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Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis.

التفاصيل البيبلوغرافية
العنوان: Factors Influencing Maintenance of Alignment and Functional Improvement Following Adult Spinal Deformity Surgery: A 3-Year Outcome Analysis.
المؤلفون: Passias PG; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Passfall L; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Moattari K; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Krol O; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Kummer NA; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Tretiakov P; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Williamson T; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Joujon-Roche R; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Imbo B; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Burhan Janjua M; Department of Neurological Surgery, Washington University, St. Louis, MO., Jankowski P; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Paulino C; Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI., Schwab FJ; Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, NY., Owusu-Sarpong S; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Singh V; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Ahmad S; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Onafowokan T; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Lebovic J; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Tariq M; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Saleh H; Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach., Vira S; Departments of Orthopaedic and Neurosurgery, University of Arizona College of Medicine, Phoenix, AZ., Smith JS; Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA., Diebo B; Department of Orthopaedic Surgery, Warren Alpert School of Medicine, Brown University, Providence, RI., Schoenfeld AJ; Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
المصدر: Spine [Spine (Phila Pa 1976)] 2024 Jan 15; Vol. 49 (2), pp. 90-96. Date of Electronic Publication: 2023 May 11.
نوع المنشور: Journal Article
اللغة: English
بيانات الدورية: Publisher: Lippincott Williams & Wilkins Country of Publication: United States NLM ID: 7610646 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1528-1159 (Electronic) Linking ISSN: 03622436 NLM ISO Abbreviation: Spine (Phila Pa 1976) Subsets: MEDLINE
أسماء مطبوعة: Publication: Hagerstown, MD : Lippincott Williams & Wilkins
Original Publication: Hagerstown, Md., Medical Dept., Harper & Row.
مواضيع طبية MeSH: Lordosis*/surgery , Scoliosis*/diagnostic imaging , Scoliosis*/surgery, Adult ; Humans ; Quality of Life ; Treatment Outcome ; Follow-Up Studies ; Retrospective Studies
مستخلص: Study Design: This was a retrospective review.
Objective: To assess the factors contributing to durability of surgical results following adult spinal deformity (ASD) surgery.
Summary of Background: Factors contributing to the long-term sustainability of ASD correction are currently undefined.
Materials and Methods: Operative ASD patients with preoperatively (baseline) and 3-year postoperatively radiographic/health-related quality of life data were included. At 1 and 3 years postoperatively, a favorable outcome was defined as meeting at least three of four criteria: (1) no proximal junctional failure or mechanical failure with reoperation, (2) best clinical outcome (BCO) for Scoliosis Research Society (SRS) (≥4.5) or Oswestry Disability Index (ODI) (<15), (3) improving in at least one SRS-Schwab modifier, and (4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1 and 3 years. Predictors of robust outcomes were identified using multivariable regression analysis with conditional inference tree for continuous variables.
Results: We included 157 ASD patients in this analysis. At 1 year postoperatively, 62 patients (39.5%) met the BCO definition for ODI and 33 (21.0%) met the BCO for SRS. At 3 years, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. Ninety-five patients (60.5%) were identified as having a favorable outcome at 1 year postoperatively. At 3 years, 85 patients (54.1%) had a favorable outcome. Seventy-eight patients (49.7%) met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6-week pelvic incidence and lumbar lordosis difference >13.9°, and having a proportional Global Alignment and Proportion score at 6 weeks.
Conclusions: Nearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.
Competing Interests: P.G.P.: Allosource: Other financial or material support. Cervical Scoliosis Research Society: Research support. Globus Medical: Paid presenter or speaker. Medtronic: Paid consultant. Royal Biologics: Paid consultant. Spine: Editorial or governing board. SpineWave: Paid consultant. Terumo: Paid consultant. Zimmer: Paid presenter or speaker. C.P.: DePuy, A Johnson & Johnson Company Ethicon: Paid presenter or speaker. F.J.S.: DePuy, A Johnson & Johnson Company: Research support. Globus Medical: Paid consultant; Paid presenter or speaker. K2M: IP royalties; Paid consultant; Paid presenter or speaker. Medicrea: Paid consultant. Medtronic: Paid consultant. Medtronic Sofamor Danek: IP royalties; Paid presenter or speaker. NuVasive: Research support. Scoliosis Research Society: Board or committee member. Spine deformity: Editorial or governing board. Stryker: Research support. VP of International Spine Society Group (ISSG): Board or committee member. Zimmer: IP royalties; Paid consultant; Paid presenter or speaker. A.J.S.: AAOS: Board or committee member. Journal of Bone and Joint Surgery—American: Editorial or governing board. North American Spine Society: Board or committee member. Springer: Publishing royalties, financial or material support. Wolters Kluwer Health—Lippincott Williams & Wilkins: Publishing royalties, financial or material support. The remaining authors report no conflicts of interest.
(Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.)
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تواريخ الأحداث: Date Created: 20230518 Date Completed: 20231218 Latest Revision: 20231218
رمز التحديث: 20231218
DOI: 10.1097/BRS.0000000000004717
PMID: 37199423
قاعدة البيانات: MEDLINE
الوصف
تدمد:1528-1159
DOI:10.1097/BRS.0000000000004717