TY - JOUR
T1 - Patients with Adult Spinal Deformity with Previous Fusions Have an Equal Chance of Reaching Substantial Clinical Benefit Thresholds in Health-Related Quality of Life Measures but Do Not Reach the Same Absolute Level of Improvement
AU - The International Spine Study Group
AU - Ailon, Tamir
AU - Smith, Justin S.
AU - Shaffrey, Christopher I.
AU - Soroceanu, Alex
AU - Lafage, Virginie
AU - Schwab, Frank
AU - Burton, Douglas
AU - Hart, Robert
AU - Kim, Han Jo
AU - Gum, Jeffrey
AU - Hostin, Richard
AU - Kelly, Michael P.
AU - Glassman, Steven
AU - Scheer, Justin K.
AU - Bess, Shay
AU - Ames, Christopher P.
N1 - Funding Information:
Conflict of interest statement: The International Spine Study Group is funded through Depuy Synthes and personal donations. Individual author financial disclosures: J. S. Smith: Zimmer Biomet—consultant, honorarium for teaching, royalties; Nuvasive—consultant, honorarium for teaching; Cerapedics—consultant; K2M—honorarium for teaching; AOSpine—fellowship funding; NREF—fellowship funding. C. Shaffrey: Medtronic—royalties, patents, consultant; Nuvasive—royalties, patents, consultant, stockholder; Zimmer Biomet—royalties, patents, consultant; K2M—consultant; Stryker—consultant; In Vivo—consultant; National Institutes of Health—grants; Department of Defense—grants; ISSG—grants; DePuy Synthes—grants; AO—grants. V. Lafage: Depuy Synthes—paid lectures; Nuvasive—paid lectures; K2M—paid lectures; Medtronic—paid lectures; Nemaris—Board member and shareholder. F. Schwab: Grants—SRS, DePuy Spine (through ISSGF); Speaking/teaching arrangements, consulting—Zimmer-Biomet, NuVasive, K2M, MSD, Medicrea; Board of Directors, Shareholder—Nemaris INC; Royalties—K2M, MSD. D. Burton: DePuy Synthes—consultant, royalties, research support. R. Hart: Globus—personal fees; Medtronic—grants; Seaspine—personal fees; DePuy Synthes—personal fees; CSRS—board member; ISSG—Executive Committee; ISSLS—board member; OHSU—patent. H. J. Kim: K2M—consultant; Zimmer Biomet—consultant; ISSGF—research funding; CSRS—research funding; HSS Journal—board membership; ASJ—board membership; GSJ—board membership. R. Hostin: DePuy Synthes–consultant; Nuvasive—research support; Seeger—research support; DJO—research support. J. Gum: Acuity—consultant; Alphatec Spine—consultant; DePuy Synthes—consultant; Integra—other financial support; Intellirod Spine—grants/research support; LifeSpine—consultant; Medtronic—consultant; MiMedx—other financial support; NuVasive—grants/research support; Pacira Pharmaceuticals—grants/research support; PACmed—consultant; Stryker Spine—consultant. S. Glassman: Medtronic—other financial support; Norton Healthcare—Salary, Contractual services; Nuvasive—grants/research support. S. Bess: K2 Medical—consultant, royalties, research support; Allosource—consultant; Pioneer—royalties; Innovasis—royalties, research support; Nuvasive—royalties, research support; DePuy Synthes Spine—research support; Stryker—research support. C. P. Ames: DePuy Synthes—consultant; Globus Medical—consultant; Medtronic—consultant; Stryker—consultant, royalties; Zimmer Biomet—royalties; Fish & Richardson, PC—patents. The remaining authors have no conflicts to report.
Publisher Copyright:
© 2018 Elsevier Inc.
PY - 2018/8
Y1 - 2018/8
N2 - Background: Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. Objective: To investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery. Methods: We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain. Results: In total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures. Conclusions: Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
AB - Background: Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction. Objective: To investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery. Methods: We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain. Results: In total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures. Conclusions: Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.
KW - Adult scoliosis
KW - Adult spinal deformity
KW - HRQOL
KW - Health-related quality of life
KW - Revision
KW - Substantial clinical benefit
UR - http://www.scopus.com/inward/record.url?scp=85047517298&partnerID=8YFLogxK
U2 - 10.1016/j.wneu.2018.04.204
DO - 10.1016/j.wneu.2018.04.204
M3 - Article
C2 - 29751181
AN - SCOPUS:85047517298
SN - 1878-8750
VL - 116
SP - e354-e361
JO - World neurosurgery
JF - World neurosurgery
ER -