General Session: Adult Spinal Deformity

Presented by: G. Poorman - View Audio/Video Presentation (Members Only)


B. Diebo(1), C. Jalai(2), G. Poorman(2), S. Horn(2), P. Zhou(2), T. Errico(2), V. Lafage(3), Q. Naziri(1), C. Paulino(1), P. Passias(2)

(1) SUNY Downstate, Orthopaedic Surgery, Brooklyn, NY, United States
(2) NYU Hospital for Joint Diseases, Orthopaedic Surgery, New York, NY, United States
(3) Hospital for Special Surgery, Spine Service, New York, NY, United States


Background: Psychological status is an important factor in the evaluations, treatments and prognoses of disabling chronic conditions. However, the psychological burden (PB) of adult spinal deformity (ASD) in relation to other disease states remains to be fully quantified.

Purpose: To determine the incidence of PB across diagnoses and to characterize the specific pre-operative psychological profile of surgical ASD patients.

Study Design/Setting: Retrospective review of the National Inpatient Sample (NIS).

Patient Sample: 4,194,083 discharges identified from 2001-2012.

Outcome Measures: Prevalence of PB among diagnosis groups.

Methods: ICD-9 coding identified 4 diagnoses: adult spinal deformity (idiopathic, degenerative scoliosis) with >4 level fused (ASD), cardiac disease (CD), diabetes (DM), lung cancer (LC). Based on ICD-9-CM codes reported in (Diagnostic and Statistical Manual of Mental Disorders) DSM 5, PB was defined as incidence of any of the following disorders: Depressive, Anxiety, Obsessive-compulsive, Stress, Somatic symptoms, Sexual dysfunction, Substance-related and addictive, Delirium, Personality and mental. Overall and specific incidences of PB were compared between the 4 diagnoses. Patients were stratified into 5 age groups (25-40, 40-55, 55-65, 65-75, 75+); psychological disorders were compared within ASD group and across all diagnoses.

Results: Distribution of diagnoses: ASD=17,537 (0.4%), CD=2,675,767 (63.8%), DM=1,137,435 (27.1%), LC=363,334 (8.7%). ASD patients had significantly higher incidence of psychological disorders (ASD=36.5%, LC=33.3%, DM=28.3%, CD=24.3%, p< 0.001). Among ASD patients, there was no significant difference in PB between 4-9 levels (n=14,165, 80.8%) and 9+ (n=3,565, 20.3%) fusions (36.1% vs. 36.8%, p=0.449). ASD patients were also similar in PB between idiopathic and degenerative scoliosis sub-groups (36.0 vs. 36.4%, p=0.761). The highest prevalence of PB was observed in 65-74 y/o (31.4% of all PB) and 55-64 y/o (30.3%), vs. 25-40 (6.2%) and 75+ (12.2%), p=0.001. The most prevalent disorders in ASD were: Depression (n=2886, 16.4% of ASD cases), Substance abuse disorders (n=1956, 11.2%), Sleep disorders (n=1318, 7.5%), Anxiety (n=1247, 7.1%), Delirium (n=592, 3.4%). Among other diagnosis, ASD had the highest prevalence of depression (ASD: 16.5%, DM: 10.3%, LC: 7.2%, CD: 7.0%), sleep disorders (ASD 7.5%, CD: 4.8%, DM: 2.5%, LC: 2.3%), anxiety disorders (ASD 7.1%, LC: 4.9%, CD: 3.1%, DM: 2.7%), delirium (ASD 3.4%, LC: 1.6%, DM: 1.0%, CD: 0.7%), however, ASD was third in substance abuse (LC: 21.6%, DM: 13.9%, ASD: 11.2%, CD: 8.2%), p< 0.001 all cases. Depression, anxiety and sleep disorders were mostly prevalent between 55-75 y/o; however, +75 y/o and 41-54 y/o brackets had the second highest prevalence of patients with delirium (27.9% of all delirium patients) and substance abuse (29.8% of all substance abuse patients), respectively.

Conclusions: Among 4 of the most debilitating chronic diseases, operative ASD patients displayed the highest psychological burden: More than 1 in every 3 ASD patients (36.5%) had at least one psychological disorder. In such patients, psychological status might impact physician evaluation, compliance with management, and ultimately successful treatment. Proper ASD psychological screening, patient counseling, and appropriate psychologic support is recommended as a compliment to ASD treatment.