Patient-Reported Outcomes After Complex Adult Spinal Deformity Surgery: 5-Year Results of the Scoli-Risk-1 Study

Abstract

Study Design: Prospective cohort. Objective: To prospectively evaluate PROs up to 5-years after complex ASD surgery. Methods: The Scoli-RISK-1 study enrolled 272 ASD patients undergoing surgery from 15 centers. Inclusion criteria was Cobb angle of >80°, corrective osteotomy for congenital or revision deformity, and/or 3-column osteotomy. The following PROs were measured prospectively at intervals up to 5-years postoperative: ODI, SF36-PCS/MCS, SRS-22, NRS back/leg. Among patients with 5-year follow-up, comparisons were made from both baseline and 2-years postoperative to 5-years postoperative. PROs were analyzed using mixed models for repeated measures. Results: Seventy-seven patients (28.3%) had 5-year follow-up data. Comparing baseline to 5-year data among these 77 patients, significant improvement was seen in all PROs: ODI (45.2 vs. 29.3, P < 0.001), SF36-PCS (31.5 vs. 38.8, P < 0.001), SF36-MCS (44.9 vs. 49.1, P = 0.009), SRS-22-total (2.78 vs. 3.61, P < 0.001), NRS-back pain (5.70 vs. 2.95, P < 0.001) and NRS leg pain (3.64 vs. 2.62, P = 0.017). In the 2 to 5-year follow-up period, no significant changes were seen in any PROs. The percentage of patients achieving MCID from baseline to 5-years were: ODI (62.0%) and the SRS-22r domains of function (70.4%), pain (63.0%), mental health (37.5%), self-image (60.3%), and total (60.3%). Surprisingly, mean values ( P > 0.05) and proportion achieving MCID did not differ significantly in patients with major surgery-related complications compared to those without. Conclusions: After complex ASD surgery, significant improvement in PROs were seen at 5-years postoperative in ODI, SF36-PCS/MCS, SRS-22r, and NRS-back/leg pain. No significant changes in PROs occurred during the 2 to 5-year postoperative period. Those with major surgery-related complications had similar PROs and proportion of patients achieving MCID as those without these complications.

What’s New in Spine Surgery

“…This article also stratified the shift in ODI based on preoperative ODI deciles, which is a useful counseling tool for shared decision-making. Similar findings were identified in the 5-year outcomes reported by the Scoli-RISK-1 Study Group 37 . This study was limited by a 5-year follow-up rate of 28%, but identified a significant improvement in patient-reported outcomes, with 62% of patients having a clinically meaningful improvement in the ODI score.…”

Complications of adult spinal deformity surgery

“…[ 51 ] Scoli-RISK-1 study revealed that patient-reported outcomes were better at 5 years postoperative in ODI, Short Form 36, Physical and Mental Component Score, SRS-22r score, and Numerical Rating Scale for back/leg pain. [ 52 ]…”

Early Postural Stability Changes in Patients Undergoing Correction of Spinal Deformity

“…Spinal fusion to correct ASD has been shown to improve health-related quality of life 5–7. However, the effects of long-segment fusion on patient balance and postural control is poorly understood.…”

“…Spinal fusion to correct ASD has been shown to improve health-related quality of life. [5][6][7] However, the effects of long-segment fusion on patient balance and postural control is poorly understood. It is well understood that postural instability leads to increased incidence of falls, and preventing a fall requires quick corrections of the COG and an optimal position in the patient's COE.…”