Recovery Kinetics of Radiographic and Implant-Related Revision Patients Following Adult Spinal Deformity Surgery. Issue 4 (6th October 2017)

• Record Type: Journal Article
• Authors: Passias, Peter G; Jalai, Cyrus M; Lafage, Virginie; Poorman, Gregory W; Vira, Shaleen; Horn, Samantha R; Scheer, Justin K; Hamilton, D Kojo; Line, Breton G; Bess, Shay; Schwab, Frank J; Ames, Christopher P; Burton, Douglas C; Hart, Robert A; Klineberg, Eric O
• Is Part Of: Neurosurgery. Volume 83:Issue 4(2018)
• Page Start: 700
• Page End: 708
• Publication Date: 2017-10-06
• Subjects: Adult spinal deformity -- Complications -- Health-related quality of life -- Integrated health state -- Outcomes -- Recovery kinetics -- Revision; Nervous system -- Surgery -- Periodicals; 617.48005
• DOI: 10.1093/neuros/nyx490
• Languages: English
• ISSNs: 0148-396X

Abstract

Abstract: BACKGROUND: Prior studies have observed similar health-related quality of life (HRQL) in revisions and nonrevision (NR) patients following adult spinal deformity (ASD) correction. However, a novel comparison approach may allow better comparisons in spine outcomes groups. OBJECTIVE: To determine if ASD revisions for radiographic and implant-related complications undergo a different recovery than NR patients. METHODS: Inclusion: ASD patients with complete HRQL (Oswestry Disability Index, Short-Form-36 version 2 (SF-36), Scoliosis Research Society [SRS]-22) at baseline, 6 wk, 1 yr, 2 yr. Generated revision groups: nonrevision (NR), revised-complete data (RC; with follow-up 2 yr after revision), and revised-incomplete data (RI; without 2-yr follow-up after revision). In a traditional analysis, analysis of variance (ANOVA) compared baseline HRQLs to follow-up changes. In a novel approach, integrated health state was normalized at baseline using area under curve analysis before ANOVA t-tests compared follow-up statuses. RESULTS: Two hundred fifty-eight patients were included with 50 undergoing reoperations (19.4%). Rod fractures (n = 15) and proximal joint kyphosis (n = 9) were most common. In standard HRQL analysis, comparing RC index surgery and RC revision surgery HRQLS revealed no significant differences throughout the 2-yr follow-up from either the initial index or revision procedure. Using normalized HRQL/integrated health state, RI displayed worse scores in SF-36 Physical Component Score, SRS activity, and SRS appearance relative to NR ( P < .05), indicating less improvement over the 2-yr period. RC were significantly worse than RI in SF-36 Mental Component Score, SRS mental, SRS satisfaction, and SRS total ( P < .05). CONCLUSION: ASD patients indicated for revisions for radiographic and implant-related complications differ significantly in their overall 2-yr recovery compared to NR, using a normalized integrated health state method. Traditional methods for analyzing revision patients' recovery kinetics may overlook delayed improvements.