General Session: Adult Spinal Deformity - Hall F

Presented by: J. Godzik

Author(s):

J. Godzik(1), R. Mauria(2), R. Hlubek(1), C. Walker(1), A. Whiting(1), U. Kakarla(1), J. Turner(1)

(1) Barrow Neurological Institute, Phoenix, AZ, United States
(2) Creighton Medical School, Ahoenix, AZ, United States

Abstract

Introduction: Falls are common, costly, and dangerous in the elderly population. The annual fall rate in adults over the age of 65 ranges from 10-29%. Adult spinal deformity (ASD) is prevalent in the elderly and leads to alterations in posture and gait. However, very little is known about the rate and risk of falls in this population. The objective of the current study wasto determine the proportion of adult spinal deformity patients experiencing falls and identify risk factors.

Methods: ASD patients were retrospectively identified from a single institution. Inclusion criteria: age ≥ 18 years, coronal Cobb >20°, sagittal vertical axis (SVA) >5 cm, pelvic tilt (PT) >25°, or thoracic kyphosis (TK) >60°, and completion of a prospectively collected fall risk questionnaire. Exclusion criteria: inability to walk, neurodegenerative disease, spinal cord injury, or stroke. Falling and fall risk were determined using the validated Morse Fall Scale (MFS). Demographic, radiographic, and health-related quality of life (HRQOL) measures including Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)-22 were collected. Univariate and logistic regression analyses were used to identify independent predictors of falling.

Results: We identified 143 patients. Mean age was 60±16, 90 (63%) were female. Mean pelvic incidence (PI) was 52°±13, lumbar lordosis (LL) 38°±21, PT 24°±13, T1 pelvic angle (T1PA) 22.7°±13.7, SVA 6.0°±6.4cm, and TK 34°±17. Incidence of falls over 6 months was 31%; mean MFS fall risk was 36±24. Patients who fell had higher TK (p< 0.001), PI (p=0.046), and PT (p=0.025). On multivariate analysis, PT (OR 1.05, p=0.013) and TK (1.05, p< 0.001) were independent predictors of falls when adjusted for relevant covariates. MFS fall risk was significantly associated with PT (p=0.001), T1PA (p< 0.001), PI (p=0.01), ODI (p< 0.001), SRS Function (p< 0.001), SRS Pain (p< 0.001), SRS Self (p=0.021), SRS average (p< 0.001) (Figure 1).

Conclusions: ASD is associated with greater fall risk and a higher fall rate compared to published rates in community-dwelling adults of similar age. Increasing PT and TK were independently associated with high risk of falling, and MFS fall risk correlated with multiple HRQOL measures.

Correlation between Fall Risk and Quality of Life