Oral Posters: Adult Spinal Deformity

Presented by: M. Swann - View Audio/Video Presentation (Members Only)

Author(s):

M. Swann(1), R. Reddy(1), T. Mange(1), D. Riepen(1), H. Box(1), B. Schell(1), M. Wiley(1), J. Romero(1), M. Khaleel(1)

(1) University of Texas Southwestern Medical Center, Orthopaedic Surgery, Dallas, TX, United States

Abstract

Summary: This is an ongoing, prospective, single institution analysis of sleep quality and disability in a population of patients with spine pathology. These patients are evaluated at an initial visit and, if surgery is performed, they are followed post-operatively to determine the impact of surgical intervention on sleep quality and other variables related to disability.

Introduction: Sleep disturbance is a frequent complaint among patients who present to our Orthopedic Spine clinic. Long-standing interruptions in normal sleep patterns can negatively affect multiple physiologic systems; cardiovascular, endocrine and psychiatric manifestations have been well established. Sleep hygiene is influenced by many variables, and patients with spine pathology often present with multiple medical co-morbidities which may affect sleep habits as well. This study was performed to establish an association between spine pathology and sleep disturbance, as well as determine if sleep quality improves after surgical intervention. Design: This is an IRB-approved, prospective cohort study performed at a single institution.

Methods: After written consent is obtained, new patients who present to our Orthopedic Spine clinic are given a Patient Reported Outcomes Measurement Information System (PROMIS) 8a Sleep Disturbance Short Form, Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Neck Disability Index (NDI) questionnaires. Demographic data, physical exam and radiographic findings are then recorded. Demographic variables included age, gender, Body Mass Index (BMI), ethnicity, diabetes mellitus (DM) and clinical depression or anxiety. Only patients with physical exam and radiographic findings consistent with lumbar or cervical radiculopathy or myelopathy were included in this study. Patients who underwent surgery were then given the same questionnaires at the six-week and three-month post-operative visit.

Results: 155 patients, consisting of 81 (52.3%) males and 74 (47.7%) females at an average age of 50.5 +/-10.1 were included. The group was comprised of 43.9% African Americans, 32.3% Caucasian, 20% Hispanic and 3.9% other. The average BMI was 31.9 +/- 6.7. The diagnoses were distributed as follows: 35 (22.6%) cervical radiculopathy/myelopathy, 102 (65.8%) lumbar radiculopathy and 18 (11.6%) combined cervical and lumbar pathology. The average PROMIS 8a score was 30.6 +/- 8.1 (T-score = 62.0); mean VAS was 7.6 +/- 2.0; mean ODI 56 +/- 18% and mean NDI 46 +/- 25%. Worse PROMIS sleep scores were predicted by combined cervical and lumbar disease (p=0.019), ODI (p=< 0.001), and VAS scores (p=0.003). Of this cohort, 59 (38.1%) went on to have surgery. The mean PROMIS score in this group had a trend toward statistically significant improvement from a baseline 30.8 to 28.7 (p=0.06) at the three month post-operative visit. There was also a significant improvement in VAS scores at this time point from 8.1 to 6.7 (p=0.02).

Conclusions: Patients with lumbar and/or cervical radiculopathy or myelopathy have poor sleep hygiene as evidenced by a mean PROMIS 8a sleep disturbance score of 30.6, which is over a standard deviation above the mean (T-score = 62.0). Those with combined cervical and lumbar disease and worse ODI and VAS scores are more likely to have impaired sleep. Patients who undergo surgery for lumbar or cervical radiculopathy or myelopathy are likely to have improved sleep habits, as well as reduced pain by 3 months post-operatively.