Kazunori Hayashi1,2, Louis Boissière3,4, Fernando Guevara-Villazón3, Daniel Larrieu3, Anouar Bourghli5, Olivier Gille3, Jean-Marc Vital3, Ferran Pellisé6, Francisco Javier Sánchez Pérez-Grueso7, Frank Kleinstück8, Emre Acaroğlu9, Ahmet Alanay10, Hiroaki Nakamura11, Ibrahim Obeid3,4. 1. Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France. kh_ocg@yahoo.co.jp. 2. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan. kh_ocg@yahoo.co.jp. 3. Spine Surgery Unit 1, Bordeaux University Pellegrin Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France. 4. ELSAN, Polyclinique Jean Villar, 61 Avenue Maryse Bastié, 33523, Bruges Cedex, France. 5. Orthopedic and Spinal Surgery Department, Kingdom Hospital, King Abdul Aziz Rd, Ar Rabi, Riyadh, 13316, Saudi Arabia. 6. Spine Surgery Unit, Vall D'Hebron Hospital, Passeig Vall Hebron 119-129, 08035, Barcelona, Spain. 7. Spine Surgery Unit, Hospital Universitario La Paz, Paseo de La Castellana, 261, 28046, Madrid, Spain. 8. Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland. 9. Ankara Spine Center, Iran Caddesi 45/2 Kavaklıder, 06450, Ankara, Turkey. 10. Comprehensive Spine Center, Acibadem Maslak Hospital, Büyükdere Cd. No:40 Maslak, 34457, Istanbul, Turkey. 11. Department of Orthopedic Surgery, Osaka City University Graduate School of Medicine, 1-4-3 Asahimachi, Abeno-ku, Osaka, 545-8585, Japan.
Abstract
PURPOSE: Preoperative patient self-image (SI) in adult spinal deformity (ASD) is the most relevant factor for surgical decision-making. Postoperative SI has an important role in a patient's satisfaction with surgery. However, few studies are available to describe these variables. The aim was to investigate the factors that correlate with SI before and 2 years after ASD surgery. METHODS: This study was a retrospective review of prospectively collected multicentric data. Patients who underwent ASD surgery with a minimum follow-up of 2 years were enrolled (n = 391). They were divided into high-SI and low-SI groups, both preoperatively and postoperatively, according to SRS-22R SI/appearance subdomain scores at baseline and at 2 years, respectively. Independently related factors for SI were determined using logistic regression analysis. RESULTS: Crucial factors for SI at baseline were the scores on the SRS-22R function/activity (OR: 2.61), SRS-22R mental health (OR: 2.63) subdomains, and relative spinopelvic alignment (RSA, OR: 0.95). SF-36 MCS (OR: 1.07) at baseline as well as sagittal vertical axis (SVA, OR: 0.99) at 2 years, and complications (OR: 0.44) were independent predictive factors for SI at 2 years. The patients who transitioned from the preoperative low-SI group to the postoperative high-SI group achieved larger global sagittal alignment restoration and had lesser complications than those who did not. CONCLUSIONS: Mental status and sagittal spinopelvic alignment are key determinants of SI. The results indicate that considering mental status, preventing complications, and global sagittal alignment, restoration is crucial for achieving substantial SI scores after ASD surgery. These slides can be retrieved under Electronic Supplementary Material.
PURPOSE: Preoperative patient self-image (SI) in adult spinal deformity (ASD) is the most relevant factor for surgical decision-making. Postoperative SI has an important role in a patient's satisfaction with surgery. However, few studies are available to describe these variables. The aim was to investigate the factors that correlate with SI before and 2 years after ASD surgery. METHODS: This study was a retrospective review of prospectively collected multicentric data. Patients who underwent ASD surgery with a minimum follow-up of 2 years were enrolled (n = 391). They were divided into high-SI and low-SI groups, both preoperatively and postoperatively, according to SRS-22R SI/appearance subdomain scores at baseline and at 2 years, respectively. Independently related factors for SI were determined using logistic regression analysis. RESULTS: Crucial factors for SI at baseline were the scores on the SRS-22R function/activity (OR: 2.61), SRS-22R mental health (OR: 2.63) subdomains, and relative spinopelvic alignment (RSA, OR: 0.95). SF-36 MCS (OR: 1.07) at baseline as well as sagittal vertical axis (SVA, OR: 0.99) at 2 years, and complications (OR: 0.44) were independent predictive factors for SI at 2 years. The patients who transitioned from the preoperative low-SI group to the postoperative high-SI group achieved larger global sagittal alignment restoration and had lesser complications than those who did not. CONCLUSIONS: Mental status and sagittal spinopelvic alignment are key determinants of SI. The results indicate that considering mental status, preventing complications, and global sagittal alignment, restoration is crucial for achieving substantial SI scores after ASD surgery. These slides can be retrieved under Electronic Supplementary Material.
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