Importance of achieving Scoliosis Research Society–22r minimal clinically important difference for improving patient satisfaction after adult spinal deformity surgery

2021 ◽  
pp. 1-9
Author(s):  
Hideyuki Arima ◽  
Tomohiko Hasegawa ◽  
Yu Yamato ◽  
Go Yoshida ◽  
Tomohiro Banno ◽  
...  
Keyword(s):  
Mental Health ◽  
Multivariate Analysis ◽  
Patient Satisfaction ◽  
Adult Spinal Deformity ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Self Image ◽  
Related Quality ◽  
Health Related ◽  
And Function

OBJECTIVE Achievement of minimal clinically important differences (MCIDs) in the Scoliosis Research Society–22r (SRS-22r) subdomains represents surgical efficacy. However, whether achievements of MCIDs in SRS-22r domains are associated with long-term satisfaction in patients with adult spinal deformity (ASD) is unclear. This study aimed to elucidate factors affecting patient satisfaction after thoracopelvic corrective fusion surgery in patients with ASD. METHODS Data obtained in 187 patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis between 2010 and 2017 and underwent follow-up for 2 years were retrospectively reviewed. The authors investigated the likelihood of achieving MCIDs in the function, pain, self-image, mental health, and subtotal domains 2 years after surgery. The following MCID values were used: function, 0.90; pain, 0.85; self-image, 1.05; mental health, 0.70; and subtotal, 1.05. Multivariate analysis was performed to evaluate factors associated with patient satisfaction 2 years after surgery. RESULTS The average satisfaction scores in the group that achieved MCID and the group that did not were as follows: 3.97 and 3.37 for function (p < 0.001), 3.66 and 3.51 for pain (p = 0.221), 3.84 and 3.06 for self-image (p < 0.001), 3.82 and 3.28 for mental health (p < 0.001), and 3.96 and 3.30 for subtotal (p < 0.001), respectively. Except for the pain domain, the group that achieved MCIDs showed greater satisfaction than the group that did not achieve MCIDs. On multivariate analysis, factors related to postoperative satisfaction were achievement of SRS-22r self-image (standardization coefficient 0.322, p < 0.001) and function (standardization coefficient 0.179, p = 0.026) MCIDs. Perioperative complications and revision surgery were not related to patient satisfaction. CONCLUSIONS Multivariate analysis demonstrated that achievement of MCIDs in SRS-22r self-image and function domains was significantly associated with postoperative satisfaction. Given that patients with poor preoperative health-related quality of life are more likely to achieve MCIDs in SRS-22r domains, surgeons should carefully consider whether to operate on patients with relatively good baseline health-related quality of life when making surgical decisions.

scholarly journals Health-related quality of life outcomes in complex adult spinal deformity surgery

2018 ◽  
Vol 28 (2) ◽  
pp. 194-200 ◽  
Author(s):  
Max S. Riley ◽  
Keith H. Bridwell ◽  
Lawrence G. Lenke ◽  
Jonathan Dalton ◽  
Michael P. Kelly
Keyword(s):  
Mental Health ◽  
Neurological Deficit ◽  
Adult Spinal Deformity ◽  
Major Complication ◽  
Self Image ◽  
Related Quality ◽  
Health Related ◽  
Function Domain

OBJECTIVESignificant health-related quality of life (HRQOL) benefits have been observed for patients undergoing primary and revision adult spinal deformity (ASD) surgery. The purpose of this study was to report changes in HRQOL measures in a consecutive series of patients undergoing complex spinal reconstructive surgery, using Scoli-RISK-1 (SR-1) inclusion criteria.METHODSThis was a single-center, retrospective cohort study. The SR-1 inclusion criteria were used to define patients with complex ASD treated between June 1, 2009, and June 1, 2011. Standard preoperative and perioperative data were collected, including the Scoliosis Research Society (SRS)–22r instrument. The HRQOL changes were evaluated at a minimum 2-year follow-up. Standardized forms were used to collect surgery-related complications data for all patients. Complications were defined as minor, transient major, or permanent major. Patients who achieved a minimum 2-year follow-up were included in the analysis.RESULTSEighty-four patients meeting SR-1 criteria were identified. Baseline demographic and surgical data were available for 74/84 (88%) patients. Forty-seven of 74 (64%) patients met the additional HRQOL criteria with a minimum 2-year follow-up (mean follow-up 3.4 years, range 2–6.5 years). Twenty-one percent of patients underwent posterior fusion only, 40% of patients had a posterior column osteotomy, and 38% had a 3-column osteotomy. Seventy-five percent of patients underwent a revision procedure. Significant improvements were observed in all SRS-22r domains: Pain: +0.8 (p < 0.001); Self-Image: +1.4 (p < 0.001); Function: +0.46 (p < 0.001); Satisfaction: +1.6 (p < 0.001); and Mental Health: +0.28 (p = 0.04). With the exception of Mental Health, more than 50% of patients achieved a minimum clinically important difference (MCID) in SRS-22r domain scores (Mental Health: 20/47, 42.6%). A total of 65 complications occurred in 31 patients. This includes 29.8% (14/47) of patients who suffered a major complication and 17% (8/47) who suffered a postoperative neurological deficit, most commonly at the root level (10.6%, 5/47). Of the 8 patients who suffered a neurological deficit, 1 (13%) was able to achieve MCID in the SRS Function domain.CONCLUSIONSThe majority of patients experienced clinically relevant improvement in SRS-22r HRQOL scores after complex ASD surgery. The greatest improvements were seen in the SRS Pain and SRS Self-Image domains. Although 30% of patients suffered a major or permanent complication, benefits from surgery were still attained. Patients sustaining a neurological deficit or major complication were unlikely to achieve HRQOL improvements meeting or exceeding MCID for the SRS Function domain.

scholarly journals Clinical improvement through nonoperative treatment of adult spinal deformity: who is likely to benefit?

2014 ◽  
Vol 36 (5) ◽  
pp. E2 ◽  
Author(s):  
Kseniya Slobodyanyuk ◽  
Caroline E. Poorman ◽  
Justin S. Smith ◽  
Themistocles S. Protopsaltis ◽  
Richard Hostin ◽  
...  
Keyword(s):  
Spinal Deformity ◽  
Adult Spinal Deformity ◽  
Research Society ◽  
Nonoperative Treatment ◽  
Inclusion Criteria ◽  
Scoliosis Research Society ◽  
Related Quality ◽  
Health Related ◽  
Radiographic Data ◽  
Age And Sex

Object The goal of this study was to determine the outcome and risk factors in patients with adult spinal deformity (ASD) who elected to receive nonoperative care. Methods In this retrospective study the authors reviewed a nonoperative branch of the International Spine Study Group database, derived from 10 sites across the US. Specific inclusion criteria included nonoperative treatment for ASD and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and at 1-year (1Y) follow-up. Health-related quality of life measures were assessed using the SRS-22 and radiographic data. Changes in SRS-22 scores were evaluated by domain and expressed in number of minimum clinically important differences (MCIDs) gained or lost; BL and 1Y scores were also compared with age- and sex-matched normative references. Results One hundred eighty-nine patients (mean age 53 years, 86% female) met inclusion criteria. Pain was the domain with the largest offset for 43% of patients, followed by the Appearance (23%), Activity (18%), and Mental (15%) domains. On average, patients improved 0.3 MCID in Pain over 1Y, without changes in Activity or Appearance. Baseline scores significantly impacted 1Y outcomes, with up to 85% of patients in the mildest category of deformity being classified as < 1 MCID of normative reference at 1Y, versus 0% of patients with the most severe initial deformity. Baseline radiographic parameters did not correlate with outcome. Conclusions Patients who received nonoperative care are significantly more disabled than age- and sex-matched normative references. The likelihood for a patient to reach SRS scores similar to the normative reference at 1Y decreases with increased BL disability. Nonoperative treatment is a viable option for certain patients with ASD, and up to 24% of patients demonstrated significant improvement over 1Y with nonoperative care.

scholarly journals Correlation of 2-year SRS-22r and ODI patient-reported outcomes with 5-year patient-reported outcomes after complex spinal fusion: a 5-year single-institution study of 118 patients

2018 ◽  
Vol 29 (4) ◽  
pp. 422-428 ◽  
Author(s):  
Owoicho Adogwa ◽  
Isaac O. Karikari ◽  
Aladine A. Elsamadicy ◽  
Amanda R. Sergesketter ◽  
Diego Galan ◽  
...  
Keyword(s):  
Mental Health ◽  
Spinal Fusion ◽  
Patient Reported Outcomes ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Self Image ◽  
Patient Reported ◽  
Spinal Arthrodesis

OBJECTIVEPatient-reported outcomes (PROs) are often measured up to 2 years after surgery; however, prospective collection of longitudinal outcomes for 5 years postoperatively can be challenging due to lack of patient follow-up. The aim of this study was to determine whether PROs collected at 2-year follow-up accurately predict long-term PROs 5 years after complex spinal fusion (≥ 5 levels).METHODSThis was an ambispective study of 118 adult patients (≥ 18 years old) undergoing ≥ 5-level spinal arthrodesis to the sacrum with iliac fixation from January 2002 to December 2011. Patient demographics and radiographic parameters as well as intraoperative variables were collected. PRO instruments (Scoliosis Research Society [SRS]-22r function, self-image, mental health, pain, and Oswestry Disability Index [ODI]) were completed before surgery then at 2 and 5 years after surgery. Primary outcome investigated in this study was the correlation between SRS-22r domains and ODI collected at 2- and 5-year follow-up.RESULTSOf the 118 patients, 111 patients had baseline PROs, 105 patients had 2-year follow-up data, and 91 patients had 5-year follow-up PRO data with 72% undergoing revision surgery. The average pre- and postoperative major coronal curve Cobb angles for the cohort were 32.1° ± 23.7° and 19.8° ± 19.3°, respectively. There was a strong correlation between 2- and 5-year ODI (r2 = 0.80, p < 0.001) and between 2- and 5-year SRS-22r domains, including function (r2 = 0.79, p < 0.001), self-image (r2 = 0.82, p < 0.001), mental health (r2 = 0.77, p < 0.001), and pain (r2 = 0.79, p < 0.001). Of the PROs, ODI showed the greatest absolute change from baseline to 2- and 5-year follow-up (2-year Δ 17.6 ± 15.9; 5-year Δ 16.5 ± 19.9) followed by SRS-22r self-image (2-year Δ 1.4 ± 0.96; 5-year Δ 1.3 ± 1.0), pain (2-year Δ 0.94 ± 0.97; 5-year Δ 0.80 ± 1.0), function (2-year Δ 0.60 ± 0.62; 5-year Δ 0.49 ± 0.79), and mental health (2-year Δ 0.49 ± 0.77; 5-year Δ 0.38 ± 0.84).CONCLUSIONSPatient-reported outcomes collected at 2-year follow-up may accurately predict long-term PROs (5-year follow-up).

scholarly journals Health-related quality of life and sagittal balance at two to 25 years after posterior transfixation for high-grade dysplastic spondylolisthesis

2021 ◽  
Vol 2 (3) ◽  
pp. 163-173
Author(s):  
Tom P C. Schlösser ◽  
Enrique Garrido ◽  
Athanasios I. Tsirikos ◽  
Michael J. McMaster
Keyword(s):  
Young Patients ◽  
Research Society ◽  
Sacral Slope ◽  
High Grade ◽  
Partial Reduction ◽  
Scoliosis Research Society ◽  
Pelvic Inclination ◽  
Self Image ◽  
Related Quality

Aims High-grade dysplastic spondylolisthesis is a disabling disorder for which many different operative techniques have been described. The aim of this study is to evaluate Scoliosis Research Society 22-item (SRS-22r) scores, global balance, and regional spino-pelvic alignment from two to 25 years after surgery for high-grade dysplastic spondylolisthesis using an all-posterior partial reduction, transfixation technique. Methods SRS-22r and full-spine lateral radiographs were collected for the 28 young patients (age 13.4 years (SD 2.6) who underwent surgery for high-grade dysplastic spondylolisthesis in our centre (Scottish National Spinal Deformity Service) between 1995 and 2018. The mean follow-up was nine years (2 to 25), and one patient was lost to follow-up. The standard surgical technique was an all-posterior, partial reduction, and S1 to L5 transfixation screw technique without direct decompression. Parameters for segmental (slip percentage, Dubousset’s lumbosacral angle) and regional alignment (pelvic tilt, sacral slope, L5 incidence, lumbar lordosis, and thoracic kyphosis) and global balance (T1 spino-pelvic inclination) were measured. SRS-22r scores were compared between patients with a balanced and unbalanced pelvis at final follow-up. Results SRS-22r domain and total scores improved significantly from preoperative to final follow-up, except for the mental health domain that remained the same. Slip percentage improved from 75% (SD 15) to 48% (SD 19) and lumbosacral angle from 70° (SD 11) to 101° (SD 11). Preoperatively, 35% had global imbalance, and at follow-up all were balanced. Preoperatively, 63% had an unbalanced pelvis, and at final follow-up this was 32%. SRS-22r scores were not different in patients with a balanced or unbalanced pelvis. However, postoperative pelvic imbalance as measured by L5 incidence was associated with lower SRS-22r self-image and total scores (p = 0.029). Conclusion In young patients with HGDS, partial reduction and transfixation improves local lumbosacral alignment, restores pelvic, and global balance and provides satisfactory long-term clinical outcomes. Higher SRS-22r self-image and total scores were observed in the patients that had a balanced pelvis (L5I < 60°) at two to 25 years follow-up. Cite this article: Bone Jt Open 2021;2(3):163–173.

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.

How does the cervical spine respond to hyperkyphosis correction in Scheuermann’s disease?

2019 ◽  
Vol 31 (4) ◽  
pp. 493-500
Author(s):  
Liang Xu ◽  
Benlong Shi ◽  
Yong Qiu ◽  
Zhonghui Chen ◽  
Xi Chen ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Research Society ◽  
Scoliosis Research Society ◽  
Pain Scores ◽  
Patient Reported ◽  
Related Quality ◽  
Lower Pain ◽  
Health Related ◽  
Negative Effect

OBJECTIVEThis study aimed to quantify the response of the cervical spine to the surgical correction of Scheuermann’s kyphosis (SK) and to postoperative proximal junctional kyphosis (PJK).METHODSFifty-nine patients (mean age 14.6 ± 2.3 years) were enrolled in the study: 35 patients in a thoracic SK (T-SK) group and 24 in a thoracolumbar SK (TL-SK) group. The mean follow-up period was 47.2 ± 17.6 months. Radiographic data, PJK-related complications, and patient-reported outcomes were compared between groups.RESULTSThe global kyphosis significantly decreased postoperatively, and similar correction rates were observed between the two groups (mean 47.1% ± 8.6% [T-SK] vs 45.8% ± 9.4% [TL-SK], p = 0.585). The cervical lordosis (CL) in the T-SK group notably decreased from 21.4° ± 13.3° to 13.1° ± 12.4° after surgery and was maintained at 14.9° ± 10.7° at the latest follow-up, whereas in the TL-SK group, CL considerably increased from 7.2° ± 10.7° to 11.7° ± 11.1° after surgery and to 13.8° ± 8.9° at the latest follow-up. PJK was identified in 16 patients (27.1%). Its incidence in the TL-SK group was notably higher than it was in the T-SK group (41.6% [n = 10] vs 17.1% [n = 6], p = 0.037). Compared with non-PJK patients, PJK patients had greater CL and lower pain scores on the Scoliosis Research Society–22 questionnaire (p < 0.05).CONCLUSIONSHyperkyphosis correction eventually resulted in reciprocal changes in the cervical spine, with CL notably decreased in the T-SK group but significantly increased in the TL-SK group. Patients developing PJK have increased CL, which seems to have a negative effect on patients’ health-related quality of life.

The Italian Spine Youth Quality of Life questionnaire measures health-related quality of life of adolescents with spinal deformities better than the reference standard, the Scoliosis Research Society 22 questionnaire

2019 ◽  
Vol 33 (8) ◽  
pp. 1404-1415 ◽  
Author(s):  
Antonio Caronni ◽  
Sabrina Donzelli ◽  
Fabio Zaina ◽  
Stefano Negrini
Keyword(s):  
Quality Of Life ◽  
Research Society ◽  
Spinal Deformities ◽  
Scoliosis Research Society ◽  
Cohen’S D ◽  
Related Quality ◽  
Health Related ◽  
Cohen's D ◽  
Better Than

Objective: To compare the validity of the Italian Spine Youth Quality of Life (ISYQOL) questionnaire with that of the Scoliosis Research Society 22 (SRS22) questionnaire, the criterion standard for health-related quality of life (HRQOL) measurement in adolescents with spinal deformities. Design: Cross-sectional study. Setting: Outpatient clinic. Subjects: Consecutive adolescents (10–18 years; 541 wearing brace) affected by idiopathic scoliosis (642 females, 100 males) or hyperkyphosis (87 females, 109 males). Interventions: NA. Main measures: The Spearman’s correlation coefficient (rho) between ISYQOL and SRS22 was used to assess ISYQOL concurrent validity. Sex, age, severity, bracing, trunk appearance and deformity type were assessed for known-groups validity. Cohen’s d quantified between-groups differences. Multiple linear regression exploring the effect of sex, age, body mass index (BMI), severity, bone age, trunk appearance, physiotherapy, bracing and sport on HRQOL of scoliosis patients was used to assess concurrent validity further. Results: Satisfactory correlations were found between ISYQOL and SRS22 (scoliosis, rho = 0.71; kyphosis, rho = 0.56). Known-groups validity analysis showed that ISYQOL detects all the between-groups differences detected by SRS22 and a males-females difference undetected by SRS22. ISYQOL Cohen’s d was larger than SRS22 Cohen’s d in three between-groups comparisons and similar in the others. Brace, sport and scoliosis severity were independently related to ISYQOL (linear regression: R2 = 0.23; p < 0.001). Brace, sport and physiotherapy were related to SRS22 ( R2 = 0.17). Conclusions: ISYQOL showed high validity when used to measure HRQOL in adolescents with spinal deformities. Moreover, ISYQOL performs better than SRS22, having better known-groups validity and (contrary to SRS22) detecting the impact of disease severity on HRQOL.

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