Adult spinal deformity patients with previous fusions have an equal chance of reaching substantial clinical benefit thresholds in health-related quality of life measures but do not reach the same absolute level of improvement.

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Adult spinal deformity patients with previous fusions have an equal chance of reaching substantial clinical benefit thresholds in health-related quality of life measures but do not reach the same absolute level of improvement.

World Neurosurg. 2018 May 08;:

Authors: Ailon T

Abstract
BACKGROUND: Substantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction.
OBJECTIVE: Investigate the impact of prior spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery.
METHODS: We conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for ASD patients undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 physical component summary (PCS), back and leg pain (numeric rating scale;NRS). Secondary outcomes included absolute and change scores in ODI, PCS, back and leg pain.
RESULTS: 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8/82.9%, to primary patients. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; p<0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbo-pelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; p<0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%) and leg pain NRS (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures.
CONCLUSIONS: Patients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.

PMID: 29751181 [PubMed - as supplied by publisher]

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