Abstract
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.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 118-125 |
| Number of pages | 8 |
| Journal | Operative neurosurgery (Hagerstown, Md.) |
| Volume | 18 |
| Issue number | 2 |
| DOIs | |
| State | Published - Feb 1 2020 |
Fingerprint
Keywords
- Adult spinal deformity
- Disability
- Functionality
- Outcomes
- Surgical correction
ASJC Scopus subject areas
- Surgery
- Clinical Neurology
Cite this
Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction : A 3-Year Survivorship Analysis. / Passias, Peter G.; Bortz, Cole A.; Lafage, Virginie; Lafage, Renaud; Smith, Justin S.; Line, Breton; Eastlack, Robert; Gupta, Munish C.; Hostin, Richard A.; Horn, Samantha R.; Segreto, Frank A.; Egers, Max; Sciubba, Daniel M.; Gum, Jeffrey L.; Kebaish, Khaled M.; Klineberg, Eric O.; Burton, Douglas C.; Schwab, Frank J.; Shaffrey, Christopher I.; Ames, Christopher P.; Bess, Shay.
In: Operative neurosurgery (Hagerstown, Md.), Vol. 18, No. 2, 01.02.2020, p. 118-125.Research output: Contribution to journal › Article
}
TY - JOUR
T1 - Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction
T2 - A 3-Year Survivorship Analysis
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
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
UR - http://www.scopus.com/inward/citedby.url?scp=85077945458&partnerID=8YFLogxK
U2 - 10.1093/ons/opz093
DO - 10.1093/ons/opz093
M3 - Article
C2 - 31149719
AN - SCOPUS:85077945458
VL - 18
SP - 118
EP - 125
JO - Operative Neurosurgery
JF - Operative Neurosurgery
SN - 2332-4252
IS - 2
ER -