The Impact of Radiculopathy on Patient-Reported Outcomes: A Propensity Matched Study on 386 Adult Spinal Deformity Patients with and without Leg Pain

2016 ◽  
Vol 16 (10) ◽  
pp. S193-S194
Author(s):  
Renaud Lafage ◽  
Justin K. Scheer ◽  
Barthelemy Liabaud ◽  
Frank J. Schwab ◽  
Justin S. Smith ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Leg Pain ◽  
Patient Reported ◽  
Matched Study ◽  
The Impact

scholarly journals Impact of obesity on complications, infection, and patient-reported outcomes in adult spinal deformity surgery

2015 ◽  
Vol 23 (5) ◽  
pp. 656-664 ◽  
Author(s):  
Alex Soroceanu ◽  
Douglas C. Burton ◽  
Bassel Georges Diebo ◽  
Justin S. Smith ◽  
Richard Hostin ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Obese Patients ◽  
Estimated Blood Loss ◽  
Sf 36 ◽  
Patient Reported ◽  
The Impact

OBJECT Adult spinal deformity (ASD) surgery is known for its high complication rate. This study examined the impact of obesity on complication rates, infection, and patient-reported outcomes in patients undergoing surgery for ASD. METHODS This study was a retrospective review of a multicenter prospective database of patients with ASD who were treated surgically. Patients with available 2-year follow-up data were included. Obesity was defined as having a body mass index (BMI) ≥ 30 kg/m2. Data collected included complications (total, minor, major, implant-related, radiographic, infection, revision surgery, and neurological injury), estimated blood loss (EBL), operating room (OR) time, length of stay (LOS), and patient-reported questionnaires (Oswestry Disability Index [ODI], Short Form-36 [SF-36], and Scoliosis Research Society [SRS]) at baseline and at 6 weeks, 1 year, and 2 years postoperatively. The impact of obesity was studied using multivariate modeling, accounting for confounders. RESULTS Of 241 patients who satisfied inclusion criteria, 175 patients were nonobese and 66 were obese. Regression models showed that obese patients had a higher overall incidence of major complications (IRR 1.54, p = 0.02) and wound infections (odds ratio 4.88, p = 0.02). Obesity did not increase the number of minor complications (p = 0.62), radiographic complications (p = 0.62), neurological complications (p = 0.861), or need for revision surgery (p = 0.846). Obesity was not significantly correlated with OR time (p = 0.23), LOS (p = 0.9), or EBL (p = 0.98). Both groups experienced significant improvement overtime, as measured on the ODI (p = 0.0001), SF-36 (p = 0.0001), and SRS (p = 0.0001) questionnaires. However, the overall magnitude of improvement was less for obese patients (ODI, p = 0.0035; SF-36, p = 0.0012; SRS, p = 0.022). Obese patients also had a lower rate of improvement over time (SRS, p = 0.0085; ODI, p = 0.0001; SF-36, p = 0.0001). CONCLUSIONS This study revealed that obese patients have an increased risk of complications following ASD correction. Despite these increased complications, obese patients do benefit from surgical intervention; however, their improvement in health-related quality of life (HRQL) is less than that of nonobese patients.

Postoperative Coronal Malalignment is Associated with Significantly Poor Patient Reported Outcomes in Operatively Treated Adult Spinal Deformity

2015 ◽  
Vol 15 (10) ◽  
pp. S148-S149 ◽  
Author(s):  
International Spine Study Group ◽  
Amit Jain ◽  
Christopher P. Ames ◽  
Brian J. Neuman ◽  
Daniel M. Sciubba ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Poor Patient ◽  
Patient Reported ◽  
Coronal Malalignment

68. Early patient-reported outcomes can be used to identify patients at risk for poor 1-year outcomes in adult spinal deformity

2019 ◽  
Vol 19 (9) ◽  
pp. S34
Author(s):  
Alvaro Ibaseta ◽  
Rafa Rahman ◽  
Nicholas S. Andrade ◽  
Richard L. Skolasky ◽  
Lee H. Riley ◽  
...  
Keyword(s):  
At Risk ◽  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported ◽  
Patients At Risk

Global coronal decompensation and adult spinal deformity surgery: comparison of upper-thoracic versus lower-thoracic proximal fixation for long fusions

2021 ◽  
pp. 1-13
Author(s):  
Thomas J. Buell ◽  
Christopher I. Shaffrey ◽  
Han Jo Kim ◽  
Eric O. Klineberg ◽  
Virginie Lafage ◽  
...  
Keyword(s):  
Thoracic Spine ◽  
Spinal Deformity ◽  
Rating Scale ◽  
Numerical Rating Scale ◽  
Adult Spinal Deformity ◽  
Leg Pain ◽  
Sagittal Vertical Axis ◽  
Upper Thoracic ◽  
The Impact

OBJECTIVE Deterioration of global coronal alignment (GCA) may be associated with worse outcomes after adult spinal deformity (ASD) surgery. The impact of fusion length and upper instrumented vertebra (UIV) selection on patients with this complication is unclear. The authors’ objective was to compare outcomes between long sacropelvic fusion with upper-thoracic (UT) UIV and those with lower-thoracic (LT) UIV in patients with worsening GCA ≥ 1 cm. METHODS This was a retrospective analysis of a prospective multicenter database of consecutive ASD patients. Index operations involved instrumented fusion from sacropelvis to thoracic spine. Global coronal deterioration was defined as worsening GCA ≥ 1 cm from preoperation to 2-year follow-up. RESULTS Of 875 potentially eligible patients, 560 (64%) had complete 2-year follow-up data, of which 144 (25.7%) demonstrated worse GCA at 2-year postoperative follow-up (35.4% of UT patients vs 64.6% of LT patients). At baseline, UT patients were younger (61.6 ± 9.9 vs 64.5 ± 8.6 years, p = 0.008), a greater percentage of UT patients had osteoporosis (35.3% vs 16.1%, p = 0.009), and UT patients had worse scoliosis (51.9° ± 22.5° vs 32.5° ± 16.3°, p < 0.001). Index operations were comparable, except UT patients had longer fusions (16.4 ± 0.9 vs 9.7 ± 1.2 levels, p < 0.001) and operative duration (8.6 ± 3.2 vs 7.6 ± 3.0 hours, p = 0.023). At 2-year follow-up, global coronal deterioration averaged 2.7 ± 1.4 cm (1.9 to 4.6 cm, p < 0.001), scoliosis improved (39.3° ± 20.8° to 18.0° ± 14.8°, p < 0.001), and sagittal spinopelvic alignment improved significantly in all patients. UT patients maintained smaller positive C7 sagittal vertical axis (2.7 ± 5.7 vs 4.7 ± 5.7 cm, p = 0.014). Postoperative 2-year health-related quality of life (HRQL) significantly improved from baseline for all patients. HRQL comparisons demonstrated that UT patients had worse Scoliosis Research Society–22r (SRS-22r) Activity (3.2 ± 1.0 vs 3.6 ± 0.8, p = 0.040) and SRS-22r Satisfaction (3.9 ± 1.1 vs 4.3 ± 0.8, p = 0.021) scores. Also, fewer UT patients improved by ≥ 1 minimal clinically important difference in numerical rating scale scores for leg pain (41.3% vs 62.7%, p = 0.020). Comparable percentages of UT and LT patients had complications (208 total, including 53 reoperations, 77 major complications, and 78 minor complications), but the percentage of reoperated patients was higher among UT patients (35.3% vs 18.3%, p = 0.023). UT patients had higher reoperation rates of rod fracture (13.7% vs 2.2%, p = 0.006) and pseudarthrosis (7.8% vs 1.1%, p = 0.006) but not proximal junctional kyphosis (9.8% vs 8.6%, p = 0.810). CONCLUSIONS In ASD patients with worse 2-year GCA after long sacropelvic fusion, UT UIV was associated with worse 2-year HRQL compared with LT UIV. This may suggest that residual global coronal malalignment is clinically less tolerated in ASD patients with longer fusion to the proximal thoracic spine. These results may inform operative planning and improve patient counseling.

Predictors of Revision Surgery in Adult Spinal Deformity and Impact on Patient-Reported Outcomes and Satisfaction: Two-Year Follow-Up

2014 ◽  
Vol 14 (11) ◽  
pp. S21 ◽  
Author(s):  
Peter G. Passias ◽  
Sun Yang ◽  
Alexandra Soroceanu ◽  
Justin S. Smith ◽  
Christopher I. Shaffrey ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Revision Surgery ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported

scholarly journals Long-term clinical and radiographic outcomes and patient satisfaction after adult spinal deformity correction

2018 ◽  
Vol 108 (4) ◽  
pp. 343-351 ◽  
Author(s):  
K. Kyrölä ◽  
H. Kautiainen ◽  
L. Pekkanen ◽  
P. Mäkelä ◽  
I. Kiviranta ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Spinal Deformity ◽  
Oswestry Disability Index ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Deformity Correction ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Patient Reported ◽  
Poor Outcomes

Background and Aims: Adult spinal deformity surgery has increased with the aging population and modern surgical approaches, although it has high complication and reoperation rates. The permanence of radiographic correction, mechanical complications, predictive factors for poor patient-reported outcomes, and patient satisfaction were analyzed. Material and Methods: A total of 79 adult patients were retrospectively analyzed at baseline and 1–9 years after adult spinal deformity correction between 2007 and 2016. Patient-reported outcomes (Oswestry Disability Index, visual analog scale, and Scoliosis Research Society–30 scores), changes in radiographic alignment, indications for reoperation, predictors of poor outcomes according to the Oswestry Disability Index and Scoliosis Research Society–30 scores, and patient satisfaction with management were studied. Results: Oswestry Disability Index and visual analog scale scores (p = 0.001), radiographic correction of thoracic kyphosis, lumbar lordosis, and pelvic retroversion (p ⩽ 0.001) and sagittal vertical axis (p = 0.043) were significantly better at 4–5 years of follow-up than at baseline. The risk for the first reoperation owing to mechanical failure of instrumentation or bone was highest within the first year, at 13.9% (95% confidence interval = 8.0%–23.7%), and 29.8% (95% confidence interval = 19.4%–43.9%) at the 5-year follow-up. Oswestry Disability Index and Scoliosis Research Society–30 total scores had a good correlation (r = −0.78; 95% CI = −0.86 to –0.68; p < 0.001). Satisfaction with management was correlated with patient-reported outcomes. Male sex and depression (p = 0.021 and 0.018, respectively) predicted poor outcomes according to the Oswestry Disability Index and/or Scoliosis Research Society–30 score. Conclusion: The achieved significant radiographic correction was maintained 5 years postoperatively. Despite reoperations, patient satisfaction and clinical outcomes were good. Depression and male sex predicted poor clinical outcomes.

scholarly journals Classifying Complications: Assessing Adult Spinal Deformity 2-Year Surgical Outcomes

2020 ◽  
Vol 10 (7) ◽  
pp. 896-907
Author(s):  
Eric O. Klineberg ◽  
Peter G. Passias ◽  
Gregory W. Poorman ◽  
Cyrus M. Jalai ◽  
Abiola Atanda ◽  
...  
Keyword(s):  
Postoperative Complications ◽  
Postoperative Complication ◽  
Spinal Deformity ◽  
Surgical Outcomes ◽  
Perioperative Complications ◽  
Adult Spinal Deformity ◽  
Complication Rates ◽  
Estimated Blood Loss ◽  
Patient Reported ◽  
The Impact

Study Design: Retrospective review of prospective database. Objective: Complication rates for adult spinal deformity (ASD) surgery vary widely because there is no accepted system for categorization. Our objective was to identify the impact of complication occurrence, minor-major complication, and Clavien-Dindo complication classification (Cc) on clinical variables and patient-reported outcomes. Methods: Complications in surgical ASD patients with complete baseline and 2-year data were considered intraoperatively, perioperatively (<6 weeks), and postoperatively (>6 weeks). Primary outcome measures were complication timing and severity according to 3 scales: complication presence (yes/no), minor-major, and Cc score. Secondary outcomes were surgical outcomes (estimated blood loss [EBL], length of stay [LOS], reoperation) and health-related quality of life (HRQL) scores. Univariate analyses determined complication presence, type, and Cc grade impact on operative variables and on HRQL scores. Results: Of 167 patients, 30.5% (n = 51) had intraoperative, 48.5% (n = 81) had perioperative, and 58.7% (n = 98) had postoperative complications. Major intraoperative complications were associated with increased EBL ( P < .001) and LOS ( P = .0092). Postoperative complication presence and major postoperative complication were associated with reoperation ( P < .001). At 2 years, major perioperative complications were associated with worse ODI, SF-36, and SRS activity and appearance scores ( P < .02). Increasing perioperative Cc score and postoperative complication presence were the best predictors of worse HRQL outcomes ( P < .05). Conclusion: The Cc Scale was most useful in predicting changes in patient outcomes; at 2 years, patients with raised perioperative Cc scores and postoperative complications saw reduced HRQL improvement. Intraoperative and perioperative complications were associated with worse short-term surgical and inpatient outcomes.

Early Patient-Reported Outcomes Predict 3-Year Outcomes in Operatively Treated Patients with Adult Spinal Deformity

2017 ◽  
Vol 102 ◽  
pp. 258-262 ◽  
Author(s):  
Amit Jain ◽  
Khaled M. Kebaish ◽  
Daniel M. Sciubba ◽  
Hamid Hassanzadeh ◽  
Justin K. Scheer ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Patient Reported Outcomes ◽  
Adult Spinal Deformity ◽  
Patient Reported
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