General Session: Value and Outcomes in Spine Surgery

Presented by: H. Bao - View Audio/Video Presentation (Members Only)


T. Cheriyan(1), H. Bao(2), F. Schwab(2), K. Kebaish(3), M. Gupta(4), C. Ames(5), C. Shaffrey(6), E. Tanzi(7), M. Kelly(8), J. Smith(6), S. Bess(9), R. Hart(10), R. Hostin(11), T. Errico(1), V. Lafage(2), International Spine Study Group

(1) NYU Hospital for Joint Diseases, New York, NY, United States
(2) Hospital for Special Surgery, New York, NY, United States
(3) Johns Hopkins Hospital, Baltimore, MD, United States
(4) UC Davis Health System, Sacramento, CA, United States
(5) UCSF, San Francisco, CA, United States
(6) University of Virginia, Charlottesville, NH, United States
(7) Memorial Sloan Kettering Cancer Center, New York, NY, United States
(8) Washington University in St. Louis, St. Louis, MO, United States
(9) Rocky Mountain Scoliosis & Spine, Denver, CO, United States
(10) OHSU, Portland, OR, United States
(11) Baylor Scott & White Health, Plano, TX, United States


Purpose: To evaluate variability in surgical strategies, radiological and clinical outcomes, and complications among different centers for severe ASD.

Introduction: Various surgical strategies are used to achieve alignment goals in ASD depending on surgeon training and preference. This study evaluated the differences among centers in surgical strategies severe ASD cases.

Methods: Patients were selected from a database of ASD patients with severe sagittal or coronal deformity. Additional inclusion criteria were T1Pelvic Angle>20° and 2-year follow-up. Demographics, surgical strategy (level fused, osteotomy, interbody fusion [IBF], BMP-2) and outcomes were compared using Chi-Square and ANOVA.

Results: 231 patients from 5 centers were included. There was no difference in patient demographics except age. Mean operative time, blood loss and length of stay were 369 minutes, 1879 ml and 8.8 days, respectively, with significant variability across centers (p< 0.01). There was significant variability in use of IBF and BMP-2 (P< 0.01). The site with the highest usage of BMP-2 simultaneously had the lowest usage of IBF and the fewest patients who reached the goal SVA (< 4cm); however, this site had the best 2-year HRQL outcomes. There were also significant differences in the type/level of osteotomy (P< 0.01). The site that performed the fewest osteotomies was significantly less likely to achieve correction in sagittal modifiers and the goal PI-LL< 10°. This low-osteotomy site also had the least improvement in 6-week and 2-year HRQLs. While sites were similar in the lengths of fusion (mean number levels fused =11±4.5) and the upper termination of instrumentation, there was significant variability in the choice of LIV (P=0.01). The site that most frequently instrumented to the ilium also performed the highest number of 3CO and the fewest SPO, though it had low BMP-2 use. However, this site had the greatest correction in sagittal modifiers and the highest number of patients who achieved the PI-LL< 10° goal with intermediate HRQLs.

Conclusions: Considerable variability in surgical strategy between different centers may result in varying radiological and clinical outcomes.

Outcome Variability