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Unfulfilled Expectations After Surgery for Adult Lumbar Scoliosis Compared with Other Degenerative Conditions

  • Original Article
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HSS Journal ®

Abstract

Background

Patients’ expectations influence their decisions to undergo surgery for scoliosis, and fulfillment of expectations is an important patient-centered outcome.

Questions/Purposes

In a 2-year cohort study, we compared the proportion of expectations fulfilled based on the number of vertebrae involved in surgery between adult lumbar scoliosis patients and controls with other degenerative conditions.

Methods

Patients pre-operatively completed a valid lumbar surgery expectations survey addressing expected improvements for symptoms, function, and psychosocial well-being (scores from 0 to 100; higher score indicates more expectations). Two years post-operatively, the patients completed another survey, this one recording how much improvement they actually experienced; fulfillment was defined as a proportion (i.e., received improvement/expected improvement). The range was 0 (none fulfilled) to > 1 (expectations surpassed). We further analyzed data according to the number of vertebrae involved in the surgery.

Results:

We included 42 scoliosis patients and 134 controls with similar mean ages (66 vs 64 years, respectively) and pre-operative expectations survey scores (72 vs 70, respectively). When we stratified by < 3 or ≥ 3 vertebrae, we found that the proportion of expectations fulfilled differed for scoliosis patients but not for controls. In multivariable analysis, lower proportion of expectations fulfilled was associated with greater pre-operative expectations, less improvement in pre- to post-operative disability, and the composite interaction of scoliosis and number of vertebrae.

Conclusions

Compared with controls, scoliosis patients who required surgery to a greater number of vertebrae were more likely to have unfulfilled expectations 2 years post-operatively. Our findings support the importance of addressing expectations pre-operatively with all patients, especially those with scoliosis who require surgery to ≥ 3 vertebrae.

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References

  1. Aebi M. The adult scoliosis. Eur Spine J. 2005;14(10):925–948. https://doi.org/10.1007/s00586-005-1053-9.

    Article  PubMed  Google Scholar 

  2. Berven S, Deviren V, Demir-Deviren S, Hu SS, Bradford DS. Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine (Phila Pa 1976). 2003;28(18):2164–2169; discussion 2169. https://doi.org/10.1097/01.BRS.0000084666.53553.D6.

    Article  Google Scholar 

  3. Bridwell KH, Glassman S, Horton W, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976). 2009;34(20):2171–2178. https://doi.org/10.1097/BRS.0b013e3181a8fdc8.

    Article  Google Scholar 

  4. Bunch WH, Chapman RG. Patient preferences in surgery for scoliosis. J Bone Joint Surg Am. 1985 Jun;67(5):794–799.

    Article  CAS  Google Scholar 

  5. Charlson ME, Pompei P, Ales KL, MacKenzie CR. A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis. 1987;40(5):373–383. https://doi.org/10.1016/0021-9681(87)90171-8.

    Article  CAS  PubMed  Google Scholar 

  6. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940–2952; discussion 2952. https://doi.org/10.1097/00007632-200011150-00017.

  7. Fairbanks JCT, Davies JB, Mbaot JC, O’Brien. The Oswestry Low Back Pain Disability Questionnaire. Physiotherapy 1980;66:271–273.

    Google Scholar 

  8. Faraj SSA, Haanstra TM, Martijn H, de Kleuver M, van Royen BJ. Functional outcome of non-surgical and surgical management for de novo degenerative lumbar scoliosis: a mean follow-up of 10 years. Scoliosis Spinal Disord. 2017;12:35. https://doi.org/10.1186/s13013-017-0143-x.

    Article  PubMed  PubMed Central  Google Scholar 

  9. Mancuso CA, Cammisa FP, Sama AA, Hughes AP, Ghomrawi HM, Girardi FP. Development and testing of an expectations survey for patients undergoing lumbar spine surgery. J Bone Joint Surg Am. 2013;95(19):1793–800. https://doi.org/10.2106/JBJS.L.00338.

    Article  PubMed  Google Scholar 

  10. Mancuso CA, Duculan R, Stal M, Girardi FP. Patients’ expectations of lumbar spine surgery. Eur Spine J. 2015;24(11):2362–9. https://doi.org/10.1007/s00586-014-3597-z.

    Article  PubMed  Google Scholar 

  11. Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Girardi FP. Proportion of expectations fulfilled: a new method to report patient-centered outcomes of spine surgery. Spine (Phila Pa 1976). 2016 Jun;41(11):963–70. https://doi.org/10.1097/BRS.0000000000001378.

    Article  Google Scholar 

  12. Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Girardi FP. Fulfillment of patients’ expectations of lumbar and cervical spine surgery. Spine J. 2016 Oct;16(10):1167–1174. https://doi.org/10.1016/j.spinee.2016.04.011.

    Article  PubMed  Google Scholar 

  13. Mancuso CA, Reid MC, Duculan R, Girardi FP. Improvement in pain after lumbar spine surgery: the role of preoperative expectations of pain relief. Clin J Pain. 2017 Feb;33(2):93–98. https://doi.org/10.1097/AJP.0000000000000383.

    Article  PubMed  PubMed Central  Google Scholar 

  14. Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Girardi FP. Successful lumbar surgery results in improved psychological well-being: a longitudinal assessment of depressive and anxiety symptoms. Spine J. 2018 Apr;18(4):606–613. https://doi.org/10.1016/j.spinee.2017.08.260.

    Article  PubMed  Google Scholar 

  15. Mancuso CA, Duculan R, Cammisa FP, Sama AA, Hughes AP, Lebl DR, Girardi FP. Sources of patients' Expectations of Lumbar Surgery. Spine (Phila Pa 1976). 2019;44(5):318–324. https://doi.org/10.1097/BRS.0000000000002830.

    Article  Google Scholar 

  16. Mannion AF, Junge A, Elfering A, Dvorak J, Porchet F, Grob D. Great expectations: really the novel predictor of outcome after spinal surgery? Spine (Phila Pa 1976). 2009;34(15):1590–1599. https://doi.org/10.1097/BRS.0b013e31819fcd52.

    Article  Google Scholar 

  17. Mirza SK, Deyo RA, Heagerty PJ, Konodi MA, Lee LA, Turner JA, et al. Development of an index to characterize the “invasiveness” of spine surgery: validation by comparison to blood loss and operative time. Spine (Phila Pa 1976).. 2008;33:2651–2662.

    Article  Google Scholar 

  18. Paulus MC, Kalantar SB, Radcliff K. Cost and value of spinal deformity surgery. Spine Deformity. 2014;39:38–393.

    Google Scholar 

  19. Roland MO, Morris RW. A study of the natural history of back pain. Part 1: Development of a reliable and sensitive measure of disability in low back pain. Spine (Phila Pa 1976).. 1983;8:141–144.

    Article  CAS  Google Scholar 

  20. Rule BG, Harvey HZ, Dobbs AR. Reliability of the Geriatric Depression Scale for younger adults. Clin Gerontol. 1989;9:37–43.

    Article  Google Scholar 

  21. Schwab FJ, Lafage V, Farcy J, Bridwell KH, Glassman S, Shainline MR. Predicting outcome and complications in the surgical treatment of adult scoliosis. Spine (Phila Pa 1976). 2008;33:2243–2247.

    Article  Google Scholar 

  22. Smith JS, Kasliwal MK, Crawford A, Shaffrey CI. Outcomes, expectations, and complications overview for the surgical treatment of adult and pediatric spinal deformity. Spine Deformity Preview Issue. 2012;4–14.

  23. Smith JS, Shaffrey CI, Glasman SD, Carreon LY, Schwab JF, Lafage V, et al. Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J. 2013;22:402–410.

    Article  Google Scholar 

  24. Spielberger CD. State-Trait Anxiety Inventory for Adults (Form Y): Manual, Test, Scoring Key. Redwood City, CA: Mind Garden Publisher; 1983.

    Google Scholar 

  25. York PJ, Kim HJ. Degenerative scoliosis. Curr Rev Musculoskelet Med. 2017;10:547–558.

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Research Division, Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA

    Carol A. Mancuso MD

  2. Weill Cornell Medicine, New York, NY, 10021, USA

    Carol A. Mancuso MD

  3. Department of Orthopedic Surgery, Hospital for Special Surgery, 535 East 70th St., New York, NY, 10021, USA

    Roland B. Duculan MD, Frank P. Cammisa MD, Andrew A. Sama MD, Alexander P. Hughes MD & Federico P. Girardi MD

Authors
  1. Carol A. Mancuso MD
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  2. Roland B. Duculan MD
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  3. Frank P. Cammisa MD
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  4. Andrew A. Sama MD
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  5. Alexander P. Hughes MD
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  6. Federico P. Girardi MD
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Corresponding author

Correspondence to Carol A. Mancuso MD.

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Conflict of Interest

Carol A. Mancuso, MD, and Roland B. Duculan, MD, declare that they have no conflict of interest. Frank P. Cammisa Jr., MD, reports institutional research support from Orthofix Medical Inc. (formerly Spinal Kinetics, Inc.), NuVasive, Inc., Mallinckrodt Pharmaceuticals, Centinel Spine, Inc. (fka Raymedica, LLC), Beatrice & Samuel A. Seaver Foundation, 4WEB Medical/4WEB, Inc., 7D Surgical, Inc., and Pfizer, Inc., and personal fees from Spine Biopharma, LLC Vertical Spine, 4WEB Medical/4WEB, Inc., Orthofix Medical Inc. (formerly Spinal Kinetics, Inc.), Woven Orthopedic Technologies, Orthobond Corporation, Healthpoint Capital Partners, LP Bonovo Orthopedics, Inc., Viscogliosi Brothers, LLC, Medical Device Partners II, LLC, RTI Surgical, Inc., Tissue Differentiation Intelligence, LLC, and NuVasive, Inc., outside the submitted work. Andrew A. Sama, MD, reports royalties from Ortho Development Corp., stock ownership in Paradigm Spine LLC, Vestia Ventures MiRus Investment LLC, and Integrity Implants, stock ownership and institutional research support from Spinal Kinetics Inc., advisory board membership and consulting fees from Clariance Inc., Kuros Biosciences AG, and DePuy Spine Products & Medical Device Business Services, consulting fees from 4WEB Inc., and institutional research support from MiMedx Group Inc., outside the submitted work. Alexander P. Hughes, MD, reports grants from Nuvasive, Inc., and institutional research support from Pfizer, Inc., 4WEB Medical, and Kuros Biosciences, outside the submitted work. Federico P. Girardi, MD, reports grants and personal fees from Nuvasive, Inc., and personal fees from Depuy Synthes Spine, EIT Emerging Implant Technologies, Spineart USA, Inc., Ethicon, Inc., Bonovo Orthopedics, Inc., Liventa Bioscience, Paradigm Spine, LLC, Healthpoint Capital Partners, LP, Alphatec Holdings, LLC, LANX, Inc., Centinel Spine, Inc., Tissue Differentiation Intelligence, Spinal Kinetics, Inc., Ortho Development Corp., and Zimmer Biomet Holdings, Inc., outside the submitted work.

Human/Animal Rights

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1975, as revised in 2013.

Informed Consent

Informed consent was obtained from all patients included in this study.

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Level of Evidence: Level 2: prognostic study

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Mancuso, C.A., Duculan, R.B., Cammisa, F.P. et al. Unfulfilled Expectations After Surgery for Adult Lumbar Scoliosis Compared with Other Degenerative Conditions. HSS Jrnl 16 (Suppl 2), 452–460 (2020). https://doi.org/10.1007/s11420-020-09812-1

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  • DOI: https://doi.org/10.1007/s11420-020-09812-1

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