Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis

被引：13

作者：

Passias, Peter G. ^{[1
]}

Bortz, Cole A. ^{[1
]}

Lafage, Virginie ^{[2
]}

Lafage, Renaud ^{[2
]}

Smith, Justin S. ^{[3
]}

Line, Breton ^{[4
]}

Eastlack, Robert ^{[5
]}

Gupta, Munish C. ^{[6
]}

Hostin, Richard A. ^{[7
]}

Horn, Samantha R. ^{[1
]}

Segreto, Frank A. ^{[1
]}

Egers, Max ^{[1
]}

Sciubba, Daniel M. ^{[8
]}

Gum, Jeffrey L. ^{[9
]}

Kebaish, Khaled M. ^{[10
]}

Klineberg, Eric O. ^{[11
]}

Burton, Douglas C. ^{[12
]}

Schwab, Frank J. ^{[2
]}

Shaffrey, Christopher, I ^{[3
]}

Ames, Christopher P. ^{[13
]}

Bess, Shay ^{[4
]}

机构：

[1] NYU Langone Orthoped Hosp, Dept Orthoped, New York, NY USA

[2] Hosp Special Surg, Dept Orthoped, 535 E 70th St, New York, NY 10021 USA

[3] Univ Virginia, Dept Neurosurg, Charlottesville, VA USA

[4] Rocky Mt Scoliosis & Spine, Denver, CO USA

[5] Scripps Clin, Div Orthopaed Surg, La Jolla, CA USA

[6] Washington Univ, Dept Orthopaed Surg, St Louis, MO 63110 USA

[7] Baylor Scott & White Med Ctr, Southwest Scoliosis Inst, Plano, TX USA

[8] Johns Hopkins Univ, Sch Med, Dept Neurosurg, Baltimore, MD 21205 USA

[9] Norton Leatherman Spine Ctr, Dept Orthopaed Surg, Louisville, KY USA

[10] Johns Hopkins Univ, Sch Med, Dept Orthopaed Surg, Baltimore, MD USA

[11] Univ Calif Davis, Dept Orthoped Surg, Davis, CA 95616 USA

[12] Univ Kansas, Med Ctr, Dept Orthoped Surg, Kansas City, KS 66103 USA

[13] Univ Calif San Francisco, Dept Neurol Surg, San Francisco, CA USA

来源：

OPERATIVE NEUROSURGERY | 2020年 / 18卷 / 02期

关键词：

Adult spinal deformity; Disability; Functionality; Outcomes; Surgical correction; CLINICALLY IMPORTANT DIFFERENCE; NONOPERATIVE TREATMENT; SURGERY; MULTICENTER; COMPLICATIONS; VALIDATION; INDEX; PAIN;

D O I：

10.1093/ons/opz093

中图分类号：

R74 [神经病学与精神病学];

学科分类号：

摘要：

BACKGROUND: Despite reports showing positive long-term functional outcomes following adult spinal deformity (ASD)-corrective surgery, it is unclear which factors affect the durability of these outcomes. OBJECTIVE: To assess durability of functional gains following ASD-corrective surgery; determine predictors for postoperative loss of functionality. METHODS: Surgical ASD patients 18 yr with 3-yr Oswestry Disability Index (ODI) follow-up, and 1-yr postoperative (1Y) ODI scores reaching substantial clinical benefit (SCB) threshold (SCB < 31.3 points). Patients were grouped: those sustaining ODI at SCB threshold beyond 1Y (sustained functionality) and those not (functional decline). Kaplan-Meier survival analysis determined postoperative durability of functionality. Multivariate Cox regression assessed the relationship between patient/surgical factors and functional decline, accounting for age, sex, and levels fused. RESULTS: A11166 included patients showed baseline to 1Y functional improvement (mean ODI: 35.3 +/- 16.5-13.6 +/- 9.2, P .001). Durability of satisfactory functional outcomes following the 1Y postoperative interval was 88.6% at 2-yr postoperative, and 71.1% at 3-yr postoperative (3Y). Those sustaining functionality after 1Y had lower baseline C2-S1 sagittal vertical axis (SVA) and Ti slope (both P < .05), and lower 1Y thoracic kyphosis (P = .035). From 1Y to 3Y, patients who sustained functionality showed smaller changes in alignment: pelvic incidence minus lumbar lordosis, SVA, T1 slope minus cervical lordosis, and C2-C7 SVA (all P < .05). Those sustaining functionality beyond 1Y were also younger, less frail at 1Y, and had lower rates of baseline osteoporosis, hypertension, and lung disease (all P < .05). Lung disease (Hazard Ratio:4.8 [1.4-16.4]), lY frailty (HR:1.4 [1.1-1.9]), and posterior approach (HR:2.6 [1.2-5.8]) were associated with more rapid decline. CONCLUSION: Seventy-one percent of ASD patients maintained satisfactory functional outcomes by 3Y. Of those who failed to sustain functionality, the largest functional decline occurred 3-yr postoperatively. Frailty, preoperative comorbidities, and surgical approach affected durability of functional gains following surgery.

引用

页码：118 / 125

页数：8

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