TY - JOUR
T1 - Durability of satisfactory functional outcomes following surgical adult spinal deformity correction
T2 - A 3-year survivorship analysis
AU - International Spine Study Group (ISSG)
AU - Passias, Peter G.
AU - Bortz, Cole A.
AU - Lafage, Virginie
AU - Lafage, Renaud
AU - Smith, Justin S.
AU - Line, Breton
AU - Eastlack, Robert
AU - Gupta, Munish C.
AU - Hostin, Richard A.
AU - Horn, Samantha R.
AU - Segreto, Frank A.
AU - Egers, Max
AU - Sciubba, Daniel M.
AU - Gum, Jeffrey L.
AU - Kebaish, Khaled M.
AU - Klineberg, Eric O.
AU - Burton, Douglas C.
AU - Schwab, Frank J.
AU - Shaffrey, Christopher I.
AU - Ames, Christopher P.
AU - Bess, Shay
N1 - Funding Information:
The International Spine Study Group (ISSG) is funded through research grants from DePuy Synthes and individual donations. The authors have no personal, financial, or institutional interest in any of the drugs, materials, or devices described in this article. Dr Passias is a consultant for Meidcrea and SpineWave, is on the Scientific Advisory Board for Allosource, provides teaching/speaking for Zimmer Biomet and Globus, has a grant from the CSRS, and is involved in a research study with Aesculap. Dr Lafage has stock ownership in Nemaris, provides teaching/speaking for DePuy Synthes, Nuvasive, K2M, and Medtronic, and is on the Board of Directors for Nemaris. Dr Smith receives royalties from, provides speaking/teaching for, and is a consultant for Zimmer Biomet, is a consultant and provides speaking/teaching to Nuvasive, is a consultant for Cerapedics, provides speaking/teaching to K2n, and receives fellowship support from AOSpine and NREF. Dr Schway provides speaking/teaching to, is a consultant for, and has royalties/patents with Zimmer Biomet, Nuvasive, K2M, and MSD, provides speaking/teaching for and is a consultant for Medicrea, and is a shareholder and on the Board of Directors for Nemaris. De Bess is a consultant for, and receives royalties and research support from K2M, is a consultant for AlloSource, receives royalties from Pioneer, Innovasis, and Nuvasive, and receives research support from Innovasis, Nuvasive, DePuy Synthes Spine, and Stryker. Dr Ames is a consultant for DePuy Synthes, Medtronic, and Stryker, receives royalties from Stryker and Zimmer Biomet, and has patents with Fish & Richardson, PC. Dr Shaffrey receives royalties from, holds patents with, and is a consultant to Medtronic, Nuvasive, and Zimmer Biomet, and is a stockholder in Nuvasive, is a consultant to K2M, Stryker, and In Vivo, has grants from NIH, the Department of Defense, ISSG, DePuy Synthes, and AOSpine. Dr Sciubba is a consultant for Medtronic, and has stock ownership in DePuy Synthes, Stryker, K2M, and NuVasive. Dr Klineberg is a consultant for DePuy Synthes, Stryker, Springer, and Trevana, receives honoraria from AOSpine and K2M, and receives fellowship support from AOSpine. Dr Burton is a consultant for DePuy Synthes and Allosource and is a patent holder with DePuy Synthes. Dr Eastlack has stock ownership in and is a consultant to Alphatec, NuVasive, and SeaSpine, has ownership in and is a patent holder with Spine Innovation, is a consultant for AESculap, Titan, and K2M, and is a patent holder with Globus, Invuity, and NuTech. Dr Gupta receives royalties from DePuy, has stock ownership in Johnson & Johnson (100 shares) and Procter & Gamble (100 shares), is a consultant for DePuy and Orthofix (contract ended 12/31/2016), has speaking/teaching arrangements with AOSpine North America (Honorarium), receives funding for trips/travel from DePuy (part of consulting), is on the Board of Directors for Scoliosis Research Society (ended 12/31/2015), FOSA-Treasurer (ended 2/2015), is on the Scientific Advisory Board/Other Office for DePuy
Funding Information:
(part of consulting), receives fellowship support from AOSpine North America (for each of the following academic years: 2015/2016, 2016/2017, 2017/2018), OMeGA (for academic years 2016/2017, 2017/2018). Dr Gum is a consultant for Medtronic, NuVasive (also advisory position), Alphatec, Stryker, Acuity (also receives royalties), K2M (also advisory position), and Mazor, has an honorarium from Pacira Pharmaceuticals and from Baxter, is employed by Norton Healthcare, receives funds from NuVasive (directly to database company), receives research support from Norton Healthcare, Integra, Inellirod Spine Inc,the International Spine Study Group Foundation, and Pfizer, and has stock in Cingulate Therapeutics. Dr Hostin Jr is a consultant to and receives research support from DePuy Spine, receives research support from NuVasvie, Seeger, DJO, and K2M.
Publisher Copyright:
Copyright © 2019 by the Congress of Neurological Surgeons.
PY - 2020/2/1
Y1 - 2020/2/1
N2 - BACKGROUND: Despite reports showing positive long-term functional outcomes following adult spinal deformity (ASD)-corrective surgery, it is unclear which factors affect the durability of these outcomes. OBJECTIVE: To assess durability of functional gains following ASD-corrective surgery; determine predictors for postoperative loss of functionality. METHODS: Surgical ASD patients > 18 yr with 3-yr Oswestry Disability Index (ODI) follow-up, and 1-yr postoperative (1Y) ODI scores reaching substantial clinical benefit (SCB) threshold (SCB < 31.3 points). Patients were grouped: those sustaining ODI at SCB threshold beyond 1Y (sustained functionality) and those not (functional decline). Kaplan-Meier survival analysis determined postoperative durability of functionality. Multivariate Cox regression assessed the relationship between patient/surgical factors and functional decline, accounting for age, sex, and levels fused. RESULTS: All 166 included patients showed baseline to 1Y functional improvement (mean ODI: 35.3 ± 16.5-13.6 ± 9.2, P<.001). Durability of satisfactory functional outcomes following the 1Y postoperative interval was 88.6% at 2-yr postoperative, and 71.1% at 3-yr postoperative (3Y). Those sustaining functionality after 1Y had lower baseline C2-S1 sagittal vertical axis (SVA) and T1 slope (both P < .05), and lower 1Y thoracic kyphosis (P = .035). From 1Y to 3Y, patients who sustained functionality showed smaller changes in alignment: pelvic incidence minus lumbar lordosis, SVA, T1 slope minus cervical lordosis, and C2-C7 SVA (all P < .05). Those sustaining functionality beyond 1Y were also younger, less frail at 1Y, and had lower rates of baseline osteoporosis, hypertension, and lung disease (all P < .05). Lung disease (Hazard Ratio:4.8 [1.4-16.4]), 1Y frailty (HR:1.4 [1.1-1.9]), and posterior approach (HR:2.6 [1.2-5.8]) were associated with more rapid decline. CONCLUSION: Seventy-one percent of ASD patients maintained satisfactory functional outcomes by 3Y. Of those who failed to sustain functionality, the largest functional decline occurred 3-yr postoperatively. Frailty, preoperative comorbidities, and surgical approach affected durability of functional gains following surgery.
AB - BACKGROUND: Despite reports showing positive long-term functional outcomes following adult spinal deformity (ASD)-corrective surgery, it is unclear which factors affect the durability of these outcomes. OBJECTIVE: To assess durability of functional gains following ASD-corrective surgery; determine predictors for postoperative loss of functionality. METHODS: Surgical ASD patients > 18 yr with 3-yr Oswestry Disability Index (ODI) follow-up, and 1-yr postoperative (1Y) ODI scores reaching substantial clinical benefit (SCB) threshold (SCB < 31.3 points). Patients were grouped: those sustaining ODI at SCB threshold beyond 1Y (sustained functionality) and those not (functional decline). Kaplan-Meier survival analysis determined postoperative durability of functionality. Multivariate Cox regression assessed the relationship between patient/surgical factors and functional decline, accounting for age, sex, and levels fused. RESULTS: All 166 included patients showed baseline to 1Y functional improvement (mean ODI: 35.3 ± 16.5-13.6 ± 9.2, P<.001). Durability of satisfactory functional outcomes following the 1Y postoperative interval was 88.6% at 2-yr postoperative, and 71.1% at 3-yr postoperative (3Y). Those sustaining functionality after 1Y had lower baseline C2-S1 sagittal vertical axis (SVA) and T1 slope (both P < .05), and lower 1Y thoracic kyphosis (P = .035). From 1Y to 3Y, patients who sustained functionality showed smaller changes in alignment: pelvic incidence minus lumbar lordosis, SVA, T1 slope minus cervical lordosis, and C2-C7 SVA (all P < .05). Those sustaining functionality beyond 1Y were also younger, less frail at 1Y, and had lower rates of baseline osteoporosis, hypertension, and lung disease (all P < .05). Lung disease (Hazard Ratio:4.8 [1.4-16.4]), 1Y frailty (HR:1.4 [1.1-1.9]), and posterior approach (HR:2.6 [1.2-5.8]) were associated with more rapid decline. CONCLUSION: Seventy-one percent of ASD patients maintained satisfactory functional outcomes by 3Y. Of those who failed to sustain functionality, the largest functional decline occurred 3-yr postoperatively. Frailty, preoperative comorbidities, and surgical approach affected durability of functional gains following surgery.
KW - Adult spinal deformity
KW - Disability
KW - Functionality
KW - Outcomes
KW - Surgical correction
UR - http://www.scopus.com/inward/record.url?scp=85077945458&partnerID=8YFLogxK
U2 - 10.1093/ons/opz093
DO - 10.1093/ons/opz093
M3 - Article
C2 - 31149719
AN - SCOPUS:85077945458
SN - 2332-4252
VL - 18
SP - 118
EP - 125
JO - Operative Neurosurgery
JF - Operative Neurosurgery
IS - 2
ER -