Christopher J Nielsen1, Stephen J Lewis2, Colby Oitment1, Allan R Martin1, Lawrence G Lenke3, Yong Qiu4, Kenneth Mc Cheung5, Marinus de Kleuver6, David W Polly7, Christopher I Shaffrey8, Justin S Smith9, Maarten Spruit10, Ahmet Alanay11, Yukihiro Matsuyama12, Thorsten Jentzsch1, Anna Rienmuller1, Hananel Shear-Yashuv1, Ferran Pellisé13, Michael P Kelly14, Jonathan N Sembrano7, Benny T Dahl15, Sigurd H Berven16, Ao Spine Knowledge Forum Deformity16. 1. Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, Ontario, Canada. 2. Department of Orthopaedic Surgery, Toronto Western Hospital, Schroeder Arthritis Institute, University of Toronto, Toronto, Ontario, Canada. Electronic address: stephen.lewis@uhn.ca. 3. Department of Orthopedic Spine Surgery, The Spine Hospital, Columbia University Medical Center, New York, NY, USA. 4. Drum Tower Hospital of Nanjing University Medical School, Spine Surgery, Nanjing, Jiangsu, China. 5. Department of Orthopaedics and Traumatology, The University of Hong Kong, Pokfulam, Hong Kong SAR, China. 6. Department of Orthopedics, Radboud University Medical Center, Nijmegen, Gelderland, the Netherlands. 7. Department of Orthopaedic Surgery, University of Minnesota, Minneapolis, MN, USA. 8. Department of Orthopaedic Surgery, Duke University, Durham, NC, USA. 9. Department of Neurosurgery, University of Virginia, Charlottesville, VA, USA. 10. Sint Maartenskliniek Nijmegen, Ubbergen (near Nijmegen) Gelderland, the Netherlands. 11. Department of Orthopedics, Acibadem University School of Medicine, Istanbul, Turkey, Turkey. 12. Department of Orthopedic Surgery, Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. 13. Hospital Universitari de la Vall d'Hebron, Barcelona, Barcelona, Spain. 14. Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO, USA. 15. Division of Orthopedic Surgery, Texas Children's Hospital and Baylor College of Medicine, Houston, TX, USA; Spine Unit, Rigshospitalet, University of Copenhagen, Denmark. 16. Department of Neurosurgery and Orthopaedic Surgery, University of California, San Francisco, CA, USA.
Abstract
BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements. PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery. STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity. OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-<20%) or no change (within 10%). RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling. CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.
BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements. PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery. STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity. OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-<20%) or no change (within 10%). RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling. CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.
Authors: Matteo Briguglio; Paolo Perazzo; Francesco Langella; Tiziano Crespi; Elena De Vecchi; Patrizia Riso; Marisa Porrini; Laura Scaramuzzo; Roberto Bassani; Marco Brayda-Bruno; Giuseppe Banfi; Pedro Berjano Journal: Front Surg Date: 2022-03-16