• Sheikh AlshababBaselBSpine service, Hospital for Special Surgery, New York, NY., Munish C Gupta, Renaud Lafage, Shay Bess, Christopher Shaffrey, Han Jo Kim, Christopher P Ames, Douglas C Burton, Justin S Smith, Robert K Eastlack, Eric O Klineberg, Gregory M Mundis, Frank J Schwab, Virginie Lafage, and International Spine Study Group (ISSG).
• Spine service, Hospital for Special Surgery, New York, NY.
• Spine. 2021 Aug 15; 46 (16): 1105-1110.

Study DesignMulticenter retrospective review of prospective database.ObjectiveThe aim of this study was to investigate potential associations between postoperative alignment and satisfaction.Summary Of Background DataAchieving high satisfaction is the main goal of any treatment, including adult spinal deformity (ASD) surgery. Despite being one of the key elements, literature is sparse regarding postoperative factors influencing patient satisfaction.MethodsASD patients with 2-year follow-up were retrospectively reviewed. Patients without revision after the index procedure were stratified according to deformity type: sagittal (T1 pelvic angle >22°), coronal (C7 plumb line [C7PL] >5 cm or MaxCobb >50°), or mixed. Bivariate correlation between satisfaction and postoperative data was conducted on the entire cohort as well as by type of preoperative deformity. Multivariate regression controlling for pre-op alignment and demographic information was used to identify independent predictors of 2Y satisfaction.ResultsA total of 509 patients were included in the analysis (58.7 ± 14.8, 80% females). The quality of life significantly improved between pre- and 2-year (ΔOswestry Disability Index [ODI]: 17.6, p < 0.001). At 2 years, SRS22 satisfaction was 4.27 ± 0.89 (median 4.5). Significant associations were found between satisfaction and disability (ODI, r = -0.50) and global coronal (C7PL r = -0.15) and sagittal (sagittal vertical axis [SVA], r = -0.10) alignment (all p < 0.01) but not with the coronal clavicle angle. Stratification by preoperative deformity revealed significant associations between satisfaction and SVA for sagittal deformity only, C7PL and MaxCobb for coronal only, and C7PL for combined deformity. In the multivariate analysis controlling for demographic and pre-op deformity, 2-year ODI and 2-year C7PL were independent predictors of satisfaction. Multilinear regression demonstrated 2-year SVA, pre-op ODI and patient's age were the independent predictors 2-year ODI.ConclusionThe ability to restore global alignment depends on the severity of the preoperative deformity as well as the correction of the main aspect of the deformity. Achieving global coronal and sagittal alignment is an independent predictor of both satisfaction and disability at 2 years post-op. Patients who continue to be disabled are also not satisfied.Level of Evidence: 3.Copyright © 2021 Wolters Kluwer Health, Inc. All rights reserved.

9 keywords...

hide…