Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis

Peter G. Passias; Cole A. Bortz; Virginie Lafage; Renaud Lafage; Justin S. Smith; Breton Line; Robert Eastlack; Munish C. Gupta; Richard A. Hostin; Samantha R. Horn; Frank A. Segreto; Max Egers; Daniel M. Sciubba; Jeffrey L. Gum; Khaled M. Kebaish; Eric O. Klineberg; Douglas C. Burton; Frank J. Schwab; Christopher I. Shaffrey; Christopher P. Ames; Shay Bess

doi:10.1093/ons/opz093

Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis

Peter G. Passias, Cole A. Bortz, Virginie Lafage, Renaud Lafage, Justin S. Smith, Breton Line, Robert Eastlack, Munish C. Gupta, Richard A. Hostin, Samantha R. Horn, Frank A. Segreto, Max Egers, Daniel M. Sciubba, Jeffrey L. Gum, Khaled M. Kebaish, Eric O. Klineberg, Douglas C. Burton, Frank J. Schwab, Christopher I. Shaffrey, Christopher P. AmesShay Bess

Orthopaedic Surgery

Research output: Contribution to journal › Article

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	https://doi.org/10.1093/ons/opz093
State	Published - Feb 1 2020

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Keywords

Adult spinal deformity
Disability
Functionality
Outcomes
Surgical correction

ASJC Scopus subject areas

Surgery
Clinical Neurology

Cite this

Passias, P. G., Bortz, C. A., Lafage, V., Lafage, R., Smith, J. S., Line, B., Eastlack, R., Gupta, M. C., Hostin, R. A., Horn, S. R., Segreto, F. A., Egers, M., Sciubba, D. M., Gum, J. L., Kebaish, K. M., Klineberg, E. O., Burton, D. C., Schwab, F. J., Shaffrey, C. I., ... Bess, S. (2020). Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis. Operative neurosurgery (Hagerstown, Md.), 18(2), 118-125. https://doi.org/10.1093/ons/opz093

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

Passias, PG, Bortz, CA, Lafage, V, Lafage, R, Smith, JS, Line, B, Eastlack, R, Gupta, MC, Hostin, RA, Horn, SR, Segreto, FA, Egers, M, Sciubba, DM, Gum, JL, Kebaish, KM, Klineberg, EO, Burton, DC, Schwab, FJ, Shaffrey, CI, Ames, CP & Bess, S 2020, 'Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis', Operative neurosurgery (Hagerstown, Md.), vol. 18, no. 2, pp. 118-125. https://doi.org/10.1093/ons/opz093

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. / Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction : A 3-Year Survivorship Analysis. In: Operative neurosurgery (Hagerstown, Md.). 2020 ; Vol. 18, No. 2. pp. 118-125.

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title = "Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis",

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.",

keywords = "Adult spinal deformity, Disability, Functionality, Outcomes, Surgical correction",

author = "Passias, {Peter G.} and Bortz, {Cole A.} and Virginie Lafage and Renaud Lafage and Smith, {Justin S.} and Breton Line and Robert Eastlack and Gupta, {Munish C.} and Hostin, {Richard A.} and Horn, {Samantha R.} and Segreto, {Frank A.} and Max Egers and Sciubba, {Daniel M.} and Gum, {Jeffrey L.} and Kebaish, {Khaled M.} and Klineberg, {Eric O.} and Burton, {Douglas C.} and Schwab, {Frank J.} and Shaffrey, {Christopher I.} and Ames, {Christopher P.} and Shay Bess",

year = "2020",

month = feb

day = "1",

doi = "10.1093/ons/opz093",

language = "English (US)",

volume = "18",

pages = "118--125",

journal = "Operative Neurosurgery",

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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

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10.1093/ons/opz093