Can Baseline Disability Predict Outcomes in Adult Spinal Deformity Surgery?

Abstract

Study Design. Retrospective Cohort Study Objective. To assess if there is a threshold of baseline disability, beyond which the patient reported outcomes after surgical correction of ASD are adversely impacted?. Background. Patient reported outcomes vary after correction of adult spinal deformity, even when patients are optimally realigned. There is a paucity of literature examining the impact of baseline disability on patient reported outcomes in adult spinal deformity(ASD). Methods. Patients with baseline (BL) and 2-year (2Y) data were included. Disability was ranked according to BL ODI into quintiles: Q1 (lowest ODI score) to Q5 (highest ODI score). Adjusted logistic regression analyses evaluated the likelihood of reaching ≥1 MCID in SRS-22 Pain, SRS-22 Activity, and SF-36 PCS at 2Y across disability groups Q1–Q4 with respect to Q5. Sensitivity tests were performed, excluding patients with any “0” Schwab modifiers at BL. Results. Compared to patients in Q5, odds of reaching MCID in SRS-22-Pain at 2Y were significantly higher for those in Q1 (OR: 3.771), Q2 (OR: 3.006), and Q3 (OR: 2.897), all P<0.021. Similarly, compared to patients in Q5, odds of reaching MCID in SRS-22-Activity at 2Y were significantly higher for those in Q2 (OR: 3.454) and Q3 (OR: 2.801), both P<0.02. Lastly, compared to patients in Q5, odds of reaching MCID in SF-36-PCS at 2Y were significantly higher for patients in Q1 (OR: 5.350), Q2 (OR: 4.795) and Q3 (OR: 6.229), all P<0.004. Conclusions. This study found that patients presenting with moderate disability at BL (ODI<40) consistently surpassed HRQL outcomes as compared to those presenting with greater levels of disability. We propose that a baseline ODI of 40 represents a disability threshold within which operative intervention maximizes patient reported outcomes. Furthermore, delaying intervention until patients progress to severe disability, may limit benefits of surgical correction in ASD patients. Level of Evidence. III

Peripheral Joint Arthritis and Its Influence on Adult Spinal Deformity

“…This could culminate in issues of central sensitization, or the type of nonspecific bodily pain manifestations that may serve as a red flag for surgeons in terms of indicating patients for operative intervention. It may also explain heightened levels of baseline disability that have been shown to prevent patients from achieving idealized health-related quality of life outcomes following surgery 3 …”

“…Fundamentally, the investigation of Balmaceno-Criss et al 1 advances the field on several fronts, including preoperative counseling and prognostication of natural history, the sequence of procedures in clinical scenarios where joint replacement and spine surgery may be needed, and the perceived impact that such procedures could have on aspects of central sensitization and manifestations of bodily pain. The reciprocal influence of spinal deformity and peripheral joint arthrosis on physical function is incredibly vital to understand from the perspective of spine surgeons, who are looking to appropriately advise individuals on the anticipated outcomes of what amounts to a high-risk, high-intensity surgical undertaking 2,3 . Yet it is equally important for patients, who may need to comprehend that a spine surgical correction might not be the last necessary procedure and that there are prospects for further peripheral joint replacement or other reconstructive-type surgeries on the horizon once they recover from their spinal procedure.…”

“…Central sensitization is a phenomenon that occurs in many individuals who experience substantive levels of pain for a period of time, which then leads to permanent alterations in the way that other types of pain and noxious stimuli are processed by the central nervous system. This may culminate in physical manifestations of chronic bodily pain or nonorganic pain presentations that could exacerbate issues associated with the spinal deformity and adversely impact perceptions around candidacy for surgery 3 . Central sensitization has been linked to inferior outcomes after total knee arthroplasty, as well as other surgical interventions 5 .…”