Do Adult Spinal Deformity Patients Undergoing Surgery Continue to Improve From 1-Year to 2-Years Postoperative?

Scott L. Zuckerman, Christopher S. Lai, Yong Shen, Meghan Cerpa, Nathan J. Lee, Mena G. Kerolus, Alex S. Ha, Ian A. Buchanan, Clinton J. Devin, Ronald A. Lehman, Lawrence G. Lenke

Research output: Contribution to journalArticlepeer-review

2 Scopus citations

Abstract

Objective: Evaluate clinical improvement as measured by patient-reported outcomes (PROs) during the 1 to 2-year interval. Study Design: Retrospective Cohort. Methods: A single-institution registry of ASD patients undergoing surgery was queried for patients with ≥6 level fusions. Demographics and radiographic variables were collected. PROs collected were the ODI and SRS-22r scores at: preoperative, 1-year and 2-years. Outcome measures of clinical improvement during the 1-2 year time interval were: 1) group medians, 2) percent minimum clinically important difference (MCID), and 3) percent minimal symptom scale (MSS)(ODI < 20 or SRS-pain + function >8). Wilcoxon rank-sum tests, chi-squared tests, Kruskal-Wallis tests, and logistic regression were performed. Results: 157 patients undergoing ASD surgery with minimum of 1-year follow-up were included. Mean age was 53.2 and mean instrumented levels was 13.1. Preoperative alignment was: Neutral Alignment (NA) 49%, Coronal Malalignment (CM) 17%, Sagittal Malalignment (SM 17%), and Combined Coronal/Sagittal Malalignment (CCSM) 18%. Preoperative to 1-year, and preoperative to 2-years, all ODI/SRS-22r significantly improved (P <.001). In all patients, the only significant improvement in PROs between 1-and 2-year postoperative were those reaching ODI MCID (69% 1-year vs. 84% 2-years; P <.001). Subgroup analysis: ≥55 years had an improved median ODI (18 vs. 8; P =.047) and an improved percent achieving ODI MCID (73% vs. 84%, P =.048). CCSM patients experienced significant improvement in SRS-appearance score (75% vs. 100%; P =.050), along with those with severe preoperative SM >7.5 cm (73% vs. 100%; P =.032). Conclusions: Most ASD patients experience the majority of PRO improvement by 1-year postoperative. However, subsets of patients that may continue to improve up to 2-years postoperative include patients ≥55 years, combined coronal/sagittal malalignment, and those with severe sagittal malalignment ≥7.5 cm.

Original languageEnglish (US)
JournalGlobal Spine Journal
DOIs
StateAccepted/In press - 2021
Externally publishedYes

Keywords

  • adult spine deformity
  • minimum clinically important difference
  • patient reported outcomes
  • postoperative outcomes
  • spine surgery

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine
  • Clinical Neurology

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