• Peter G Passias, Lara Passfall, Kevin Moattari, Oscar Krol, Nicholas A Kummer, Peter Tretiakov, Tyler Williamson, Rachel Joujon-Roche, Bailey Imbo, Burhan JanjuaMuhammadMDepartment of Neurological Surgery, Washington University, St. Louis, MO., Pawel Jankowski, Carl Paulino, Frank J Schwab, Stephane Owusu-Sarpong, Vivek Singh, Salman Ahmad, Tobi Onafowokan, Jordan Lebovic, Muhammad Tariq, Hesham Saleh, Shaleen Vira, Justin S Smith, Bassel Diebo, and Andrew J Schoenfeld.
• Department of Neurological Surgery, Hoag Memorial Hospital Presbyterian, Newport Beach.
• Spine. 2024 Jan 15; 49 (2): 909690-96.

Study DesignThis was a retrospective review.ObjectiveTo assess the factors contributing to durability of surgical results following adult spinal deformity (ASD) surgery.Summary Of BackgroundFactors contributing to the long-term sustainability of ASD correction are currently undefined.Materials And MethodsOperative ASD patients with preoperatively (baseline) and 3-year postoperatively radiographic/health-related quality of life data were included. At 1 and 3 years postoperatively, a favorable outcome was defined as meeting at least three of four criteria: (1) no proximal junctional failure or mechanical failure with reoperation, (2) best clinical outcome (BCO) for Scoliosis Research Society (SRS) (≥4.5) or Oswestry Disability Index (ODI) (<15), (3) improving in at least one SRS-Schwab modifier, and (4) not worsening in any SRS-Schwab modifier. A robust surgical result was defined as having a favorable outcome at both 1 and 3 years. Predictors of robust outcomes were identified using multivariable regression analysis with conditional inference tree for continuous variables.ResultsWe included 157 ASD patients in this analysis. At 1 year postoperatively, 62 patients (39.5%) met the BCO definition for ODI and 33 (21.0%) met the BCO for SRS. At 3 years, 58 patients (36.9%) had BCO for ODI and 29 (18.5%) for SRS. Ninety-five patients (60.5%) were identified as having a favorable outcome at 1 year postoperatively. At 3 years, 85 patients (54.1%) had a favorable outcome. Seventy-eight patients (49.7%) met criteria for a durable surgical result. Multivariable adjusted analysis identified the following independent predictors of surgical durability: surgical invasiveness >65, being fused to S1/pelvis, baseline to 6-week pelvic incidence and lumbar lordosis difference >13.9°, and having a proportional Global Alignment and Proportion score at 6 weeks.ConclusionsNearly 50% of the ASD cohort demonstrated good surgical durability, with favorable radiographic alignment and functional status maintained up to 3 years. Surgical durability was more likely in patients whose reconstruction was fused to the pelvis and addressed lumbopelvic mismatch with adequate surgical invasiveness to achieve full alignment correction.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

25 keywords...

hide…