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Clinical Improvement Through Surgery for Adult Spinal Deformity: What Can Be Expected and Who Is Likely to Benefit Most?

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Abstract

Study Design

Multicenter, prospective, nonconsecutive, surgical case series from the International Spine Study Group.

Objectives

To evaluate the extent of clinical improvement after surgery for adult spinal deformity (ASD) based on minimal clinically important difference (MCID) and baseline measures.

Summary of Background Data

For ASD, evaluation of surgical treatment success using clinical scores should take into account baseline disability and pain and the improvement defined relative to the MCID.

Methods

Inclusion criteria included operative patients (age > 18 years) with baseline and 2-year SRS-22 scores. Normative values for the SRS scores were included and improvement for patients was expressed in number of MCIDs. At baseline, patients were classified by differences in activity and pain scores from normative values in four groups: “worst,” “severe,” “poor,” and, “moderate.” At 2 years after surgery, patients were classified into four groups based on their change in SRS score as follows: “no improvement or deterioration,” “ mediocre,” “ satisfactory,” or “optimal.” Distinction among curve types was also performed based on the SRS-Schwab ASD classification.

Results

A total of 223 patients (age = 55 ± 15 years) were included. At baseline, for 77% of the patients, the worst scores were in Activity or Pain. At baseline, the distribution was 36% “worst,” 28% “severe,” 19% “poor,” and 17% “moderate.” Patients with sagittal malalignment only were more likely to be in the “worst” state (54%). The overall distribution of improvement was as follows: 24% no improvement or deterioration, 17% mediocre, 25% satisfactory, and 33% optimal. Forty-one percent of baseline “moderate” patients achieved no improvement. Of the baseline “worst” patients, 20% achieved no improvement, and 36% and 19% achieved “satisfactory” and “optimal” improvement, respectively.

Conclusion

Overall, 24% of patients did not experience improvement after surgery. Patients with baseline severe disability were more likely to perceive improvement than patients with less disability.

Level of Evidence

Level II.

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Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, 306 E. 15th Street, Suite 1F, New York, NY, 10003, USA

    Bertrand Moal PhD, Virginie Lafage PhD, Jamie S. Terran BS & Frank Schwab MD

  2. Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA, 22903, USA

    Justin S. Smith MD, PhD

  3. Department of Neurosurgery, University of California San Francisco, San Francisco, CA, 94143, USA

    Christopher P. Ames MD

  4. Department of Orthopedic Surgery, San Diego Center for Spinal Disorders, La Jolla, CA, 92037, USA

    Gregory Mundis MD

  5. Department of Orthopedic Surgery, University of California Davis, Sacramento, CA, 95817, USA

    Eric Klineberg MD

  6. Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, OR, 97239, USA

    Robert Hart MD

  7. Department of Orthopedic Surgery, Hospital for Special Surgery, New York, NY, 10021, USA

    Oheneba Boachie-Adjei MD

  8. Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, CO, 80205, USA

    Shay Bess MD

  9. Laboratory of Biomechanics, Arts et Metier ParisTech, Paris, France

    Bertrand Moal PhD & Wafa Skalli PhD

Authors
  1. Bertrand Moal PhD
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  2. Virginie Lafage PhD
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  3. Justin S. Smith MD, PhD
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  4. Christopher P. Ames MD
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  5. Gregory Mundis MD
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  6. Jamie S. Terran BS
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  7. Eric Klineberg MD
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  8. Robert Hart MD
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  9. Oheneba Boachie-Adjei MD
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  10. Shay Bess MD
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  11. Wafa Skalli PhD
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  12. Frank Schwab MD
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Consortia

International Spine Study Group

Corresponding author

Correspondence to Virginie Lafage PhD.

Additional information

IRB approval obtained at each participating site.

Financial support: This study was supported by the International Spine Study Group and partially funded via a grant received from Depuy Synthes (Grant # NCT00738439) and the Scoliosis Research Society.

Author disclosures: BM (none), VL (none), JSS (none), CPA (none), GM (none), JST (none), EK (none), RH (none), OB-A (none), SB (none), WS (none), FS (none).

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Moal, B., Lafage, V., Smith, J.S. et al. Clinical Improvement Through Surgery for Adult Spinal Deformity: What Can Be Expected and Who Is Likely to Benefit Most?. Spine Deform 3, 566–574 (2015). https://doi.org/10.1016/j.jspd.2015.04.004

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  • DOI: https://doi.org/10.1016/j.jspd.2015.04.004

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