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

Results

Participant Characteristics

Of 356 patients who underwent corrective fusion surgery for ASD during the study period, 167 met the inclusion criteria (Figure 1). Patients' average age was 67.5 ± 9.9 years (23 males). The cohort's average BMI was 23.0 ± 3.8 kg/m2. The mean CCI was 0.4 ± 0.8. The pathology of patients undergoing extensive corrective fusion surgery for ASD is described in Table 1.

Figure 1.

A chart capturing participant flow through the study eligibility criteria.

Surgical Details and Outcomes

The upper instrumented vertebra was T4 in 10 patients, T5 in eight patients, T6 in three patients, T7 in six patients, T8 in 15 patients, T9 in 34 patients, T10 in 84 patients, T11 in six patients, and T12 in one patient. Pelvic fixation was performed using S1 screws for 11 patients and iliac screws for 156 patients. The mean number of vertebral levels fused was 9.8 ± 1.2. The types of procedure performed were 38 (23%) cases of pedicle subtraction osteotomy, 19 (11%) of vertebral column resection, and 49 (29%) of lateral lumbar interbody fusion. Revision surgeries were performed a total of 35 times in a total of 33 ASD patients (19.8%). There were 17 cases of rod fracture, eight of proximal junctional failure (PJF), five of implant-related disorders, four of hematomas, and one of infection.

Radiographic and PROM Parameters

The mean postoperative LL, PT, PI minus LL, and SVA significantly improved from 11.3° to 42.6°, 35.1° to 25.5°, 40.3° to 11.1°, and 113.5 mm to 57.2 mm, respectively (all P < 0.001) (Table 2). Scores of all SRS-22r domains significantly improved 2 years after surgery (all P < 0.001) (Table 2).

Proportion of ASD Patients Achieving MCID for SRS-22r

The proportion of patients who achieved MCID for SRS-22r was 36.5% for Function, 46.1% for Pain, 61.1% for Self-image, 56.9% for Mental Health, and 44.3% for the Subtotal domain. In the multivariate analysis, preoperative SRS-22r Function (OR = 0.204, 95% CI 0.105–0.396) affected the likelihood of achieving MCID for SRS-22r Function (Table 3). The preoperative SRS-22r Pain (OR = 0.205, 95% CI 0.117–0.361) affected the likelihood of achieving MCID for SRS-22r Pain (Table 4). The preoperative SRS-22r Subtotal score (OR = 0.211, 95% CI 0.107–0.413), preoperative PT (OR = 1.072, 95% CI 1.012–1.136), preoperative PI minus LL (OR = 0.965, 95% CI 0.934–0.997), and postoperative SVA (OR = 0.985, 95% CI 0.974–0.995) were significant predictors of achieving MCID for the SRS-22r Subtotal score (Table 5).

Cutoff Value for the Preoperative SRS-22r Domain Score for Predicting Achievement of MCID

The ROC curve analysis (Figure 2A) indicated that the best cutoff level of the preoperative SRS-22r Function for predicting the achievement of MCID for SRS-22r Function was 2.55, with sensitivity and specificity of 65.1% and 67.2%, respectively. The area under the ROC curve (AUC) was 0.734 (P < 0.001; 95% CI 0.657–0.812). The ROC curve analysis (Figure 2B) indicated that the best cutoff level of the preoperative SRS-22r Pain for predicting the achievement of MCID for SRS-22r Pain was 2.90, with sensitivity and specificity of 72.2% and 70.1%, respectively. The area under the ROC curve (AUC) was 0.792 (P < 0.001; 95% confidence interval [CI], 0.725–0.859). The ROC curve analysis (Figure 2C) indicated that the best cutoff level of the preoperative SRS-22r Subtotal for predicting the achievement of MCID of the SRS-22r Subtotal score was 2.52, with sensitivity and specificity of 66.7% and 68.9%, respectively. The AUC was 0.998 (P < 0.001; 95% CI 0.619–0.778).

Figure 2.

(A) Preoperative scoliosis research society-22r (SRS-22r) function for predicting achievement of minimum clinically important difference (MCID) to SRS-22r function using receiver-operating characteristic (ROC) curve analysis. The value of 2.55 represents the cutoff value of the preoperative SRS-22r Function with the best sensitivity and specificity. (B) Preoperative SRS-22r pain for predicting achievement of MCID to SRS-22r pain using ROC curve analysis. The value of 2.90 represents the cutoff value of the preoperative SRS-22r pain with the best sensitivity and specificity. (C) Preoperative SRS-22r subtotal for predicting achievement of MCID to SRS-22r subtotal using ROC curve analysis. The value of 2.55 represents the cutoff value of the preoperative SRS-22r subtotal with the best sensitivity and specificity. AUC indicates area under the curve.

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