Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients

Ibrahim, John; Singh, Paramjit; Beckerman, Daniel; Hu, Serena S.; Tay, Bobby; Deviren, Vedat; Burch, Shane; Berven, Sigurd

doi:10.1177/2192568219849393

Cited by 18 publications

(14 citation statements)

References 24 publications

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“…9 Past studies have established that multiple comorbidities can negatively impact PROMs such as the visual analogue scale (VAS), EuroQoL 5 Dimensions, Oswestry Disability Index, and 12-item Short Form health survey (SF-12) physical and mental composite scores. 10 Moreover, investigators have reported that higher comorbidity burdens act as negative predictive factors for achieving an MCID for disability and physical function scores among ACDF and lumbar decompressions patients, respectively. 5,11 While numerous studies report on how multiple comorbidities increase the risk of complications, 12,13 few focus on the cervical spine and even fewer investigate the effects on physical function.…”

Section: Introductionmentioning

confidence: 99%

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

et al. 2021

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This study aims to detail the association between comorbidity burden and achieving minimum clinically important difference (MCID) following anterior cervical discectomy and fusion (ACDF). Methods: A prospective surgical registry was retrospectively reviewed. Patients with missing preoperative Patient-Reported Outcomes Measurement Information System physical function (PROMIS PF) were excluded. Patients were stratified by Charlson Comorbidity Index (CCI): no comorbidities = 0 point; low CCI = 1-2 points; high CCI = ≥ 3 points. Demographic and perioperative characteristics were collected and evaluated for differences. Visual analogue scale (VAS), 12-item Short Form health survey (SF-12), and PROMIS PF were collected pre-and postoperatively and assessed for differences. Differences in achievement of MCID were compared using established values: VAS neck = 2.6, VAS arm = 4.1, NDI = 8.5, SF-12 physical composite score (SF-12 PCS) = 8.1, PROMIS PF = 4.5. Results: One hundred twenty-five ACDF patients were included: 37 had no comorbidities, 64 with low CCI, and 24 with high CCI. Higher CCI groups were older, nonsmokers, diabetic, arthritic, hypertensive, and had cancer. Multilevel fusions, operative time, length of stay, and later discharge day were associated with high CCI. VAS neck differed preoperatively by group. SF-12 PCS and PROMIS PF were inversely associated with CCI groups. CCI did not impact achievement of MCID for all outcomes. A lower rate of reaching MCID was demonstrated at 3 months for SF-12 PCS. Conclusion: Regardless of comorbidity burden, patients undergoing ACDF for cervical pathology demonstrated a similar rate of achieving MCID for VAS neck, VAS arm, NDI, and PROMIS PF. Regardless of CCI score, ACDF can have a significant benefit for patients.

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Section: Introductionmentioning

confidence: 99%

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

et al. 2021

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“…The current study utilized a propensity matching strategy to control for covariates, while previous studies did not. The results from the lumbar, cervical myelopathy, and cervical radiculopathy unmatched samples indicated patients with PD were older and had higher ASA grades, both of which have been shown to influence spine surgery outcomes 17–20. By accounting for these covariates through propensity matching, this study was able to independently examine the effect a diagnosis of PD has on elective spine outcomes.…”

Section: Discussionmentioning

confidence: 95%

“…Parkinson Disease • Steinle et al higher ASA grades, both of which have been shown to influence spine surgery outcomes. [17][18][19][20] By accounting for these covariates through propensity matching, this study was able to independently examine the effect a diagnosis of PD has on elective spine outcomes. With the exception of small differences in 12-month reoperation rates and EQ-5D scores in the lumbar analysis, when analyzed independently, a diagnosis of PD did not significantly affect PROs or complication, reoperation, or readmission rates, and should not independently represent a major contraindication to elective spine surgery.…”

Section: Surgerymentioning

confidence: 99%

“…While several case series describe higher complication and reoperation rates as well as poor improvement in quality of life measure scores for patients with PD, some studies have shown evidence for clinical improvement in patients with PD undergoing surgery to address spinal pathology including deformity and myelopathy 4,5,13–16. Inconsistent results from past studies could be due to small sample sizes and failure to control for covariates including age, surgical approach, American Society of Anesthesiology (ASA) grade, baseline status, number of operated levels, and preoperative disability, all of which have been shown to influence spine surgery outcomes 17–23…”

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confidence: 99%

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Complications, Readmissions, Revisions, and Patient-reported Outcomes in Patients With Parkinson Disease Undergoing Elective Spine Surgery: A Propensity-matched Analysis

Steinle

Nian

Pennings

et al. 2022

Spine

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Study Design. Retrospective analysis on prospectively collected data. Objective. To determine the effectiveness of elective spine surgery in patients with Parkinson disease (PD). Background Context. PD has become increasingly prevalent in an aging population. While surgical treatment for degenerative spine pathology is often required in this population, previous literature has provided mixed results regarding its effectiveness. Methods. Data from the Quality Outcomes Database (QOD) was queried between April 2013 and January 2019. Three surgical groups were identified. (1) elective lumbar surgery, (2) elective cervical surgery for myelopathy, (3) elective cervical surgery for radiculopathy. Patients without PD were propensity matched against patients with PD in a 5:1 ratio without replacement based on American Society of Anesthesiology grade, arthrodesis, surgical approach, number of operated levels, age, and baseline Oswestry Disability Index, Numerical Rating Scale (NRS) extremity pain, NRS back pain, and EuroQol 5-Dimensions (EQ-5D). The mean difference was calculated for continuous outcomes (Oswestry Disability Index, NRS leg pain, NRS back pain, and EQ-5D at 3 and 12 mo after surgery) and the risk difference was calculated for binary outcomes (patient satisfaction, complications, readmission, reoperation, and mortality). Results. For the lumbar analysis, PD patients had a higher rate of reoperation at 12 months (risk difference = 0.057, P = 0.015) and lower mean EQ-5D score at 12 months (mean difference = −0.053, P = 0.005) when compared with patients without PD. For the cervical myelopathy cohort, PD patients had lower NRS neck pain scores at 3 months (mean difference = −0.829, P = 0.005) and lower patient satisfaction at 3 months (risk difference = −0.262, P = 0.041) compared with patients without PD. For the cervical radiculopathy cohort, PD patients demonstrated a lower readmission rate at 3 months (risk difference = −0.045, P = 0.014) compared with patients without PD. Conclusion. For the matched analysis, in general, patients with and without PD had similar patient-reported outcomes and complication, readmission, and reoperation rates. These results demonstrate that a diagnosis of PD alone should not represent a major contraindication to elective spine surgery.

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“…Patients in the proportioned groups were significantly younger than the moderately and severely disproportioned groups, but previous studies have not indicated age alone is a predictor of PROMs. [ 29 30 ] Therefore, longer-term studies are indicated to determine if patients with disproportioned alignments have worse PROMs or increased complications including ASD.…”

Section: Discussionmentioning

confidence: 99%

Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis?

Karamian

DiMaria

Lambrechts

et al. 2022

Journal of Craniovertebral Junction and Spine

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Study Design: Retrospective cohort study. Objective: The objective of this study is to determine the effect of focal lordosis and global alignment and proportion (GAP) scores on patient reported outcome measures (PROMs) after posterior lumbar fusion for patients with 1- or 2-level lumbar degenerative spondylolisthesis (DS). Summary of Background Data: In patients with DS, improvements in spinopelvic parameters are believed to improve clinical outcomes. However, the effect of changing focal lordosis in patients with 1-or 2-level degenerative lumbar spondylolisthesis is unclear. Materials and Methods: Postoperative spinopelvic parameters and perioperative focal lordosis changes were measured for 162 patients at a single academic center from January 2013 to December 2017. Patients were divided into three groups: >2° (lordotic group), between 2° and −2° (neutral group), and −2°° (kyphotic group). Patients were then reclassified based on GAP scores. Recovery ratios (RR) and the number of patients achieving the minimal clinically important difference (MCID) were calculated for PROMs. Standard descriptive statistics were reported for patient demographics and outcomes data. Multiple linear regression analysis controlled for confounders. Alpha was set at P < 0.05. Results: There was no significant association between change in focal lordosis and surgical complications including adjacent segment disease ( P = 0.282), instrumentation failure ( P = 0.196), pseudarthrosis ( P = 0.623), or revision surgery ( P = 0.424). In addition, the only PROM affected by change in focal lordosis was Mental Component Scores (ΔMCS-12) (lordotic = 2.5, neutral = 8.54, and kyphotic = 5.96, P = 0.017) and RR for MCS-12 (lordotic = 0.02, neutral = 0.14, kyphotic 0.10, P = 0.008). Linear regression analysis demonstrated focal lordosis was a predictor of decreased improvement in MCS-12 (β = −6.45 [−11.03- −1.83], P = 0.007). GAP scores suggested patients who were correctly proportioned had worse MCID compared to moderately disproportioned and severely disproportioned patients ( P = 0.024). Conclusions: The change in focal lordosis not a significant predictor of change in PROMs for disability, pain, or physical function. Proportioned patients based on the GAP score had worse MCID for Oswestry Disability Index. Level of Evidence: III

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Outcomes and Quality of Life Improvement After Multilevel Spinal Fusion in Elderly Patients

Cited by 18 publications

References 24 publications

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

Comorbidity Influence on Postoperative Outcomes Following Anterior Cervical Discectomy and Fusion

Complications, Readmissions, Revisions, and Patient-reported Outcomes in Patients With Parkinson Disease Undergoing Elective Spine Surgery: A Propensity-matched Analysis

Does change in focal lordosis after spinal fusion affect clinical outcomes in degenerative spondylolisthesis?

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