The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients

International Spine Study Group

Research output: Contribution to journalArticle

16 Citations (Scopus)

Abstract

OBJECT: Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined.

METHODS: The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups.

RESULTS: Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6% for the SRS-22 pain score MCID to 24.4% for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3% to 62.3% and from 16.2% to 47.8%, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6% vs 41.9%, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up.

CONCLUSIONS: Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings.

Original languageEnglish (US)
Pages (from-to)340-348
Number of pages9
JournalJournal of neurosurgery. Spine
Volume23
Issue number3
DOIs
StatePublished - Sep 1 2015

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Osteotomy
Spine
Scoliosis
Thorax
Quality of Life
Research
Lordosis
Health Surveys

Keywords

  • 3-column osteotomy
  • 3CO = 3-column osteotomy
  • ASD = adult spinal deformity
  • HRQOL = health-related quality of life
  • ISSG = International Spine Study Group
  • MCID = minimum clinically important difference
  • MCS = Mental Component Summary
  • minimum clinically important difference
  • ODI = Oswestry Disability Index
  • PCS = Physical Component Summary
  • pedicle subtraction osteotomy
  • PI-LL = mismatch between pelvic incidence and lumbar lordosis
  • PSO = pedicle subtraction osteotomy
  • SCB = substantial clinical benefit
  • SF-36 = 36-Item Short Form Health Survey
  • spinal deformity
  • spinal disorders
  • SRS-22 = Scoliosis Research Society-22 questionnaire
  • substantial clinical benefit
  • SVA = sagittal vertical axis
  • UIV = uppermost instrumented vertebra
  • VCR = vertebral column resection
  • vertebral column resection

ASJC Scopus subject areas

  • Medicine(all)

Cite this

The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy : analysis of 140 patients. / International Spine Study Group.

In: Journal of neurosurgery. Spine, Vol. 23, No. 3, 01.09.2015, p. 340-348.

Research output: Contribution to journalArticle

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title = "The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients",
abstract = "OBJECT: Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined.METHODS: The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups.RESULTS: Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6{\%} for the SRS-22 pain score MCID to 24.4{\%} for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3{\%} to 62.3{\%} and from 16.2{\%} to 47.8{\%}, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6{\%} vs 41.9{\%}, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up.CONCLUSIONS: Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings.",
keywords = "3-column osteotomy, 3CO = 3-column osteotomy, ASD = adult spinal deformity, HRQOL = health-related quality of life, ISSG = International Spine Study Group, MCID = minimum clinically important difference, MCS = Mental Component Summary, minimum clinically important difference, ODI = Oswestry Disability Index, PCS = Physical Component Summary, pedicle subtraction osteotomy, PI-LL = mismatch between pelvic incidence and lumbar lordosis, PSO = pedicle subtraction osteotomy, SCB = substantial clinical benefit, SF-36 = 36-Item Short Form Health Survey, spinal deformity, spinal disorders, SRS-22 = Scoliosis Research Society-22 questionnaire, substantial clinical benefit, SVA = sagittal vertical axis, UIV = uppermost instrumented vertebra, VCR = vertebral column resection, vertebral column resection",
author = "{International Spine Study Group} and Shayan Fakurnejad and Scheer, {Justin K.} and Virginie Lafage and Smith, {Justin S.} and Vedat Deviren and Richard Hostin and Mundis, {Gregory M.} and Burton, {Douglas C.} and Klineberg, {Eric Otto} and Munish Gupta and Khaled Kebaish and Shaffrey, {Christopher I.} and Shay Bess and Frank Schwab and Ames, {Christopher P.}",
year = "2015",
month = "9",
day = "1",
doi = "10.3171/2014.12.SPINE141031",
language = "English (US)",
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pages = "340--348",
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TY - JOUR

T1 - The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy

T2 - analysis of 140 patients

AU - International Spine Study Group

AU - Fakurnejad, Shayan

AU - Scheer, Justin K.

AU - Lafage, Virginie

AU - Smith, Justin S.

AU - Deviren, Vedat

AU - Hostin, Richard

AU - Mundis, Gregory M.

AU - Burton, Douglas C.

AU - Klineberg, Eric Otto

AU - Gupta, Munish

AU - Kebaish, Khaled

AU - Shaffrey, Christopher I.

AU - Bess, Shay

AU - Schwab, Frank

AU - Ames, Christopher P.

PY - 2015/9/1

Y1 - 2015/9/1

N2 - OBJECT: Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined.METHODS: The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups.RESULTS: Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6% for the SRS-22 pain score MCID to 24.4% for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3% to 62.3% and from 16.2% to 47.8%, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6% vs 41.9%, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up.CONCLUSIONS: Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings.

AB - OBJECT: Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined.METHODS: The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22°), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11°). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups.RESULTS: Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 ± 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6% for the SRS-22 pain score MCID to 24.4% for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3% to 62.3% and from 16.2% to 47.8%, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6% vs 41.9%, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up.CONCLUSIONS: Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings.

KW - 3-column osteotomy

KW - 3CO = 3-column osteotomy

KW - ASD = adult spinal deformity

KW - HRQOL = health-related quality of life

KW - ISSG = International Spine Study Group

KW - MCID = minimum clinically important difference

KW - MCS = Mental Component Summary

KW - minimum clinically important difference

KW - ODI = Oswestry Disability Index

KW - PCS = Physical Component Summary

KW - pedicle subtraction osteotomy

KW - PI-LL = mismatch between pelvic incidence and lumbar lordosis

KW - PSO = pedicle subtraction osteotomy

KW - SCB = substantial clinical benefit

KW - SF-36 = 36-Item Short Form Health Survey

KW - spinal deformity

KW - spinal disorders

KW - SRS-22 = Scoliosis Research Society-22 questionnaire

KW - substantial clinical benefit

KW - SVA = sagittal vertical axis

KW - UIV = uppermost instrumented vertebra

KW - VCR = vertebral column resection

KW - vertebral column resection

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DO - 10.3171/2014.12.SPINE141031

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