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Predictors and Correlative Factors for Low Back Pain after Long Fusion Arthrodesis in Patients with Adult Scoliosis

Abstract

Introduction

Low back pain (LBP) still exists at the follow-up visit in some cases after long fusion arthrodesis for adult scoliosis. However, few available studies have elaborated the reasons and factors associated with this symptom. Therefore, the aim of the current study was to identify the correlative factors and predictors of postoperative LBP after long fusion arthrodesis and provide evidence to improve the surgical strategy.

Methods

Seventy-nine patients with adult scoliosis who underwent long fusion arthrodesis were divided into a group with no or mild LBP (NLBP group) and one with moderate or severe LBP (MLBP group) according to the average Oswestry Dability Index (ODI) at the last follow-up visit. The Japanese Orthopaedic Association (JOA) score, ODI and complications were used to evaluate clinical outcomes. %Fat infltration area (%FIA), sagittal and coronal parameters were recorded to evaluate radiological outcomes. Multivariate logistic regression analysis was conducted to identify the predictors and correlative factors for postoperative LBP.

Results

Thirty-three patients (41.77%) with ODI (30.06% ± 6.92%) higher than the average at the last follow-up were divided into the MLBP group, while the rest (58.23%) with last follow-up ODI (13.26% ± 5.31%) lower than the average were divided into the NLBP group. In multivariate logistic regression, the preoperative sagittal vertical axis (SVA) (P < 0.001), %FIA (P = 0.003) and osteoporosis (P = 0.016) were identified to be predictors and last follow-up SVA (P < 0.001), last follow-up lumbar lordosis (LL) (P = 0.031) and adjacent segment degeneration (ASD) (P = 0.043) were identified as correlative factors. The receiver-operating characteristic (ROC) curve showed satisfactory accuracy in preoperative SVA (P < 0.001) and %FIA (P < 0.001) to predict postoperative LBP.

Conclusion

Postoperative LBP after long fusion arthrodesis for adult scoliosis was common. Postoperative LBP was associated with increased SVA and decreased LL and ASD. Preoperative SVA > 3.54 cm, %FIA > 24.82% and osteoporosis showed good accuracy to predict the postoperative symptoms. Optimal surgical methods should be used for patients with these factors to decrease the incidence and degree of postoperative LBP.

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Acknowledgements

We thank the participants of the study.

Funding

This work was funded by the Natural Science Foundation of China (grant no. 8207090550). The journal’s Rapid Service Fee was funded by the authors.

Authorship

All named authors meet the International Committee of Medical Journal Editors (ICMJE) criteria for authorship for this article, take responsibility for the integrity of the work as a whole, and have given their approval for this version to be published.

Authors’ Contributions

ZD and CHX designed the study. ZD, GXD and DWY collected data and performed the statistical analysis. ZD and CHX drafted the manuscript. All authors read and approved the final manuscript.

Disclosures

Di Zhang, Xianda Gao, Wenyuan Ding and Huixian Cui declare that they have no conflict of interest.

Compliance with Ethics Guidelines

This study was approved by the Institutional Ethics Board of the Third Hospital of Hebei Medical University (G2020-010-1), and the methods were carried out in accordance with the approved guidelines (Declaration of Helsinki and local clinical research regulations). Informed consent for clinical and imaging data was given by all participants.

Data Availability

The datasets used and/or analyzed during the present study are available from the corresponding author upon reasonable request.

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Correspondence to Huixian Cui.

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Zhang, D., Gao, X., Ding, W. et al. Predictors and Correlative Factors for Low Back Pain after Long Fusion Arthrodesis in Patients with Adult Scoliosis. Adv Ther 38, 3803–3815 (2021). https://doi.org/10.1007/s12325-021-01763-1

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  • DOI: https://doi.org/10.1007/s12325-021-01763-1

Keywords

  • Adult
  • Arthrodesis
  • Low back pain
  • Postoperative complications
  • Scoliosis