Shian Liu1, Bassel G Diebo1, Jensen K Henry1, Justin S Smith2, Richard Hostin3, Matthew E Cunningham4, Gregory Mundis5, Christopher P Ames6, Douglas Burton7, Shay Bess8, Behrooz Akbarnia9, Robert Hart10, Peter G Passias1, Frank J Schwab4, Virginie Lafage11. 1. Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. 2. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 800212, USA. 3. Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Boulevard, #810, Plano, TX, USA. 4. Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. 5. Scripps Clinic Torrey Pines, 10666 N Torrey Pines Road, La Jolla, CA 92037, USA. 6. Department of Neurosurgery, University of California, San Francisco Medical Center, 400 Parnassus Street, San Francisco, CA, USA. 7. Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA. 8. Rocky Mountain Scoliosis and Spine Center, 2055 High St, Denver, CO 80205, USA. 9. Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, La Jolla, CA, 92037, USA. 10. Department of Orthopaedic Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. 11. Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Boulevard, #810, Plano, TX, USA. Electronic address: virginie.lafage@gmail.com.
Abstract
BACKGROUND CONTEXT: Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of nonoperative patients and proposes predictors of those most likely to benefit. PURPOSE: The study aims to determine the factors that affect likelihood of nonoperative patients to reach MCID. STUDY DESIGN/ SETTING: This is a retrospective review of a prospective, multicenter database. PATIENT SAMPLE: The study includes nonoperative ASD patients. OUTCOME MEASURES: Health-related quality-of-life measures, including the Scoliosis Research Society (SRS)-22 questionnaire, were used. METHODS: The study used a multicenter database of 215 nonoperative patients with ASD and with minimum 2-year follow-up. Using a multivariate analysis, two groups were compared to identify possible predictors: those who reached MCID in the SRS pain or activity (N=86) at 2 years and those who did not reach MCID (N=129). A subgroup multivariate analysis of patients with a deficit (potential improvement) in both SRS pain and activity (N=84) was performed. Data collection was supported by a grant from DePuy for the International Spine Study Group Foundation. RESULTS: At baseline, the nonoperative patients who reached MCID had a significantly lower SRS pain score (3.0 vs. 3.6), smaller thoracolumbar Cobb (TL Cobb) angle (29.6° vs. 36.5°; 87 patients with SRS-Schwab classification of lumbar or double), lower sacral slope (33.1° vs. 36.4°), and less lumbar lordosis (46.5° vs. 52.8°) (all p<.05). The SRS pain and TL Cobb were significant predictors for reaching MCID. The pelvic incidence minus lumbar lordosis (PI-LL) was significant on univariate analysis but not on multivariate analysis (7.5° vs. 2.6°; p=.14). In the subset of severely disabled patients, worse vertebral obliquity was a predictor for not achieving MCID (p<.05). CONCLUSIONS: Nonoperative ASD patients who achieved MCID in SRS activity or pain had a lower baseline SRS pain score and less coronal deformity in the TL region. Greater baseline pain offers significant room for potential improvement, which may be important in identifying ASD patients who have the potential to reach MCID nonoperatively. Coronal deformities in the TL region and associated vertebral obliquity may negatively impact potential for improvement in nonoperative care.
BACKGROUND CONTEXT: Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of nonoperative patients and proposes predictors of those most likely to benefit. PURPOSE: The study aims to determine the factors that affect likelihood of nonoperative patients to reach MCID. STUDY DESIGN/ SETTING: This is a retrospective review of a prospective, multicenter database. PATIENT SAMPLE: The study includes nonoperative ASDpatients. OUTCOME MEASURES: Health-related quality-of-life measures, including the Scoliosis Research Society (SRS)-22 questionnaire, were used. METHODS: The study used a multicenter database of 215 nonoperative patients with ASD and with minimum 2-year follow-up. Using a multivariate analysis, two groups were compared to identify possible predictors: those who reached MCID in the SRS pain or activity (N=86) at 2 years and those who did not reach MCID (N=129). A subgroup multivariate analysis of patients with a deficit (potential improvement) in both SRS pain and activity (N=84) was performed. Data collection was supported by a grant from DePuy for the International Spine Study Group Foundation. RESULTS: At baseline, the nonoperative patients who reached MCID had a significantly lower SRS pain score (3.0 vs. 3.6), smaller thoracolumbar Cobb (TL Cobb) angle (29.6° vs. 36.5°; 87 patients with SRS-Schwab classification of lumbar or double), lower sacral slope (33.1° vs. 36.4°), and less lumbar lordosis (46.5° vs. 52.8°) (all p<.05). The SRS pain and TL Cobb were significant predictors for reaching MCID. The pelvic incidence minus lumbar lordosis (PI-LL) was significant on univariate analysis but not on multivariate analysis (7.5° vs. 2.6°; p=.14). In the subset of severely disabled patients, worse vertebral obliquity was a predictor for not achieving MCID (p<.05). CONCLUSIONS: Nonoperative ASDpatients who achieved MCID in SRS activity or pain had a lower baseline SRS pain score and less coronal deformity in the TL region. Greater baseline pain offers significant room for potential improvement, which may be important in identifying ASDpatients who have the potential to reach MCID nonoperatively. Coronal deformities in the TL region and associated vertebral obliquity may negatively impact potential for improvement in nonoperative care.
Authors: Takashi Fujishiro; Louis Boissière; Derek Thomas Cawley; Daniel Larrieu; Olivier Gille; Jean-Marc Vital; Ferran Pellisé; Francisco Javier Sanchez Pérez-Grueso; Frank Kleinstück; Emre Acaroglu; Ahmet Alanay; Ibrahim Obeid Journal: Eur Spine J Date: 2019-03-07 Impact factor: 3.134
Authors: Takashi Fujishiro; Louis Boissière; Derek Thomas Cawley; Daniel Larrieu; Olivier Gille; Jean-Marc Vital; Ferran Pellisé; Francisco Javier Sanchez Pérez-Grueso; Frank Kleinstück; Emre Acaroglu; Ahmet Alanay; Ibrahim Obeid Journal: Eur Spine J Date: 2019-07-17 Impact factor: 3.134
Authors: Andrew J Pugely; Michael P Kelly; Christine R Baldus; Yubo Gao; Lukas Zebala; Christopher Shaffrey; Steven Glassman; Oheneba Boachie-Adjei; Stefan Parent; Stephen Lewis; Tyler Koski; Charles Edwards; Frank Schwab; Keith H Bridwell Journal: Spine (Phila Pa 1976) Date: 2018-06-01 Impact factor: 3.241
Authors: Jennifer C Theis; Anna Grauers; Elias Diarbakerli; Panayiotis Savvides; Allan Abbott; Paul Gerdhem Journal: Scoliosis Spinal Disord Date: 2017-04-12