Oral Posters: Adult Spinal Deformity
Presented by: T. Pannu - View Audio/Video Presentation (Members Only)
R. Lafage(1), J. Scheer(2), T. Pannu(1), F. Schwab(1), J. Smith(3), P. Passias(4), R. Hostin(5), C. Ames(6), G. Mundis(7), D. Burton(8), H.J. Kim(1), S. Bess(4), E. Klineberg(9), V. Lafage(1), International Spine Study Group (ISSG)
(1) Hospital for Special Surgery, Spine Service, New York, NY, United States
(2) Northwestern University Feinberg School of Medicine, Department of Neurological Surgery, Chicago, IL, United States
(3) University of Virginia Medical Center, Department of Neurosurgery, Charlottesville, VA, United States
(4) NYU Langone Medical Center, Spine Division, Department of Orthopaedics, New York, NY, United States
(5) Baylor Scoliosis Center, Plano, TX, United States
(6) San Francisco Medical Center, University of California, Department of Neurosurgery, 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
(9) University of California, Davis, Department of Orthopedic Surgery, Sacramento, CA, United States
Introduction and Purpose: Correlation between sagittal radiographic parameters and PRO is widely recognized. However, in case of similar sagittal malalignment, additional impact of radiculopathy on PRO remains unclear. The purpose of the study is to compare patients with radicular leg pain to propensity matched patients without leg pain in order to assess the influence of concomitant radiculopathy on PRO after deformity corrective surgery.
Methods: Surgical patients with PRO and radiographic assessment at baseline (BL) and 2- year follow up were included. Patients were stratified based upon the presence or absence of leg pain (VAS leg pain > 3 [Leg pain] vs. < 3 [no leg pain]) and propensity matched by age, PI-LL and SVA at BL. Patient's demographic, PRO (ODI, SRS22r and VAS back and leg pain) and sagittal alignment were compared between groups at BL, post-op and change between pre and post. Surgical strategy was also compared.
Results: 180 pts (90 on each group) out of 320 were included. Groups had similar sagittal profile, age and coronal SRS Schwab Type. At BL, Leg pain patients demonstrated a larger ODI associated with smaller SRS22r (Total and Pain) and similar VAS back. Both groups received similar surgery in term of approach, number/type of osteotomies, Interbody fusions (IBFs) and decompression. Fusion length was similar between groups (12.4 vs. 11.3). Similar improvement was observed between groups (radiographic: PI-LL, PT, SVA, TPA; PRO: ODI, SRS Total and Pain) with a significant difference in ΔVAS leg (0.8 vs. -2.8 p < 0.001). Post-op, there was no difference in sagittal profile but leg pain patients remained with a larger disability than patients with no leg pain (ODI: 23.2 vs. 30.3; SRS Pain: 3.6 vs 3.2; VAS leg: 1.7 vs 4; all p < 0.05).
Conclusion: Correction of sagittal deformity is one of the primary goals of surgery and improves PRO. However, some patients need to have their concurrent neurologic problem (radiculopathy) addressed by the surgery simultaneously. For these patients, the larger BL disability remains almost the same post-operatively. Further study is encouraged to investigate the proportion of the improvement due to the decompression in comparison to one due to realignment in this specific population.
Comparison between pts with and without leg pain