• Tamir Ailon, D Koho Hamilton, Erik Klineberg, Alan H Daniels, Virginie Lafage, Shay Bess, Douglas C Burton, Munish Gupta, Frank Schwab, Christopher P Ames, Justin S Smith, Christopher I Shaffrey, Robert A Hart, and International Spine Study Group.
• Swedish Neurosciences Institute, Seattle, Washington, USA.
• World Neurosurg. 2018 Sep 1; 117: e1e7e1-e7.

BackgroundPseudarthrosis and rod fracture (RF) remain significant concerns after fusion for adult spinal deformity (ASD). Although a radiographic system of fusion grade has been proposed, the correlation between fusion grade and health-related quality of life measures (HRQoL) is not known.MethodsIn a retrospective review of a prospectively collected clinical database, patients that underwent ≥5-level posterior instrumented arthrodesis for ASD were evaluated. Fusion grade was determined on plain films using the Lenke criteria. Patients were grouped as 1) complete fusion (grade I or II at all levels), 2) incomplete fusion (grade 3 or 4 at any level), 3) rod fracture without revision (RF), and 4) rod fracture with revision (RFR). Outcome measures were the Oswestry Disability Index, Medical Outcomes Study 36-Item Short-Form Health Survey Physical and Mental Component Summaries, Scoliosis Research Society-22r total, and Lumbar Stiffness and Disability Index.ResultsThere were 205 (85%) patients who achieved the minimum 2-year follow-up and were included. Complete fusion was achieved in 115 patients (56.1%), 55% patients (26.8%) had incomplete fusion, and 35% patients (17.1%) had RF. Of the 35 patients with RF, 19 (17.1%; 19/205) underwent revision while 16 (7.8%; 16/205) had RF without revision. HRQoL measures were significantly worse in the RFR group, whereas no significant differences were found between groups 1, 2, and 3.ConclusionsRadiographic fusion grade after ASD surgery did not significantly impact HRQoL in the absence of RF. RFR was associated with significantly worse clinical outcomes. Fusion grade may be less predictive of clinical outcomes than the occurrence of RF.Copyright © 2018. Published by Elsevier Inc.

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