165 Durability of Satisfactory Functional Outcomes Following Surgical Adult Spinal Deformity Correction: A 3-Year Survivorship Analysis. Issue Volume 65:Issue CN(2018)Supplement 1 (16th August 2018)

• Record Type: Journal Article
• Authors: Passias, Peter G; Bortz, Cole; Lafage, Virginie; Lafage, Renaud; Smith, Justin S; Line, Breton G; Eastlack, Robert; Gupta, Munish C; Hostin, Richard A; Horn, Samantha R; Sciubba, Daniel M; Gum, Jeffrey L; Kebaish, Khaled; Klineberg, Eric; Burton, Douglas C; Schwab, Frank; Shaffrey, Christopher I; Ames, Christopher P; Janjua, Muhammad Burhan Ud Din
• Is Part Of: Neurosurgery. Volume 65:Issue CN(2018)Supplement 1
• Page Start: 103
• Page End: 103
• Publication Date: 2018-08-16
• Subjects: Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyy303.165
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: INTRODUCTION: Despite reports showing positive long-term functional outcomes following adult spinal deformity (ASD) corrective surgery, it is still unclear which factors may impact the durability of these outcomes. METHODS: Surgical ASD patients (scoliosis = 20°, SVA = 5 cm, PT = 25°, and/or TK > 60°) >18 yr with 3-yr Oswestry Disability Index (ODI) follow-up, 1-yr postop (1Y) ODI scores reaching substantial clinical benefit 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 postop durability of functionality. Multivariate Cox regression assessed the relationship between patient/surgical factors and functional decline, accounting for age, sex, levels fused. RESULTS: All 166 surgical ASD patients (57 ± 15 yr, 75% F, 11 ± 4 levels; 68% posterior approach, 2% anterior, 31% combined) showed baseline (BL) to 1Y functional improvement (ODI: 35 ± 17 to 14 ± 9, P < .001), with 100% of patients reaching SCB at 1Y. After 1Y postop, durability of satisfactory functional outcomes was 89% at 2Y postop and 71% at 3Y. Those sustaining functionality after 1Y had lower BL C2-S1 SVA (sustained: 61 vs deteriorated: 88 mm, P = .040) and T1 slope (26° vs 31°, P = .022), and at 1Y postop had lower thoracic kyphosis (40° vs 47°, P = .035). From 1Y-3Y postop, patients who sustained functionality showed smaller alignment changes: PI-LL (0.4° vs 2.8°, P = .020), SVA (0.5 mm vs 15.5 mm, P = .022), TS-CL (2.7° vs 7.0°, P = .017), cSVA (0.4 mm vs 5.0 mm, P = .002). Those sustaining functionality beyond 1Y were also younger (55 yr vs 64 yr, P < .001), less frail at 1Y (modified Frailty Index 1.4 vs 2.0, P < .001), had lower BMIs (25 kg/m 2 vs 28 kg/m 2, P = .010), and lower rates of reoperation past 1Y (9% vs 23%, P = .011), BL osteoporosis (9% vs 23%, P = .019), heart disease (6% vs 21%, P = .004), hypertension (28% vs 54%, P = .001), and lung disease (1% vs 6%, P = .040). Multivariate analysis showed lung disease (HR:4.8 [1.4-16.4]), 1Y frailty (HR:1.4 [1.1-1.9]), and posterior approach (HR:2.6 [1.2-5.8]) as associated with shorter time to functional decline. CONCLUSION: Seventy-one percent of surgical ASD patients maintained satisfactory functional outcomes by 3-yr postop. Those failing to sustain satisfactory functionality showed the greatest functional decline at 3-yr postop. Frailty, comorbidity burden, and surgical approach all affected durability of functional gains.