• Tamir Ailon, Justin S Smith, Christopher I Shaffrey, Alex Soroceanu, Virginie Lafage, Frank Schwab, Douglas Burton, Robert Hart, Han Jo Kim, Jeffrey Gum, Richard Hostin, Michael P Kelly, Steven Glassman, Justin K Scheer, Shay Bess, Christopher P Ames, and International Spine Study Group.
• Department of Orthopedics, University of British Columbia, Vancouver, British Columbia. Electronic address: tamir.ailon@vch.ca.
• World Neurosurg. 2018 Aug 1; 116: e354-e361.

BackgroundSubstantial clinical benefit (SCB) represents a threshold above which patients recognize substantial improvement and represents a rational target for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions may impact outcomes after deformity correction.ObjectiveTo investigate the impact of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year health-related quality of life (HRQOL) after ASD surgery.MethodsWe conducted a retrospective review comparing baseline demographic, HRQOL, and radiographic features for patients with ASD undergoing primary versus revision procedures. The primary outcome measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes included absolute and change scores in ODI, PCS, and back and leg pain.ResultsIn total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those undergoing revision surgery had similar demographic features (age 58.3/55.9, female 80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL (ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0, pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse 2-year HRQOL for all measures.ConclusionsPatients undergoing revision surgery have worse baseline HRQOL and deformity. Although they do not achieve the same absolute level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold for improvement in 2-year HRQOL.Copyright © 2018 Elsevier Inc. All rights reserved.

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