Factors Associated With Improved Quality of Life Outcomes in Patients Undergoing Surgery for Adult Spinal Deformity

Hideyuki Arima, MD, PhD; Tomohiko Hasegawa, MD, PhD; Yu Yamato, MD, PhD; Daisuke Togawa, MD, PhD; Go Yoshida, MD, PhD; Tatsuya Yasuda, MD, PhD; Tomohiro Banno, MD, PhD; Shin Oe, MD, PhD; Yuki Mihara, MD, PhD; Hiroki Ushirozako, MD, PhD; Tomohiro Yamada, MD; Yuh Watanabe, MD; Koichiro Ide, MD; Keiichi Nakai, MD; Yukihiro Matsuyama, MD, PhD

Disclosures

Spine. 2021;46(6):E384-E391. 

In This Article

Abstract and Introduction

Abstract

Study Design: Retrospective longitudinal cohort study.

Objective: This study aimed to elucidate factors affecting the likelihood of achieving minimum clinically important difference (MCID) to patient-reported outcomes defined by the Scoliosis Research Society-22r (SRS-22r) among patients with adult spinal deformity (ASD) who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis.

Summary of Background Data: Achieving MCID for SRS-22r parameters was a measure of surgical efficacy. Patient characteristics and surgical and radiographic factors that affect the likelihood of achieving MCID for SRS-22r parameters are unknown.

Methods: Data from patients with ASD who underwent extensive corrective fusion surgery from the thoracic spine to the pelvis during 2010 to 2016 were retrospectively reviewed. Data from a total of 167 patients with ≥2 years of follow-up were included. Multivariate analysis was used to investigate factors associated with the likelihood of achieving MCID for each of the SRS-22r domains (Function, Pain, Subtotal) 2 years after surgery. The following MCID values were used: 0.90 for Function, 0.85 for Pain, and 1.05 for the Subtotal.

Results: MCID achievement rate was 36.5% for Function, 46.1% for Pain, and 44.3% for the Subtotal domain. In multivariate analysis, preoperative SRS-22r Function (odds ratio [OR] = 0.204, 95% confidence interval [CI] 0.105–0.396) increased the likelihood of achieving MCID for SRS-22r Function. Preoperative SRS-22r Subtotal (OR = 0.211, 95% CI, 0.107–0.413), preoperative pelvic tilt (OR = 1.072, 95% CI, 1.012–1.136), preoperative pelvic incidence minus lumbar lordosis (OR = 0.965, 95% CI, 0.934–0.997), and postoperative sagittal vertical axis (OR = 0.985, 95% CI, 0.974–0.995) affected the likelihood of achieving MCID for the SRS-22r Subtotal.

Conclusion: Patients with poor preoperative health-related quality of life were more likely to achieve improvement in SRS-22r parameters after extensive corrective fusion surgery for ASD. Achieving postoperative sagittal alignment increased the likelihood of achieving MCID for the SRS-22r Subtotal domain.

Level of Evidence: 3

Introduction

Adult spinal deformity (ASD) encompasses various types of pathology such as remnant idiopathic scoliosis, de novo kyphosis, scoliosis associated with disc degeneration, kyphosis after vertebral body fracture, and iatrogenic kyphosis after spinal fusion.[1] Symptoms associated with ASD vary, including back pain, leg pain, visceral disorders, and psychological disorders.[2–4] Conservative treatment for moderate to severe ASD is less effective compared to surgery, which is required to improve health-related quality of life (HRQOL).[5–7] Surgical treatment for ASD often requires multilevel spinal fusion from the thoracic spine to the pelvis.[8]

Efficacy of treatment for ASD is assessed based on patient-reported outcomes (PROM). The Scoliosis Research Society-22r (SRS-22r) Questionnaire is a PROM assessment tool for ASD, which has been previously reported as reliable, valid, and representative of treatment effects.[9–12] Minimal clinically important difference (MCID) represents improvement to baseline status that is clinically meaningful;[13] specific values for SRS-22r were previously calculated in studies from North America and Japan.[14,15] However, patient characteristics and surgical and radiographic factors that affect the likelihood of achieving MCID for the SRS-22r parameters are unknown. This study aimed to elucidate factors that affect the likelihood of achieving MCID for the SRS-22r domains in patients with ASD undergoing extensive spinal corrective fusion from the thoracic spine to the pelvis.

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