TY - JOUR
T1 - Individual differences in postoperative recovery trajectories for adult symptomatic lumbar scoliosis
AU - Greenberg, Jacob K.
AU - Kelly, Michael P.
AU - Landman, Joshua M.
AU - Zhang, Justin K.
AU - Bess, Shay
AU - Smith, Justin S.
AU - Lenke, Lawrence G.
AU - Shaffrey, Christopher I.
AU - Bridwell, Keith H.
N1 - Funding Information:
Dr. Kelly: grants from NIH and SRS during the conduct of the study; and grants from Setting Scoliosis Straight Foundation, International Spine Study Group Foundation (ISSGF), and AO Spine. Dr. Bess: consultant for K2M and Stryker, patent holder with K2M, and research or clinical support from the ISSGF, DePuy Synthes, Medtronic, NuVasive, K2M, Stryker, Globus Medical, SI Bone, Carlsmed, and ISSGF. Dr. Smith: consultant for NuVasive, Zimmer Biomet, Stryker, DePuy Synthes, Cerapedics, Carlsmed, and SeaSpine; direct stock ownership in Alphatec and NuVasive; editorial board member of Journal of Neurosurgery: Spine, Neurosurgery, Operative Neurosurgery, Spine Deformity, and Neurospine; member of Executive Committee of the ISSGF and Board of Directors for the SRS; research support from DePuy Synthes; royalties from Zimmer Biomet, NuVasive, and Thieme; fellowship funding from AO Spine; and non–study-related research support from DePuy Synthes and AO Spine. Dr. Lenke: consultant for Medtronic, Acuity Surgical, and Abryx; royalties from Medtronic and Acuity Surgical; reimbursement for airfare/ hotel from Broadwater, SRS, and AO Spine; grant support from SRS, Setting Scoliosis Straight Foundation, and AO Spine; philanthropic research funding from the Evans Family Donation and Fox Family Foundation; and fellowship support to the institution from AO Spine. Dr. Shaffrey: consultant for Medtronic, NuVasive, SI Bone, and Siemens; direct stock ownership in NuVasive; and patent holder with NuVasive, Medtronic, and Zimmer Biomet. Dr. Bridwell: grants from SRS.
Funding Information:
The ASLS-1 study was funded by the National Institute of Arthritis and Musculoskeletal and Skin Diseases of the U.S. National Institutes of Health (R01AR055176). Dr. Greenberg was supported by grants from the Agency for Healthcare Research and Quality (1F32HS027075-01A1), and the Thrasher Research Fund (no. 15024).
Publisher Copyright:
© AANS 2022, except where prohibited by US copyright law.
PY - 2022/9
Y1 - 2022/9
N2 - OBJECTIVE The Adult Symptomatic Lumbar Scoliosis-1 (ASLS-1) trial demonstrated the benefit of adult symptomatic lumbar scoliosis (ASLS) surgery. However, the extent to which individuals differ in their postoperative recovery trajectories is unknown. This study's objective was to evaluate variability in and factors moderating recovery trajectories after ASLS surgery. METHODS The authors used longitudinal, multilevel models to analyze postoperative recovery trajectories following ASLS surgery. Study outcomes included the Oswestry Disability Index (ODI) score and Scoliosis Research Society-22 (SRS-22) subscore, which were measured every 3 months until 2 years postoperatively. The authors evaluated the influence of preoperative disability level, along with other potential trajectory moderators, including radiographic, comorbidity, pain/function, demographic, and surgical factors. The impact of different parameters was measured using the R2, which represented the amount of variability in ODI/SRS-22 explained by each model. The R2 ranged from 0 (no variability explained) to 1 (100% of variability explained). RESULTS Among 178 patients, there was substantial variability in recovery trajectories. Applying the average trajectory to each patient explained only 15% of the variability in ODI and 21% of the variability in SRS-22 subscore. Differences in preoperative disability (ODI/SRS-22) had the strongest influence on recovery trajectories, with patients having moderate disability experiencing the greatest and most rapid improvement after surgery. Reflecting this impact, accounting for the preoperative ODI/SRS-22 level explained an additional 56%-57% of variability in recovery trajectory, while differences in the rate of postoperative change explained another 7%-9%. Among the effect moderators tested, pain/function variables-such as visual analog scale back pain score-had the biggest impact, explaining 21%-25% of variability in trajectories. Radiographic parameters were the least influential, explaining only 3%-6% more variance than models with time alone. The authors identified several significant trajectory moderators in the final model, such as significant adverse events and the number of levels fused. CONCLUSIONS ASLS patients have highly variable postoperative recovery trajectories, although most reach steady state at 12 months. Preoperative disability was the most important influence, although other factors, such as number of levels fused, also impacted recovery.
AB - OBJECTIVE The Adult Symptomatic Lumbar Scoliosis-1 (ASLS-1) trial demonstrated the benefit of adult symptomatic lumbar scoliosis (ASLS) surgery. However, the extent to which individuals differ in their postoperative recovery trajectories is unknown. This study's objective was to evaluate variability in and factors moderating recovery trajectories after ASLS surgery. METHODS The authors used longitudinal, multilevel models to analyze postoperative recovery trajectories following ASLS surgery. Study outcomes included the Oswestry Disability Index (ODI) score and Scoliosis Research Society-22 (SRS-22) subscore, which were measured every 3 months until 2 years postoperatively. The authors evaluated the influence of preoperative disability level, along with other potential trajectory moderators, including radiographic, comorbidity, pain/function, demographic, and surgical factors. The impact of different parameters was measured using the R2, which represented the amount of variability in ODI/SRS-22 explained by each model. The R2 ranged from 0 (no variability explained) to 1 (100% of variability explained). RESULTS Among 178 patients, there was substantial variability in recovery trajectories. Applying the average trajectory to each patient explained only 15% of the variability in ODI and 21% of the variability in SRS-22 subscore. Differences in preoperative disability (ODI/SRS-22) had the strongest influence on recovery trajectories, with patients having moderate disability experiencing the greatest and most rapid improvement after surgery. Reflecting this impact, accounting for the preoperative ODI/SRS-22 level explained an additional 56%-57% of variability in recovery trajectory, while differences in the rate of postoperative change explained another 7%-9%. Among the effect moderators tested, pain/function variables-such as visual analog scale back pain score-had the biggest impact, explaining 21%-25% of variability in trajectories. Radiographic parameters were the least influential, explaining only 3%-6% more variance than models with time alone. The authors identified several significant trajectory moderators in the final model, such as significant adverse events and the number of levels fused. CONCLUSIONS ASLS patients have highly variable postoperative recovery trajectories, although most reach steady state at 12 months. Preoperative disability was the most important influence, although other factors, such as number of levels fused, also impacted recovery.
KW - adult spinal deformity
KW - longitudinal data analysis
KW - lumbar
KW - multilevel models
KW - scoliosis
KW - spine surgery
UR - http://www.scopus.com/inward/record.url?scp=85137800120&partnerID=8YFLogxK
U2 - 10.3171/2022.2.SPINE211233
DO - 10.3171/2022.2.SPINE211233
M3 - Article
C2 - 35334466
AN - SCOPUS:85137800120
SN - 1547-5654
VL - 37
SP - 429
EP - 438
JO - Journal of Neurosurgery: Spine
JF - Journal of Neurosurgery: Spine
IS - 3
ER -