Tamir Ailon1, Justin S Smith2, Christopher I Shaffrey2, Alex Soroceanu3, Virginie Lafage4, Frank Schwab4, Douglas Burton5, Robert Hart6, Han Jo Kim4, Jeffrey Gum7, Richard Hostin8, Michael P Kelly9, Steven Glassman7, Justin K Scheer10, Shay Bess11, Christopher P Ames12. 1. Department of Orthopedics, University of British Columbia, Vancouver, British Columbia. Electronic address: tamir.ailon@vch.ca. 2. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia. 3. Department of Orthopedics, University of Calgary, Calgary, Alberta. 4. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York. 5. Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas. 6. Department of Orthopedics, Swedish Medical Center, Seattle, Washington. 7. Norton Leatherman Spine Center, Louisville, Kentucky. 8. Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas. 9. Department of Orthopedic Surgery, Washington University School of Medicine, Saint Louis, Missouri. 10. Department of Neurosurgery, University of Illinois, Chicago, Illinois. 11. Presbytarian/St. Luke's Medical Center, Denver, Colorado. 12. Department of Neurosurgery, University of California-San Francisco, San Francisco, California.
Abstract
BACKGROUND: Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. OBJECTIVE: To investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery. METHODS: We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain. RESULTS: In total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures. CONCLUSIONS: Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
BACKGROUND: Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. OBJECTIVE: To investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery. METHODS: We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain. RESULTS: In total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures. CONCLUSIONS:Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
Authors: Michael P Kelly; Jon D Lurie; Elizabeth L Yanik; Christopher I Shaffrey; Christine R Baldus; Oheneba Boachie-Adjei; Jacob M Buchowski; Leah Y Carreon; Charles H Crawford; Charles Edwards; Thomas J Errico; Steven D Glassman; Munish C Gupta; Lawrence G Lenke; Stephen J Lewis; Han Jo Kim; Tyler Koski; Stefan Parent; Frank J Schwab; Justin S Smith; Lukas P Zebala; Keith H Bridwell Journal: J Bone Joint Surg Am Date: 2019-02-20 Impact factor: 5.284