Advantages and Disadvantages of Adult Spinal Deformity Surgery and Its Impact on Health-Related Quality of Life

Yoshida, Go; Boissière, Louis; Larrieu, Daniel; Bourghli, Anouar; Vital, J. M.; Gille, Olivier; Pointillart, Vincent; Challier, Vincent; Mariey, R; Pellisé, Ferràn; Vila-Casademunt, Alba; Pérez-Grueso, Francisco Javier Sánchez; Alanay, Ahmet; Acaroğlu, Emre; Kleinstück, Frank; Obeid, Ibrahim

doi:10.1097/brs.0000000000001770

Cited by 66 publications

(46 citation statements)

References 19 publications

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“…Traditionally, surgical management for ASD patients offers superior radiographic and health-related quality of life (HRQOL) outcomes compared with nonoperative care [4-6], particularly because improvement in pain relief or the ability to stand may contribute to stabilization at physiological sagittal alignment. Conversely, long-segment fusion negatively influences HRQOL, particularly for personal care or bending movements, such as lifting [7]. However, it is not known how long patients will be incapacitated postoperatively before they reach their preoperative status, which domains of QOL have a better or worse outcome for long-time follow-up, and whether good correction is associated with good clinical results.…”

Section: Introductionmentioning

confidence: 99%

Minimum Clinically Important Differences in Oswestry Disability Index Domains and Their Impact on Adult Spinal Deformity Surgery

et al. 2019

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Study DesignRetrospective study.PurposeTo calculate the minimum clinically important difference (MCID) for total and individual domains of the Oswestry Disability Index (ODI) and assess score distribution and changes over time in surgically treated adult spinal deformity (ASD) patients.Overview of LiteratureDespite the common use of ODI for assessing ASD, there are no robust studies defining MCID values for this index.MethodsThis study included 240 consecutive ASD patients with a minimum of 2 years of follow-up. We calculated MCID values for total and individual ODI domains using all or part of the Scoliosis Research Society-22R questionnaire as anchors. Using current MCID values, we measured the acquisition rates in patients who acquired MCID at follow-up in both total and individual ODI domains. Differences in pathology, age, and locations of the upper and lower instrumented vertebrae were analyzed.ResultsMCID of the total ODI score was 11%, with an area under the curve of 0.737. Each domain ranged from 0 to 2, with 1 being the most common value. In the pain and standing domains, >60% of the patients acquired MCID, although acquisition rates of the personal care, lifting, sleep, and sexual activity domains were relatively low (20%–35%). Patients with MCID had more radiographic improvement in lumbar lordosis, sagittal vertical axis, and T1 pelvic angle than those without MCID (p<0.05).ConclusionsTo our knowledge, this is the first study to describe MCID of ODI (11%) after ASD surgery. In the pain and standing domains, most patients acquired MCID although the rates of acquisition of MCID in the personal care, lifting, sleep, and sexual activity domains were low. Spine surgeons should counsel their patients regarding the benefits and setbacks of ASD surgery.

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Section: Introductionmentioning

confidence: 99%

Minimum Clinically Important Differences in Oswestry Disability Index Domains and Their Impact on Adult Spinal Deformity Surgery

et al. 2019

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“…Adult spinal deformity is a common disease with a reported incidence ranging from 29 to 68% [1,2]. Adult patients with spinal deformity can present with back pain, symptoms of nerve compression, and impaired quality of life [3][4][5][6]. Surgical management offers better radiographic and clinical Electronic supplementary material The online version of this article (https ://doi.org/10.1007/s0058 6-019-06187 -8) contains supplementary material, which is available to authorized users.…”

Section: Introductionmentioning

confidence: 99%

Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis

et al. 2019

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Purpose Choosing an optimal distal fusion level for adult spinal deformity (ASD) is still controversial. To compare the radiographic and clinical outcomes of distal fusion to L5 versus the sacrum in ASD, we conducted a meta-analysis. Methods Relevant studies on long fusion terminating at L5 or the sacrum in ASD were retrieved from the PubMed, Embase, Cochrane, and Google Scholar databases. Then, studies were manually selected for inclusion based on predefined criteria. The meta-analysis was performed by RevMan 5.3. Results Eleven retrospective studies with 1211 patients were included in meta-analysis. No significant difference was found in overall complication rate (95% CI 0.60 to 1.30) and revision rate (95% CI 0.59 to 1.99) between fusion to L5 group (L group) and fusion to the sacrum group (S group). Significant lower rate of pseudarthrosis and implant-related complications (95% CI 0.29 to 0.64) as well as proximal adjacent segment disease (95% CI 0.35 to 0.92) was found in L group. Patients in S group obtained a better correction of lumbar lordosis (95% CI − 7.85 to − 0.38) and less loss of sagittal balance (95% CI − 1.80 to − 0.50). Conclusion Our meta-analysis suggested that long fusion terminating at L5 or the sacrum was similar in scoliosis correction, overall complication rate, revision rate, and improvement in pain and disability. However, fusion to L5 had advantages in lower rate of pseudarthrosis, implant-related complications, and proximal adjacent segment disease, while fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance, and absence of distal adjacent segment disease. Graphic abstractThese slides can be retrieved under Electronic Supplementary Material.Key points 1. The meta-analysis suggested that fusion to L5 was similar to fusion to the sacrum in the correction of scoliosis, overall complication rate, revision rate and improvements of pain and disability.2. Fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance and absence of distal adjacent segment disease. Fusion toL5 had advantages in lower rate of pseudarthrosis and implantrelated complications and proximal adjacent segment disease. Jia F, Wang G, Liu X, Li T, Sun J (2019) Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis. Eur Spine J; scoliosis lordosis SVA overall complicaƟons revisions pseudarthrosis and implant-related complicaƟons Jia F, Wang G, Liu X, Li T, Sun J (2019) Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis. Eur Spine J;Take Home Messages 1. There were no significant differences between two groups in overall complication rate and revision rate, which was counter-intuitive. The improvements of pain and disability were also similar in both groups.2. Fusion to the sacrum had advantages in the restoration of lumbar lordosis, maintenance of sagittal balance and absence of distal adjacent segment di...

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“…In adults with degenerative scoliosis and back pain, adult spinal deformity (ASD) surgery offers significant reduction in pain and improved quality of life relative to medical intervention (1)(2)(3)(4)(5). Various surgical options exist to optimize functional outcomes while limiting morbidity.…”

Section: Introductionmentioning

confidence: 99%

Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery

Zuckerman¹,

Lakomkin²,

Smith³

et al. 2018

J Spine Surg

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Death after elective ASD surgery is a devastating yet uncommon event with an incidence of 1%. Preoperative factors of age, ASA score, cancer history, and unexpected weight loss, along with postoperative complications of pneumonia, DVT, and unplanned intubation were independently associated with all-cause mortality within 1 year of ASD surgery. Interestingly, the potentially more severe complications of sepsis, PE, and MI did not independently predict death.

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Advantages and Disadvantages of Adult Spinal Deformity Surgery and Its Impact on Health-Related Quality of Life

Abstract: 4.

Cited by 66 publications

References 19 publications

Minimum Clinically Important Differences in Oswestry Disability Index Domains and Their Impact on Adult Spinal Deformity Surgery

Minimum Clinically Important Differences in Oswestry Disability Index Domains and Their Impact on Adult Spinal Deformity Surgery

Comparison of long fusion terminating at L5 versus the sacrum in treating adult spinal deformity: a meta-analysis

Incidence and predictors of all-cause mortality within one year after adult spinal deformity surgery

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