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Natural history of adult spinal deformity: how do patients with suboptimal surgical outcomes fare relative to nonoperative counterparts?

Peter G. Passias Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Rachel Joujon-Roche Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Jamshaid M. Mir Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Tyler K. Williamson Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Peter S. Tretiakov Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Bailey Imbo Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Oscar Krol Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Lara Passfall Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Salman Ahmad Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Jordan Lebovic Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Stephane Owusu-Sarpong Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Tomi Lanre-Amos Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Themistocles Protopsaltis Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;

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Renaud Lafage Hospital for Special Surgery, New York;

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Virginie Lafage Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;

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Paul Park University of Michigan, Ann Arbor, Michigan;

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Dean Chou Department of Neurological Surgery, UCSF Medical Center, San Francisco, California;

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Praveen V. Mummaneni Department of Neurological Surgery, UCSF Medical Center, San Francisco, California;

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傅Kai-Ming g . Department of Neurosurgery, Cornell University School of Medicine, New York, New York;

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Khoi D. Than Department of Neurosurgery, Duke University, Durham, North Carolina;

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Justin S. Smith Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;

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M. Burhan Janjua Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri;

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Andrew J. Schoenfeld Department of Orthopedic Surgery, Brigham and Women’s Hospital, Harvard Medical School, Boston, Massachusetts;

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Bassel G. Diebo Deparment of Orthopedic Surgery, SUNY Downstate, New York, New York; and

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Shaleen Vira Department of Orthopedic Surgery, UT Southwestern, Dallas, Texas

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Publication Date:
14 Apr 2023
Page Range:
92–100
Volume/Issue:
Volume 39: Issue 1
DOI link:
https://doi.org/10.3171/2023.2.SPINE22559
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OBJECTIVE

Management of adult spinal deformity (ASD) has increasingly favored operative intervention; however, the incidence of complications and reoperations is high, and patients may fail to achieve idealized postsurgical results. This study compared health-related quality of life (HRQOL) metrics between patients with suboptimal surgical outcomes and those who underwent nonoperative management as a proxy for the natural history (NH) of ASD.

开云体育世界杯赔率

ASD患者2年数据包括在内。Patients who were offered surgery but declined were considered nonoperative (i.e., NH) patients. Operative patients with suboptimal outcome (SOp)—defined as any reoperation, major complication, or ≥ 2 severe Scoliosis Research Society (SRS)–Schwab modifiers at follow-up—were selected for comparison. Propensity score matching (PSM) on the basis of baseline age, deformity, SRS-22 Total, and Charlson Comorbidity Index score was used to match the groups. ANCOVA and stepwise logistic regression analysis were used to assess outcomes between groups at 2 years.

RESULTS

In total, 441 patients were included (267 SOp and 174 NH patients). After PSM, 142 patients remained (71 SOp 71 and 71 NH patients). At baseline, the SOp and NH groups had similar demographic characteristics, HRQOL, and deformity (all p > 0.05). At 2 years, ANCOVA determined that NH patients had worse deformity as measured with sagittal vertical axis (36.7 mm vs 21.3 mm, p = 0.025), mismatch between pelvic incidence and lumbar lordosis (11.9° vs 2.9°, p < 0.001), and pelvic tilt (PT) (23.1° vs 20.7°, p = 0.019). The adjusted regression analysis found that SOp patients had higher odds of reaching the minimal clinically important differences in Oswestry Disability Index score (OR [95% CI] 4.5 [1.7–11.5], p = 0.002), SRS-22 Activity (OR [95% CI] 3.2 [1.5–6.8], p = 0.002), SRS-22 Pain (OR [95% CI] 2.8 [1.4–5.9], p = 0.005), and SRS-22 Total (OR [95% CI] 11.0 [3.5–34.4], p < 0.001).

CONCLUSIONS

Operative patients with SOp still experience greater improvements in deformity and HRQOL relative to the progressive radiographic and functional deterioration associated with the NH of ASD. The NH of nonoperative management should be accounted for when weighing the risks and benefits of operative intervention for ASD.

ABBREVIATIONS

ASD = adult spinal deformity ; ASD-FI = ASD frailty index ; BMI = body mass index ; CCI = Charlson Comorbidity Index ; HRQOL = health-related quality of life ; MCID = minimal clinically important difference ; NH = natural history ; ODI = Oswestry Disability Index ; PI = pelvic incidence ; PI-LL = mismatch between pelvic incidence and lumbar lordosis ; PSM = propensity score matching ; PT = pelvic tilt ; SOp = suboptimal outcome ; SRS = Scoliosis Research Society ; SVA = sagittal vertical axis ．
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Cover Journal of Neurosurgery: Spine

Volume 39: Issue 1 (Jul 2023)

inJournal of Neurosurgery: Spine
Figure from Vedantam et al. (pp 28–39).
Volume 39: Issue 1

Contributor Notes

CorrespondencePeter G. Passias: New York Spine Institute, NYU Medical Center—Orthopaedic Hospital, New York, NY.peter.passias@nyumc.org．

INCLUDE WHEN CITINGPublished online April 14, 2023; DOI: 10.3171/2023.2.SPINE22559.

Disclosures这个报道拨款来自美敦力公司和/博士sonal fees from Globus outside the submitted work. Dr. Protopsaltis reported personal fees from Globus, personal fees from NuVasive, personal fees from Altus, personal fees from Medtronic, grants from Medtronic, and stock from OnePoint Surgical outside the submitted work. Dr. V. Lafage reported consulting fees from Alphatec, consulting fees from Globus Medical, royalties from NuVasive, personal fees for lectures from Johnson and Johnson, personal fees for lectures from Stryker, executive committee membership for the International Spine Study Group, and committee membership for SRS outside the submitted work. Dr. Park reported personal fees from Globus, personal fees from NuVasive, personal fees from DePuy Synthes, personal fees from Accelus, personal fees from LifeNet, grants from Cerapedics, grants from SI Bone, grants from International Spine Study Group, grants from DePuy Synthes, royalties from Globus, and lodging and travel expenses from Medtronic outside the submitted work. Dr. Chou reported personal fees from Globus and personal fees from Orthofix outside the submitted work. Dr. Mummaneni reported grants from the International Spine Study Group during the conduct of the study, personal fees from DePuy Synthes, personal fees from NuVasive, personal fees from Stryker, personal fees from Globus, stock from Spinicity ISD, personal fees from Springer publisher, and personal fees from Thieme publisher outside the submitted work. Dr. Fu reported personal fees from DePuy outside the submitted work. Dr. Than reported personal fees from DePuy Synthes, personal fees from NuVasive, personal fees from Accelus, personal fees from Bioventus, personal fees from Cerapedics, and personal fees from SI Bone outside the submitted work. Dr. Smith reported grants from DePuy Synthes/International Spine Study Group during the conduct of the study, personal fees from Cerapedics, personal fees from Carlsmed, personal fees from SeaSpine, personal fees from ZimVie, stock from NuVasive, grants from AO Spine for travel support for research meetings, grants from DePuy Synthes, and stock from Alphatec outside the submitted work, as well as editorial board membership for Neurosurgery, Operative Neurosurgery, Journal of Neurosurgery: Spine, Spine Deformity, and Neurospine. Dr. Schoenfeld reported grants from the Department of Defense and grants from NIH-NIAMS outside the submitted work and royalties from Wolters Kluwer and Springer and serves as the editor-in-chief of Spine, serves on the editorial board of the Journal of Bone and Joint Surgery, and serves on the board of directors of NASS.
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