TY - JOUR
T1 - Comprehensive study of back and leg pain improvements after adult spinal deformity surgery
T2 - Analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction
AU - International Spine Study Group
AU - Scheer, Justin K.
AU - Smith, Justin S.
AU - Clark, Aaron J.
AU - Lafage, Virginie
AU - Kim, Han Jo
AU - Rolston, John D.
AU - Eastlack, Robert
AU - Hart, Robert A.
AU - Protopsaltis, Themistocles S.
AU - Kelly, Michael P.
AU - Kebaish, Khaled
AU - Gupta, Munish
AU - Klineberg, Eric
AU - Hostin, Richard
AU - Shaffrey, Christopher I.
AU - Schwab, Frank
AU - Ames, Christopher P.
N1 - Funding Information:
The International Spine Study Group Foundation, through which this study was conducted, was funded by research grants from DePuy Spine and by individual donations. Dr. Ames is a consultant for DePuy, Medtronic, and Stryker; owns stock in Doctors Research Group, Baxano Surgical, and Visualase; holds a patent with Fish & Richardson, P.C.; and receives royalties from Aesculap and Biomet Spine. Dr. Eastlack is a consultant for NuVasive, Alphatec Spine, DiFusion, DePuy/Synthes, Invuity, K2M, Ulrich, and Pioneer; owns stock in NuVasive, Spine Innovations, and Alphatec Spine; holds patents with Invuity and Globus; and received clinical, research, or editorial support from NuVasive, Pioneer, and Baxano. Dr. Gupta is a consultant for DePuy/Synthes, Medtronic, and Orthofix; and owns stock in Proctor and Gamble, Johnson & Johnson, Pfizer, and Pioneer. Dr. Hart is a consultant for DePuy, Medtronic, and Globus; owns stock in Spine Connect; holds a patent with OHSU; received clinical or research support from Medtronic and ISSG; and receives royalties from Seaspine and DePuy. Dr. Hostin is a consultant for DePuy and received clinical or research support from NuVasive, Seeger, DJO, DePuy, and K2M. Dr. Kelly received clinical or research support from AOSpine and Barnes Jewish Foundation. Dr. Kim is a consultant for Medtronic, Biomet, and K2M and received an educational honorarium from DePuy and Stryker and research funding from DePuy through ISSG. Dr. Klineberg has received speaker fees and fellowship and research grants from DePuy, AOSpine, and OREF. Dr. Protopsaltis is a consultant for DePuy, Medicrea, and Globus; received clinical or research support from Zimmer; and is on the speaker's bureau of Alphatec Spine. Dr. Shaffrey is a consultant for NuVasive, Biomet, Globus, Medtronic, and Stryker; owns stock in NuVasive; and holds patents with and receives royalties from Biomet, Medtronic, and NuVasive. Dr. Smith is a consultant for NuVasive, Biomet, DePuy, Globus, and Medtronic and received clinical or research support from DePuy/ISSG.
Publisher Copyright:
©AANS, 2015.
PY - 2015/5
Y1 - 2015/5
N2 - OBJECT: Back and leg pain are the primary outcomes of adult spinal deformity (ASD) and predict patients' seeking of surgical management. The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD. Outcomes were assessed according to pain severity, type of surgical procedure, Scoliosis Research Society (SRS)-Schwab spine deformity class, and patient satisfaction. METHODS: This study retrospectively reviewed data in a prospective multicenter database of ASD patients. Inclusion criteria were the following: age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure, spine SRS-Schwab deformity class, preoperative pain severity, and patient satisfaction. Numerical rating scale (NRS) scores of back and leg pain, Oswestry Disability Index (ODI) scores, physical component summary (PCS) scores of the 36-Item Short Form Health Survey, minimum clinically important differences (MCIDs), and substantial clinical benefits (SCBs) were assessed. RESULTS: Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed. Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen. The incidence of postoperative leg pain was 37.0% at 6 weeks postoperatively and 33.3% at the 2-year follow-up (FU). At the 2-year FU, among patients with any preoperative back or leg pain, 24.3% and 37.8% were free of back and leg pain, respectively, and among patients with severe (NRS scores of 7-10) preoperative back or leg pain, 21.0% and 32.8% were free of back and leg pain, respectively. Decompression resulted in more patients having an improvement in leg pain and their pain scores reaching MCID. Although osteotomies improved back pain, they were associated with a higher incidence of leg pain. Patients whose spine had an SRS-Schwab coronal curve Type N deformity (sagittal malalignment only) were least likely to report improvements in back pain. Patients with a Type L deformity were most likely to report improved back or leg pain and to have reductions in pain severity scores reaching MCID and SCB. Patients with a Type D deformity were least likely to report improved leg pain and were more likely to experience a worsening of leg pain. Preoperative pain severity affected pain improvement over 2 years because patients who had higher preoperative pain severity experienced larger improvements, and their changes in pain severity were more likely to reach MCID/SCB than for those reporting lower preoperative pain. Reductions in back pain contributed to improvements in ODI and PCS scores and to patient satisfaction more than reductions in leg pain did. CONCLUSIONS: The authors' results provide a valuable reference for counseling patients preoperatively about what improvements or worsening in back or leg pain they may experience after surgical intervention for ASD.
AB - OBJECT: Back and leg pain are the primary outcomes of adult spinal deformity (ASD) and predict patients' seeking of surgical management. The authors sought to characterize changes in back and leg pain after operative or nonoperative management of ASD. Outcomes were assessed according to pain severity, type of surgical procedure, Scoliosis Research Society (SRS)-Schwab spine deformity class, and patient satisfaction. METHODS: This study retrospectively reviewed data in a prospective multicenter database of ASD patients. Inclusion criteria were the following: age > 18 years and presence of spinal deformity as defined by a scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. Patients were grouped into nonoperated and operated subcohorts and by the type of surgical procedure, spine SRS-Schwab deformity class, preoperative pain severity, and patient satisfaction. Numerical rating scale (NRS) scores of back and leg pain, Oswestry Disability Index (ODI) scores, physical component summary (PCS) scores of the 36-Item Short Form Health Survey, minimum clinically important differences (MCIDs), and substantial clinical benefits (SCBs) were assessed. RESULTS: Patients in whom ASD had been operatively managed were 6 times more likely to have an improvement in back pain and 3 times more likely to have an improvement in leg pain than patients in whom ASD had been nonoperatively managed. Patients whose ASD had been managed nonoperatively were more likely to have their back or leg pain remain the same or worsen. The incidence of postoperative leg pain was 37.0% at 6 weeks postoperatively and 33.3% at the 2-year follow-up (FU). At the 2-year FU, among patients with any preoperative back or leg pain, 24.3% and 37.8% were free of back and leg pain, respectively, and among patients with severe (NRS scores of 7-10) preoperative back or leg pain, 21.0% and 32.8% were free of back and leg pain, respectively. Decompression resulted in more patients having an improvement in leg pain and their pain scores reaching MCID. Although osteotomies improved back pain, they were associated with a higher incidence of leg pain. Patients whose spine had an SRS-Schwab coronal curve Type N deformity (sagittal malalignment only) were least likely to report improvements in back pain. Patients with a Type L deformity were most likely to report improved back or leg pain and to have reductions in pain severity scores reaching MCID and SCB. Patients with a Type D deformity were least likely to report improved leg pain and were more likely to experience a worsening of leg pain. Preoperative pain severity affected pain improvement over 2 years because patients who had higher preoperative pain severity experienced larger improvements, and their changes in pain severity were more likely to reach MCID/SCB than for those reporting lower preoperative pain. Reductions in back pain contributed to improvements in ODI and PCS scores and to patient satisfaction more than reductions in leg pain did. CONCLUSIONS: The authors' results provide a valuable reference for counseling patients preoperatively about what improvements or worsening in back or leg pain they may experience after surgical intervention for ASD.
KW - Adult spinal deformity
KW - Back pain
KW - Leg pain
KW - PSO
KW - SRS-Schwab classification
KW - Satisfaction
KW - Scoliosis
KW - Spinal disorders
KW - VCR
UR - http://www.scopus.com/inward/record.url?scp=84935415499&partnerID=8YFLogxK
U2 - 10.3171/2014.10.SPINE14475
DO - 10.3171/2014.10.SPINE14475
M3 - Article
C2 - 25700238
AN - SCOPUS:84935415499
SN - 1547-5654
VL - 22
SP - 540
EP - 553
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 5
ER -