Clinical Improvement Through Surgery for Adult Spinal Deformity: What Can Be Expected and Who Is Likely to Benefit Most?

Bertrand Moal, Virginie Lafage, Justin S. Smith, Christopher P. Ames, Gregory Mundis, Jamie S. Terran, Eric Otto Klineberg, Robert Hart, Oheneba Boachie-Adjei, Shay Bess, Wafa Skalli, Frank Schwab

Research output: Contribution to journalArticle

5 Citations (Scopus)

Abstract

Study Design Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group. Objectives To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures. Summary of Background Data For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID. Methods Inclusion criteria included operative patients (age >18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: "worst," "severe," "poor," and, "moderate." At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: "no improvement or deterioration," "mediocre," "satisfactory," or "optimal." Distinction among curve types was also performed based on the SRS-Schwab ASD classification. Results A total of 223 patients (age = 55 ± 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36% "worst," 28% "severe," 19% "poor," and 17% "moderate." Patients with sagittal malalignment only were more likely to be in the "worst" state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25% satisfactory, and 33% optimal. Forty-one percent of baseline "moderate" patients achieved no improvement. Of the baseline "worst" patients, 20% achieved no improvement, and 36% and 19% achieved "satisfactory" and "optimal" improvement, respectively. Conclusion Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability. Level of Evidence Level II.

Original languageEnglish (US)
Pages (from-to)566-574
Number of pages9
JournalSpine Deformity
Volume3
Issue number6
DOIs
StatePublished - 2015

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Pain
Multicenter Studies
Spine
Minimal Clinically Important Difference
Therapeutics

Keywords

  • Adult spinal deformity
  • Clinical outcomes
  • MCID
  • Normative data
  • Sagittal alignment

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine

Cite this

Clinical Improvement Through Surgery for Adult Spinal Deformity : What Can Be Expected and Who Is Likely to Benefit Most? / Moal, Bertrand; Lafage, Virginie; Smith, Justin S.; Ames, Christopher P.; Mundis, Gregory; Terran, Jamie S.; Klineberg, Eric Otto; Hart, Robert; Boachie-Adjei, Oheneba; Bess, Shay; Skalli, Wafa; Schwab, Frank.

In: Spine Deformity, Vol. 3, No. 6, 2015, p. 566-574.

Research output: Contribution to journalArticle

Moal, B, Lafage, V, Smith, JS, Ames, CP, Mundis, G, Terran, JS, Klineberg, EO, Hart, R, Boachie-Adjei, O, Bess, S, Skalli, W & Schwab, F 2015, 'Clinical Improvement Through Surgery for Adult Spinal Deformity: What Can Be Expected and Who Is Likely to Benefit Most?', Spine Deformity, vol. 3, no. 6, pp. 566-574. https://doi.org/10.1016/j.jspd.2015.04.004
Moal, Bertrand ; Lafage, Virginie ; Smith, Justin S. ; Ames, Christopher P. ; Mundis, Gregory ; Terran, Jamie S. ; Klineberg, Eric Otto ; Hart, Robert ; Boachie-Adjei, Oheneba ; Bess, Shay ; Skalli, Wafa ; Schwab, Frank. / Clinical Improvement Through Surgery for Adult Spinal Deformity : What Can Be Expected and Who Is Likely to Benefit Most?. In: Spine Deformity. 2015 ; Vol. 3, No. 6. pp. 566-574.
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author = "Bertrand Moal and Virginie Lafage and Smith, {Justin S.} and Ames, {Christopher P.} and Gregory Mundis and Terran, {Jamie S.} and Klineberg, {Eric Otto} and Robert Hart and Oheneba Boachie-Adjei and Shay Bess and Wafa Skalli and Frank Schwab",
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AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Ames, Christopher P.

AU - Mundis, Gregory

AU - Terran, Jamie S.

AU - Klineberg, Eric Otto

AU - Hart, Robert

AU - Boachie-Adjei, Oheneba

AU - Bess, Shay

AU - Skalli, Wafa

AU - Schwab, Frank

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N2 - Study Design Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group. Objectives To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures. Summary of Background Data For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID. Methods Inclusion criteria included operative patients (age >18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: "worst," "severe," "poor," and, "moderate." At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: "no improvement or deterioration," "mediocre," "satisfactory," or "optimal." Distinction among curve types was also performed based on the SRS-Schwab ASD classification. Results A total of 223 patients (age = 55 ± 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36% "worst," 28% "severe," 19% "poor," and 17% "moderate." Patients with sagittal malalignment only were more likely to be in the "worst" state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25% satisfactory, and 33% optimal. Forty-one percent of baseline "moderate" patients achieved no improvement. Of the baseline "worst" patients, 20% achieved no improvement, and 36% and 19% achieved "satisfactory" and "optimal" improvement, respectively. Conclusion Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability. Level of Evidence Level II.

AB - Study Design Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group. Objectives To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures. Summary of Background Data For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID. Methods Inclusion criteria included operative patients (age >18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: "worst," "severe," "poor," and, "moderate." At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: "no improvement or deterioration," "mediocre," "satisfactory," or "optimal." Distinction among curve types was also performed based on the SRS-Schwab ASD classification. Results A total of 223 patients (age = 55 ± 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36% "worst," 28% "severe," 19% "poor," and 17% "moderate." Patients with sagittal malalignment only were more likely to be in the "worst" state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25% satisfactory, and 33% optimal. Forty-one percent of baseline "moderate" patients achieved no improvement. Of the baseline "worst" patients, 20% achieved no improvement, and 36% and 19% achieved "satisfactory" and "optimal" improvement, respectively. Conclusion Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability. Level of Evidence Level II.

KW - Adult spinal deformity

KW - Clinical outcomes

KW - MCID

KW - Normative data

KW - Sagittal alignment

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