Radiographic Fusion Grade Does Not Impact Health-Related Quality of Life in the Absence of Instrumentation Failure for Patients Undergoing Posterior Instrumented Fusion for Adult Spinal Deformity

International Spine Study Group

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Background: Pseudarthrosis and rod fracture (RF) remain significant concerns after fusion for adult spinal deformity (ASD). Although a radiographic system of fusion grade has been proposed, the correlation between fusion grade and health-related quality of life measures (HRQoL) is not known. Methods: In a retrospective review of a prospectively collected clinical database, patients that underwent ≥5-level posterior instrumented arthrodesis for ASD were evaluated. Fusion grade was determined on plain films using the Lenke criteria. Patients were grouped as 1) complete fusion (grade I or II at all levels), 2) incomplete fusion (grade 3 or 4 at any level), 3) rod fracture without revision (RF), and 4) rod fracture with revision (RFR). Outcome measures were the Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey Physical and Mental Component Summaries, Scoliosis Research Society-22r total, and Lumbar Stiffness and Disability Index. Results: There were 205 (85%) patients who achieved the minimum 2-year follow-up and were included. Complete fusion was achieved in 115 patients (56.1%), 55% patients (26.8%) had incomplete fusion, and 35% patients (17.1%) had RF. Of the 35 patients with RF, 19 (17.1%; 19/205) underwent revision while 16 (7.8%; 16/205) had RF without revision. HRQoL measures were significantly worse in the RFR group, whereas no significant differences were found between groups 1, 2, and 3. Conclusions: Radiographic fusion grade after ASD surgery did not significantly impact HRQoL in the absence of RF. RFR was associated with significantly worse clinical outcomes. Fusion grade may be less predictive of clinical outcomes than the occurrence of RF.

Original languageEnglish (US)
Pages (from-to)e1-e7
JournalWorld Neurosurgery
Volume117
DOIs
StatePublished - Sep 1 2018
Externally publishedYes

Fingerprint

Spinal Fusion
Quality of Life
Outcome Assessment (Health Care)
Pseudarthrosis
Arthrodesis
Scoliosis
Motion Pictures
Health Surveys
Databases
Research

Keywords

  • Adult spinal deformity
  • Complications
  • Fusion
  • HRQoL
  • Instrumentation failure
  • Lumbar spine
  • Pseudarthrosis
  • Quality of life
  • Revision
  • Rod fracture

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology

Cite this

@article{f83cfdab4ec448e098e14c53d542be9b,
title = "Radiographic Fusion Grade Does Not Impact Health-Related Quality of Life in the Absence of Instrumentation Failure for Patients Undergoing Posterior Instrumented Fusion for Adult Spinal Deformity",
abstract = "Background: Pseudarthrosis and rod fracture (RF) remain significant concerns after fusion for adult spinal deformity (ASD). Although a radiographic system of fusion grade has been proposed, the correlation between fusion grade and health-related quality of life measures (HRQoL) is not known. Methods: In a retrospective review of a prospectively collected clinical database, patients that underwent ≥5-level posterior instrumented arthrodesis for ASD were evaluated. Fusion grade was determined on plain films using the Lenke criteria. Patients were grouped as 1) complete fusion (grade I or II at all levels), 2) incomplete fusion (grade 3 or 4 at any level), 3) rod fracture without revision (RF), and 4) rod fracture with revision (RFR). Outcome measures were the Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey Physical and Mental Component Summaries, Scoliosis Research Society-22r total, and Lumbar Stiffness and Disability Index. Results: There were 205 (85{\%}) patients who achieved the minimum 2-year follow-up and were included. Complete fusion was achieved in 115 patients (56.1{\%}), 55{\%} patients (26.8{\%}) had incomplete fusion, and 35{\%} patients (17.1{\%}) had RF. Of the 35 patients with RF, 19 (17.1{\%}; 19/205) underwent revision while 16 (7.8{\%}; 16/205) had RF without revision. HRQoL measures were significantly worse in the RFR group, whereas no significant differences were found between groups 1, 2, and 3. Conclusions: Radiographic fusion grade after ASD surgery did not significantly impact HRQoL in the absence of RF. RFR was associated with significantly worse clinical outcomes. Fusion grade may be less predictive of clinical outcomes than the occurrence of RF.",
keywords = "Adult spinal deformity, Complications, Fusion, HRQoL, Instrumentation failure, Lumbar spine, Pseudarthrosis, Quality of life, Revision, Rod fracture",
author = "{International Spine Study Group} and Tamir Ailon and Hamilton, {D. Koho} and Klineberg, {Eric Otto} and Daniels, {Alan H.} and Virginie Lafage and Shay Bess and Burton, {Douglas C.} and Munish Gupta and Frank Schwab and Ames, {Christopher P.} and Smith, {Justin S.} and Shaffrey, {Christopher I.} and Hart, {Robert A.}",
year = "2018",
month = "9",
day = "1",
doi = "10.1016/j.wneu.2018.04.127",
language = "English (US)",
volume = "117",
pages = "e1--e7",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",

}

TY - JOUR

T1 - Radiographic Fusion Grade Does Not Impact Health-Related Quality of Life in the Absence of Instrumentation Failure for Patients Undergoing Posterior Instrumented Fusion for Adult Spinal Deformity

AU - International Spine Study Group

AU - Ailon, Tamir

AU - Hamilton, D. Koho

AU - Klineberg, Eric Otto

AU - Daniels, Alan H.

AU - Lafage, Virginie

AU - Bess, Shay

AU - Burton, Douglas C.

AU - Gupta, Munish

AU - Schwab, Frank

AU - Ames, Christopher P.

AU - Smith, Justin S.

AU - Shaffrey, Christopher I.

AU - Hart, Robert A.

PY - 2018/9/1

Y1 - 2018/9/1

N2 - Background: Pseudarthrosis and rod fracture (RF) remain significant concerns after fusion for adult spinal deformity (ASD). Although a radiographic system of fusion grade has been proposed, the correlation between fusion grade and health-related quality of life measures (HRQoL) is not known. Methods: In a retrospective review of a prospectively collected clinical database, patients that underwent ≥5-level posterior instrumented arthrodesis for ASD were evaluated. Fusion grade was determined on plain films using the Lenke criteria. Patients were grouped as 1) complete fusion (grade I or II at all levels), 2) incomplete fusion (grade 3 or 4 at any level), 3) rod fracture without revision (RF), and 4) rod fracture with revision (RFR). Outcome measures were the Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey Physical and Mental Component Summaries, Scoliosis Research Society-22r total, and Lumbar Stiffness and Disability Index. Results: There were 205 (85%) patients who achieved the minimum 2-year follow-up and were included. Complete fusion was achieved in 115 patients (56.1%), 55% patients (26.8%) had incomplete fusion, and 35% patients (17.1%) had RF. Of the 35 patients with RF, 19 (17.1%; 19/205) underwent revision while 16 (7.8%; 16/205) had RF without revision. HRQoL measures were significantly worse in the RFR group, whereas no significant differences were found between groups 1, 2, and 3. Conclusions: Radiographic fusion grade after ASD surgery did not significantly impact HRQoL in the absence of RF. RFR was associated with significantly worse clinical outcomes. Fusion grade may be less predictive of clinical outcomes than the occurrence of RF.

AB - Background: Pseudarthrosis and rod fracture (RF) remain significant concerns after fusion for adult spinal deformity (ASD). Although a radiographic system of fusion grade has been proposed, the correlation between fusion grade and health-related quality of life measures (HRQoL) is not known. Methods: In a retrospective review of a prospectively collected clinical database, patients that underwent ≥5-level posterior instrumented arthrodesis for ASD were evaluated. Fusion grade was determined on plain films using the Lenke criteria. Patients were grouped as 1) complete fusion (grade I or II at all levels), 2) incomplete fusion (grade 3 or 4 at any level), 3) rod fracture without revision (RF), and 4) rod fracture with revision (RFR). Outcome measures were the Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey Physical and Mental Component Summaries, Scoliosis Research Society-22r total, and Lumbar Stiffness and Disability Index. Results: There were 205 (85%) patients who achieved the minimum 2-year follow-up and were included. Complete fusion was achieved in 115 patients (56.1%), 55% patients (26.8%) had incomplete fusion, and 35% patients (17.1%) had RF. Of the 35 patients with RF, 19 (17.1%; 19/205) underwent revision while 16 (7.8%; 16/205) had RF without revision. HRQoL measures were significantly worse in the RFR group, whereas no significant differences were found between groups 1, 2, and 3. Conclusions: Radiographic fusion grade after ASD surgery did not significantly impact HRQoL in the absence of RF. RFR was associated with significantly worse clinical outcomes. Fusion grade may be less predictive of clinical outcomes than the occurrence of RF.

KW - Adult spinal deformity

KW - Complications

KW - Fusion

KW - HRQoL

KW - Instrumentation failure

KW - Lumbar spine

KW - Pseudarthrosis

KW - Quality of life

KW - Revision

KW - Rod fracture

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U2 - 10.1016/j.wneu.2018.04.127

DO - 10.1016/j.wneu.2018.04.127

M3 - Article

C2 - 29709744

AN - SCOPUS:85049649744

VL - 117

SP - e1-e7

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

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