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Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults

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Abstract

Purpose

Predictors of marked improvement versus failure to improve following surgery for adult scoliosis have not been identified. Our objective was to identify factors that distinguish between patients with the best and worst outcomes following surgery for adult scoliosis.

Methods

This is a secondary analysis of a prospective, multicenter spinal deformity database. Inclusion criteria included: age 18–85, scoliosis (Cobb ≥ 30°), and 2-year follow-up. Based on the Oswestry Disability Index (ODI) and the SRS-22 at 2-year follow-up, patients with the best and worst outcomes were identified for younger (18–45) and older (46–85) adults with scoliosis. Clinical and radiographic factors were compared between patients with the best and worst outcomes.

Results

276 patients met inclusion criteria (89 younger and 187 older patients). Among younger patients, predictors of poor outcome included: depression/anxiety, smoking, narcotic medication use, older age, greater body mass index (BMI) and greater severity of pain prior to surgery. Among older patients, predictors of poor outcome included: depression/anxiety, narcotic medication use, greater BMI and greater severity of pain prior to surgery. None of the other baseline or peri-operative factors assessed distinguished the best and worst outcomes for younger or older patients, including severity of deformity, operative parameters, or the occurrence of complications.

Conclusions

Not all patients achieve favorable outcomes following surgery for adult scoliosis. Baseline and peri-operative factors distinguishing between patients with the best and worst outcomes were predominantly patient factors, including BMI, depression/anxiety, smoking, and pain severity; not comorbidities, severity of deformity, operative parameters, or complications.

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References

  1. Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M, Farcy JP (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30:1082–1085

    Article  PubMed  Google Scholar 

  2. Glassman SD, Schwab FJ, Bridwell KH, Ondra SL, Berven S, Lenke LG (2007) The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine 32:93–97

    Article  PubMed  Google Scholar 

  3. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton WC, Ondra S, Schwab F, Shainline M, Fu KG, Bridwell KH (2009) Operative versus nonoperative treatment of leg pain in adults with scoliosis. A retrospective review of a prospective multicenter database with two-year follow-up. Spine 34:1693–1698

    Article  PubMed  Google Scholar 

  4. Smith JS, Shaffrey CI, Berven S, Glassman S, Hamill C, Horton WC, Ondra S, Schwab F, Shainline M, Fu KG, Bridwell KH (2009) Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 65:86–94

    Article  PubMed  Google Scholar 

  5. Smith JS, Fu KM, Urban P, Shaffrey CI (2008) Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 9:326–331

    Article  PubMed  Google Scholar 

  6. Glassman SD, Carreon LY, Shaffrey CI, Polly DW, Ondra SL, Berven SH, Bridwell KH (2010) The costs and benefits of nonoperative management for adult scoliosis. Spine (Phila Pa 1976) 35:578–582

    Article  Google Scholar 

  7. Fu KM, Smith JS, Sansur CA, Shaffrey CI (2010) Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis. Neurosurgery 66:42–47 discussion 47

    Article  PubMed  Google Scholar 

  8. Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D (2009) 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) 34:2171–2178

    Article  Google Scholar 

  9. Li G, Passias P, Kozanek M, Fu E, Wang S, Xia Q, Li G, Rand FE, Wood KB (2009) Adult scoliosis in patients over sixty-five years of age: outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976) 34:2165–2170

    Article  Google Scholar 

  10. Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL, Horton WC, Ondra SL, Sansur CA, Bridwell KH (2010) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36:817–824

    Article  Google Scholar 

  11. Fritz JM, Irrgang JJ (2001) A comparison of a modified Oswestry Low Back Pain Disability Questionnaire and the Quebec Back Pain Disability Scale. Phys Ther 81:776–788

    PubMed  CAS  Google Scholar 

  12. Berven S, Deviren V, Demir-Deviren S, Hu SS, Bradford DS (2003) Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine 28:2164–2169 discussion 2169

    Article  PubMed  Google Scholar 

  13. Charlson ME, Pompei P, Ales KL, MacKenzie CR (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  PubMed  CAS  Google Scholar 

  14. Carreon LY, Puno RM, Dimar JR 2nd, Glassman SD, Johnson JR (2003) Perioperative complications of posterior lumbar decompression and arthrodesis in older adults. J Bone Jt Surg Am 85-A:2089–2092

    Google Scholar 

  15. O’Brien MF, Kuklo TR, Blanke KM, Lenke LG (2005) Spinal deformity study group radiographic measurement manual. Medtronic, Memphis

    Google Scholar 

  16. Mac-Thiong JM, Transfeldt EE, Mehbod AA, Perra JH, Denis F, Garvey TA, Lonstein JE, Wu C, Dorman CW, Winter RB (2009) Can c7 plumbline and gravity line predict health related quality of life in adult scoliosis? Spine (Phila Pa 1976) 34:E519–E527

    Article  Google Scholar 

  17. Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radiographic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688

    Article  PubMed  Google Scholar 

  18. Aalto TJ, Malmivaara A, Kovacs F, Herno A, Alen M, Salmi L, Kroger H, Andrade J, Jimenez R, Tapaninaho A, Turunen V, Savolainen S, Airaksinen O (2006) Preoperative predictors for postoperative clinical outcome in lumbar spinal stenosis: systematic review. Spine (Phila Pa 1976) 31:E648–E663

    Article  Google Scholar 

  19. Clayson D, Mahon B, Levine DB (1981) Preoperative personality characteristics as predictors of postoperative physical and psychological patterns in scoliosis. Spine (Phila Pa 1976) 6:9–12

    Article  CAS  Google Scholar 

  20. Slover J, Abdu WA, Hanscom B, Weinstein JN (2006) The impact of comorbidities on the change in short-form 36 and oswestry scores following lumbar spine surgery. Spine (Phila Pa 1976) 31:1974–1980

    Article  Google Scholar 

  21. Peolsson A, Peolsson M (2008) Predictive factors for long-term outcome of anterior cervical decompression and fusion: a multivariate data analysis. Eur Spine J 17:406–414

    Article  PubMed  Google Scholar 

  22. Trief PM, Ploutz-Snyder R, Fredrickson BE (2006) Emotional health predicts pain and function after fusion: a prospective multicenter study. Spine (Phila Pa 1976) 31:823–830

    Article  Google Scholar 

  23. Krebs EE, Lurie JD, Fanciullo G, Tosteson TD, Blood EA, Carey TS, Weinstein JN (2010) Predictors of long-term opioid use among patients with painful lumbar spine conditions. J Pain 11:44–52

    PubMed  CAS  Google Scholar 

  24. Dewing CB, Provencher MT, Riffenburgh RH, Kerr S, Manos RE (2008) The outcomes of lumbar microdiscectomy in a young, active population: correlation by herniation type and level. Spine (Phila Pa 1976) 33:33–38

    Article  Google Scholar 

  25. Djurasovic M, Bratcher KR, Glassman SD, Dimar JR, Carreon LY (2008) The effect of obesity on clinical outcomes after lumbar fusion. Spine (Phila Pa 1976) 33:1789–1792

    Article  Google Scholar 

  26. Gepstein R, Shabat S, Arinzon ZH, Berner Y, Catz A, Folman Y (2004) Does obesity affect the results of lumbar decompressive spinal surgery in the elderly? Clin Orthop Relat Res 426:138–144

    Google Scholar 

  27. Andreshak TG, An HS, Hall J, Stein B (1997) Lumbar spine surgery in the obese patient. J Spinal Disord 10:376–379

    Article  PubMed  CAS  Google Scholar 

  28. Glassman SD, Hamill CL, Bridwell KH, Schwab FJ, Dimar JR, Lowe TG (2007) The impact of perioperative complications on clinical outcome in adult deformity surgery. Spine (Phila Pa 1976) 32:2764–2770

    Article  Google Scholar 

  29. Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029

    Article  PubMed  Google Scholar 

Download references

Acknowledgments

Funding for the Spinal Deformity Study Group provided by Medtronic.

Conflict of interest

The present study was performed through the Spinal Deformity Study Group, which received funding from Medtronic. Dr. Smith is a consultant for Medtronic, DePuy, and Biomet; has received honoraria for teaching from Medtronic, DePuy, Biomet, and Globus; and has received research study group support from Medtronic and DePuy. Dr. Shaffrey is a consultant for Biomet; receives royalties from Medtronic and Biomet; has received honoraria from DePuy; has received research support from NIH, US Department of Defense, AO, and NACTN; and has received fellowship support from AO. Dr. Glassman is a consultant for Medtronic; has received royalties from Medtronic; has received research funding from Medtronic and Norton Healthcare; is an employee of Norton Healthcare; and has received travel expenses from Stryker. Dr. Schwab is a shareholder in Nemaris, Inc; is a consultant for DePuy; is a consultant for Medtronic; has received research grant support from DePuy; and has received research grant support from Medtronic. Dr. Lafage is a shareholder in Nemaris, Inc. Dr. Bridwell is a consultant for DePuy.

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Authors and Affiliations

  1. Department of Neurosurgery, University of Virginia Health Sciences Center, PO Box 800212, Charlottesville, VA, 22908, USA

    Justin S. Smith & Christopher I. Shaffrey

  2. Norton Leatherman Spine Center, Louisville, KY, USA

    Steven D. Glassman & Leah Y. Carreon

  3. Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, NY, USA

    Frank J. Schwab & Virginie Lafage

  4. Department of Orthopaedic Surgery, University of Virginia, Charlottesville, VA, USA

    Vincent Arlet

  5. Department of Neurosurgery, Weill Cornell Medical College, New York, NY, USA

    Kai-Ming G. Fu

  6. Spinal Deformity Service, Washington University, St Louis, MO, USA

    Keith H. Bridwell

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  1. Justin S. Smith
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  2. Christopher I. Shaffrey
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  3. Steven D. Glassman
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  4. Leah Y. Carreon
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  5. Frank J. Schwab
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  6. Virginie Lafage
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  7. Vincent Arlet
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  8. Kai-Ming G. Fu
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  9. Keith H. Bridwell
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The Spinal Deformity Study Group

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Correspondence to Justin S. Smith.

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Smith, J.S., Shaffrey, C.I., Glassman, S.D. et al. Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J 22, 402–410 (2013). https://doi.org/10.1007/s00586-012-2547-x

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  • DOI: https://doi.org/10.1007/s00586-012-2547-x

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