TY - JOUR
T1 - Counseling Guidelines for Anticipated Postsurgical Improvements in Pain, Function, Mental Health, and Self-image for Different Types of Adult Spinal Deformity
AU - Line, Breton
AU - Bess, Shay
AU - Lafage, Virginie
AU - Ames, Christopher
AU - Burton, Douglas
AU - Kim, Han Jo
AU - Gupta, Munish
AU - Hart, Robert
AU - Klineberg, Eric
AU - Kelly, Michael
AU - Kebaish, Khaled
AU - Hostin, Richard
AU - Mundis, Gregory
AU - Schwab, Frank
AU - Shaffrey, Christopher
AU - Smith, Justin S.
N1 - Funding Information:
From the aDenver International Spine Center, Rocky Mountain Hospital for Children and Presbyterian St. Luke’s Medical Center, Denver, CO; bDepartment of Orthopedic Surgery, Hospital for Special Surgery, New York, NY; cDepartment of Neurosurgery, University of California San Francisco School of Medicine, San Francisco, CA; dDepartment of Orthopedic Surgery, University of Kansas School of Medicine, Kansas City, KS; eWashington University, St. Louis, MO; fSwedish Neuroscience Institute, Seattle, WA; gDepartment of Orthopedic Surgery, University of California Davis School of Medicine, Sacramento, CA; hDepartment of Orthopedic Surgery, Johns Hopkins University School of Medicine, Baltimore, MD; iBaylor Scoliosis Center, Plano, TX; jSan Diego Center for Spinal Disorders, La Jolla, CA; and kDepartment of Neurosurgery, University of Virginia School of Medicine, Charlottesville, VA Acknowledgment date: September 10, 2019. First revision date: December 5, 2019. Second revision date: February 5, 2020. Acceptance date: February 10, 2020. The manuscript submitted does not contain information about medical device(s)/drug(s). Funding for this study was obtained in part from research grants from Depuy/ Synthes Spine, K2 Medical and Nuvasive which included funding for the multi-center database and data acquisition support. Relevant financial activities outside the submitted work: board membership, consultancy, grants, royalties, stocks, payment for lecture, travel/accommodations/meeting expenses. Address correspondence and reprint requests to Shay Bess, MD, Denver International Spine Center, 1601 East 19th Avenue, Suite 6250, Denver, CO 80218; E-mail: shay_bess@hotmail.com
Publisher Copyright:
© 2020 Lippincott Williams and Wilkins. All rights reserved.
PY - 2020/8/15
Y1 - 2020/8/15
N2 - Study Design.Retrospective analysis of a multicenter prospective adult spinal deformity (ASD) database.Objective.Quantify postoperative improvements in pain, function, mental health, and self-image for different ASD types.Summary of Background Data.Medical providers are commonly requested to counsel patients on anticipated improvements in specific health domains including pain, function, and self-image following surgery. ASD is a heterogeneous condition; therefore, health domain improvements may vary according to deformity type. Few studies have quantified outcomes for specific ASD types.Methods.Surgically treated ASD patients (=4 levels fused) prospectively enrolled into a multicenter database, minimum 2-year follow-up, were categorized into ASD types according to Scoliosis Research Society-Schwab ASD classification (THORACIC, LUMBAR, DOUBLE, SAGITTAL, MIXED). Demographic, radiographic, operative, and patient reported outcome measures (NRS back and leg pain, SRS-22r, SF-36) data were evaluated. Preoperative and last postoperative values for pain, physical and social function, mental health, and self-image were evaluated, improvements in each domain were quantified, and domain scores compared to generational normative values. Postoperative improvements were also calculated for three age cohorts (<45 yr, 45-65 yr, and >65 yr) within each deformity type.Results.359 of 564 patients eligible for study (mean age 57.9 yr, mean scoliosis 43.4°, mean SVA 63.3mm, mean 11.7 levels fused) had =2 yr follow-up. Domain improvements for the entire ASD population were 45.1% for back pain, 41.3% for leg pain, 27.1% for physical function, 35.9% for social function, 62.0% for self-image, and 22.6% for mental health (P<0.05). LUMBAR, SAGITTAL, and MIXED had greatest improvements in pain and function, while THORACIC and DOUBLE had greatest improvements in self-image. Self-image was the most impacted preoperative domain and demonstrated the greatest postoperative improvement for all ASD types.Conclusion.ASD patients demonstrated quantifiable postoperative improvements in pain, self-image, physical and social function, and mental health; however, improvements differed between ASD types. Further research is needed to understand specific patient expectations for ASD treatment.Level of Evidence: 3.
AB - Study Design.Retrospective analysis of a multicenter prospective adult spinal deformity (ASD) database.Objective.Quantify postoperative improvements in pain, function, mental health, and self-image for different ASD types.Summary of Background Data.Medical providers are commonly requested to counsel patients on anticipated improvements in specific health domains including pain, function, and self-image following surgery. ASD is a heterogeneous condition; therefore, health domain improvements may vary according to deformity type. Few studies have quantified outcomes for specific ASD types.Methods.Surgically treated ASD patients (=4 levels fused) prospectively enrolled into a multicenter database, minimum 2-year follow-up, were categorized into ASD types according to Scoliosis Research Society-Schwab ASD classification (THORACIC, LUMBAR, DOUBLE, SAGITTAL, MIXED). Demographic, radiographic, operative, and patient reported outcome measures (NRS back and leg pain, SRS-22r, SF-36) data were evaluated. Preoperative and last postoperative values for pain, physical and social function, mental health, and self-image were evaluated, improvements in each domain were quantified, and domain scores compared to generational normative values. Postoperative improvements were also calculated for three age cohorts (<45 yr, 45-65 yr, and >65 yr) within each deformity type.Results.359 of 564 patients eligible for study (mean age 57.9 yr, mean scoliosis 43.4°, mean SVA 63.3mm, mean 11.7 levels fused) had =2 yr follow-up. Domain improvements for the entire ASD population were 45.1% for back pain, 41.3% for leg pain, 27.1% for physical function, 35.9% for social function, 62.0% for self-image, and 22.6% for mental health (P<0.05). LUMBAR, SAGITTAL, and MIXED had greatest improvements in pain and function, while THORACIC and DOUBLE had greatest improvements in self-image. Self-image was the most impacted preoperative domain and demonstrated the greatest postoperative improvement for all ASD types.Conclusion.ASD patients demonstrated quantifiable postoperative improvements in pain, self-image, physical and social function, and mental health; however, improvements differed between ASD types. Further research is needed to understand specific patient expectations for ASD treatment.Level of Evidence: 3.
KW - adult spinal deformity
KW - improvement
KW - patient-reported outcome measures
KW - surgery
UR - http://www.scopus.com/inward/record.url?scp=85088676004&partnerID=8YFLogxK
U2 - 10.1097/BRS.0000000000003473
DO - 10.1097/BRS.0000000000003473
M3 - Article
C2 - 32706564
AN - SCOPUS:85088676004
SN - 0362-2436
VL - 45
SP - 1118
EP - 1127
JO - Spine
JF - Spine
IS - 16
ER -