Oral Posters: Adult Spinal Deformity
Presented by: J. Varghese - View Audio/Video Presentation (Members Only)
P. Alijanipour(1), J. Varghese(1,2), J. Henry(3), J. Smith(4), J. Gum(5), C. Shaffrey(4), C. Ames(6), G. Mundis(7), D. Burton(8), S. Bess(3), A. Buckland(3), F. Schwab(1), V. Lafage(1), H.J. Kim(1), International Spine Study Group (ISSG)
(1) Hospital for Special Surgery, Spine Service, New York, NY, United States
(2) SUNY Downstate Medical Center, Department of Orthopaedic Surgery, Brooklyn, NY, United States
(3) NYU Langone Medical Center, New York, NY, United States
(4) University of Virginia Medical Center, Charlottesville, VA, United States
(5) Norton Leatherman Spine Center, Louisville, KY, United States
(6) San Francisco Medical Center, University of California, San Francisco, CA, United States
(7) Scripps Clinic Torrey Pines, La Jolla, CA, United States
(8) University of Kansas Medical Center, Department of Orthopaedic Surgery, Kansas City, KS, United States
Introduction: A substantial portion of non-sleeping hours are spent in the seated position. However, most realignment goals in adult spinal deformity (ASD) surgery are based on the analysis of parameters in the standing position. It is unclear how changes in sagittal parameters or other health-related quality of life outcomes correlate with sitting endurance.
Purpose: To assess the relationships between the Oswestry Disability Index Sitting question, radiographic parameters, and other health related quality of life metrics.
Methods: This is a retrospective review of a prospectively collected multicenter database. Operative adult spinal deformity patients that underwent a five level or greater fusion, with pre- and post-operative radiographs, health related quality of life (HRQoL) measures available, no revisions, and 2 years of follow-up were included. The collected data included the sagittal spinopelvic radiographic parameters, Oswestry Disability Index (ODI) questionnaire, the Scoliosis Research Society (SRS-22) questionnaire, and the Numerical Rating Scale (NRS) questionnaire. Each individual ODI question assessed the impact of pain/disability in a specific domain on a scale of 0 (best) to 5 (worse). The improvement in the ODI-Sitting question (ODI-S) based on surgical characteristics and radiographic parameters was assessed using t-tests and correlations. For 2Y post-op and ΔBaseline-2Y post-op, correlations among ODI-Total, individual ODI questions, and SRS-22 Satisfaction were performed, controlling for NRS-leg pain via linear regression. Regression analyses were used to compare correlations among ODI-Total, individual ODI questions, SRS-satisfaction, and radiographic parameters while controlling for leg pain (NRS-leg).
Results: Of 325 eligible, 237 patients were included (mean 56.4y). The average ODI-Sitting score improved significantly from baseline to 2Y (1.75 vs 1.24, p< 0.001). The improvement in ODI-Sitting was not significantly affected by pelvic fixation, number of levels fused, upper-instrumented vertebra or PT/PI ratio. At 2Y post-op, ODI-Sitting correlated most strongly with ODI-Total (R=0.683, p< 0.001), ODI-Employment (R=0.529, p< 0.001), and ODI-Travel (R=0.546, p< 0.001). 2Y ODI-Sitting correlated most weakly with ODI-Walking (R=0.392, p< 0.001) and SRS-Satisfaction (R=0.396, p< 0.001). ΔODI-Sitting from Baseline to 2Y Post-op correlated best with ΔODI-Total (R=0.548, p< 0.001), ΔODI-Travel (R=0.430, p< 0.001), and ΔODI-Sleeping (R=0.396, p< 0.001). Conversely, ΔODI-Sitting correlated weakly with ΔSRS-Satisfaction (R=0.195, p=0.015) and ΔODI-Lifting (R=0.181, p=0.026). In the regression analysis, when controlling for leg pain and ΔODI-Total, ΔODI-Sitting was predicted by ΔPI-LL (B=-0.226, p< 0.007) with R=0.586, p< 0.001.
Conclusions: When controlling for leg pain and total ODI score, the improvements in sitting endurance was predicted by the change in PI-LL mismatch. However, no other sagittal spinopelvic parameter was able to accurately predict the changes in ODI-sitting. Improvements in ODI-sitting were greatly influenced by changes in the overall ODI score. Improvements in walking and standing function did not correlate strongly with better sitting tolerance.