimensions into CD classification systems to guide tailored surgical planning and outcome assessment.

Distinct HRQOL Patterns: Four distinct patterns of health-related quality of life (HRQOL) deficits were identified in patients with cervical deformity: sleep/fatigue impairment, low neck disability, severe dysphagia and neck disability, and predominant myelopathy.

Cluster Analysis: Principal component and cluster analyses using NDI, mJOA, and SWAL-QOL questionnaires grouped patients into four homogeneous outcome clusters, each reflecting a unique constellation of clinical deficits.

Radiographic Associations: Each HRQOL deficit pattern was significantly associated with specific cervical deformity morphotypes: severe dysphagia/neck disability with cervicothoracic deformity, myelopathy with focal deformity, and sleep/fatigue or low disability with flat neck deformity.

Clinical Implications: Recognizing these HRQOL patterns may inform tailored management strategies, surgical planning, and prognosis for different cervical deformity subtypes.

Measurement Tools: The study utilized validated patient-reported outcome measures: Neck Disability Index (NDI), modified Japanese Orthopaedic Association (mJOA) scale, and Swallowing Quality of Life (SWAL-QOL) questionnaire.

Radiographic Parameters: Comprehensive imaging assessments included cervical and spinopelvic alignment measures, such as cervical SVA, T1 slope, C2–7 lordosis, and T1S-CL mismatch.

Demographic Factors: No significant differences in age, sex, BMI, or most comorbidities were found across clusters, except for higher rates of depression and prior spine surgery in those with the most severe clinical deficits.

Classification Framework: Findings support integrating HRQOL measures with radiographic parameters for a more comprehensive, patient-centered cervical deformity classification system.

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Natural history of ventriculomegaly in adults: a cluster analysis

J Neurosurg 132:741–748, 2020

Chronic ventriculomegaly in the absence of raised intracranial pressure (ICP) is a known entity in adult hydrocephalus practice. The natural history and indication for treatment is, however, poorly defined. A highly heterogeneous group, some adults with ventriculomegaly are asymptomatic, while others have life-threatening deteriorations. The authors hypothesized that the various presentations can be subtyped and represent different stages of decompensation. A cluster analysis was performed on a cohort of patients with chronic ventriculomegaly with the aim of elucidating typical clinical characteristics and outcomes in chronic ventriculomegaly in adults.

METHODS Data were collected from 79 patients with chronic ventriculomegaly referred to a single center, including demographics, presenting symptoms, and 24-hour ICP monitoring (ICPM). A statistical cluster analysis was performed to determine the presence of subgroups.

RESULTS Four main subgroups and one highly dissimilar group were identified. Patients with ventriculomegaly commonly have a perinatal event followed by one of four main presentations: 1) incidental ventriculomegaly with or without headache; 2) highly symptomatic presentation (including reduced consciousness) and raised ICP; 3) early presenting with symptoms of headache and nausea (with abnormal pulsatility); and 4) late presenting with features common to normal pressure hydrocephalus. Each symptomatic group has characteristic radiological features, ICPM, and responses to treatment.

CONCLUSIONS Cluster analysis has identified subgroups of adult patients with ventriculomegaly. Such groups may represent various degrees of decompensation. Surgical interventions may not be equally effective across the subgroups, presenting an avenue for further research. The identified subtypes provide further insight into the natural history of this lesser studied form of hydrocephalus.

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