• Peter G Passias, Katherine E Pierce, Pooja Dave, Renaud Lafage, Virginie Lafage, Andrew J Schoenfeld, Breton Line, Juan Uribe, Richard Hostin, Alan Daniels, Robert Hart, Douglas Burton, Han Jo Kim, Gregory M Mundis, Robert Eastlack, Bassel G Diebo, Jeffrey L Gum, Christopher Shaffrey, Frank Schwab, Christopher P Ames, Justin S Smith, Shay Bess, Eric Klineberg, Munish C Gupta, D Kojo Hamilton, and International Spine Study Group.
• Departments of Orthopaedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York, NY.
• Spine. 2023 Nov 1; 48 (21): 148114851481-1485.

Study DesignRetrospective review of a prospectively enrolled adult spinal deformity (ASD) database.ObjectiveTo investigate what patient factors elevate the risk of sub-optimal outcomes after deformity correction.BackgroundCurrently, it is unknown what factors predict a poor outcome after adult spinal deformity surgery, which may require increased preoperative consideration and counseling.Materials And MethodsPatients >18 yrs undergoing surgery for ASD(scoliosis≥20°, SVA≥5 cm, PT≥25°, or TK≥60°). An unsatisfactory outcome was defined by the following categories met at two years: (1) clinical: deteriorating in ODI at two years follow-up (2) complications/reoperation: having a reoperation and major complication were deemed high risk for poor outcomes postoperatively (HR). Multivariate analyses assessed predictive factors of HR patients in adult spinal deformity patients.ResultsIn all, 633 adult spinal deformity (59.9 yrs, 79% F, 27.7 kg/m 2, CCI: 1.74) were included. Baseline severe Schwab modifier incidence (++): 39.2% pelvic incidence and lumbar lordosis, 28.8% sagittal vertical axis, 28.9% PT. Overall, 15.5% of patients deteriorated in ODI by two years, while 7.6% underwent reoperation and had a major complication. This categorized 11 (1.7%) as HR. HR were more comorbid in terms of arthritis (73%), heart disease (36%), and kidney disease (18%), P <0.001. Surgically, HR had greater EBL (4431ccs) and underwent more osteotomies (91%), specifically Ponte(36%) and Three Column Osteotomies(55%), which occurred more at L2(91%). HR underwent more PLIFs (45%) and had more blood transfusion units (2641ccs), all P <0.050. The multivariate regression determined a combination of a baseline Distress and Risk Assessment Method score in the 75th percentile, having arthritis and kidney disease, a baseline right lower extremity motor score ≤3, cSVA >65 mm, C2 slope >30.2°, CTPA >5.5° for an R2 value of 0.535 ( P <0.001).ConclusionsWhen addressing adult spine deformities, poor outcomes tend to occur in severely comorbid patients with major baseline psychological distress scores, poor neurologic function, and concomitant cervical malalignment.Copyright © 2023 Wolters Kluwer Health, Inc. All rights reserved.

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