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Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score–Matched Comparison Between African and US Populations

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Abstract

Study Design

Retrospective analysis of propensity score–matched (PSM) observational cohorts.

Objectives

To evaluate and compare preoperative health-related quality of life (HRQoL) scores and radiographic measurements of young African and US adults with spinal deformity (ASD).

Summary of Background Data

Young ASD patients in the United States are motivated more to correct coronal and sagittal plane deformities than to alleviate pain. Motivations for surgical correction in young ASD patients in Africa have not been previously investigated.

Methods

Retrospective review of two large databases of African and US patients with ASD. African patients who underwent ASD surgery were PSM by age, gender, and pelvic tilt with US patients. Preoperative radiographic parameters and HRQoL scores (ODI, SRS-22r, back/leg pain) were compared between cohorts. Pearson correlations used to evaluate relationships between radiographic parameters and HRQoL scores.

Results

Fifty-four US patients (average age 22.9 ± 4.9 years; 0% African American) and 54 African patients (24.6 ± 7.2 years) met inclusion criteria. Compared to the United States, African patients had significantly lower body mass index (21.1 ± 3.3 vs. 24.6 ± 7.2) and more severe scoliosis, coronal malalignment, and sagittal malalignment (p <.05). Africans also had significantly better Oswestry Disability Index (12.8 vs. 17.7), worse Scoliosis Research Society questionnaire (SRS-22r)–Appearance (2.5 vs. 3.2), SRS-Function (3.3 vs. 3.9), and SRS-Total (3.2 vs. 3.5) scores than US patients (p <.05). SRS-Appearance scores correlated with Cobb angles of the upper thoracic (r = −0.321), thoracic (r = −0.277), and thoracolumbar (r = −0.300) curves for US patients. For African patients, global sagittal alignment and C7 inclination correlated with SRS-Appearance (r = −0.347,–0.346, respectively).

Conclusions

Young African ASD patients have significantly more severe deformity, less disability, and worse SRS-22r scores preoperatively than a matched cohort of US patients. Spinal deformity and associated poor self-image appear to be the major drivers of surgical intervention in this cohort. Global malalignment in African patients is most closely correlated with appearance scores and should be surgically addressed accordingly.

Level of Evidence

Level III.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA

    Bradley Y. Harris JD

  2. School of Medicine, Wayne State University, 540 E Canfield St, Detroit, MI, 48201, USA

    Matthew F. Roth BSc

  3. Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY, 10021, USA

    Bassel G. Diebo MD, Frank J. Schwab MD & Virginie Lafage PhD

  4. Orthopaedic Surgery, Rocky Mountain Scoliosis and Spine, 2055 High St, Denver, CO, 80205, USA

    Shay Bess MD

  5. Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA

    Alexander A. Theologis MD

  6. Neurosurgery, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA, 92093, USA

    Justin K. Scheer BS

  7. Neurosurgery, University of California San Francisco, San Francisco, CA, USA

    Christopher P. Ames MD

  8. American Jewish Joint Distribution Committee, New York, NY, USA

    Richard Hodes MD

  9. Research, FOCOS Orthopedic Hospital, Teshie St, Pantang, Accra, Ghana

    Jennifer Ayamga MPhil

  10. Orthopedics, FOCOS Orthopedic Hospital, Teshie St, Pantang, Accra, Ghana

    Oheneba Boachie-Adjei MD

Authors
  1. Bradley Y. Harris JD
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  2. Matthew F. Roth BSc
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  3. Bassel G. Diebo MD
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  4. Shay Bess MD
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  5. Alexander A. Theologis MD
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  6. Justin K. Scheer BS
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  7. Frank J. Schwab MD
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  8. Virginie Lafage PhD
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  9. Christopher P. Ames MD
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  10. Richard Hodes MD
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  11. Jennifer Ayamga MPhil
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  12. Oheneba Boachie-Adjei MD
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Consortia

International Spine Study Group

Corresponding author

Correspondence to Virginie Lafage PhD.

Additional information

Conflicts of Interest and Source of Funding

This Study was partially funded by the International Spine Study Group through a grant from Depuy Synthes Spine.

Author disclosures

BYH (none); MFR (none); BGD (none); SB (grants from Grant from DePuy Synthes for International Spine Study Group Foundation [ISSGF], during the conduct of the study; grants and personal fees from K2 Medical, grants and personal fees from NuVasive, grants and personal fees from Innovasis, personal fees from Allosource, grants from Stryker, grants from Medtronic, personal fees from Pioneer, outside the submitted work); AAT (none); JKS (none); FJS (other from Nemaris INC, grants from AO, grants from SRS, grants from DePuy Synthesis Spine, personal fees from K2M, personal fees from NuVasive, personal fees from Medicrea, personal fees from MSD, personal fees from Biomet, personal fees from K2M, personal fees from MSD, outside the submitted work); VL (other from Nemaris INC, grants from DePuy Synthesis Spine, grants from NIH, grants from SRS, personal fees from Medcrea, personal fees from MSD, personal fees from DePuy, outside the submitted work); CPA (personal fees from UCSF, personal fees from DePuy, personal fees from Stryker, personal fees from Medtronic, personal fees from Biomet Spine, personal fees from Stryker, personal fees from Doctors Research Group, outside the submitted work; in addition, CPA has a patent Fish & Richardson, P.C. licensed); RH (none); JA (none); OB-A (grants from DePuy, personal fees and non-financial support from K2M, during the conduct of the study; grants and personal fees from K2M, outside the submitted work; in addition, OB-A has a patent K2M with royalties paid, and a patent WEIGAO with royalties paid).

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Harris, B.Y., Roth, M.F., Diebo, B.G. et al. Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score–Matched Comparison Between African and US Populations. Spine Deform 4, 351–357 (2016). https://doi.org/10.1016/j.jspd.2016.03.006

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  • DOI: https://doi.org/10.1016/j.jspd.2016.03.006

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