Clinical and Patient-Reported Outcomes of Adult Spinal Deformity Surgery with Ten-Year Follow-Up

Thursday, June 1, 2023

8:30 AM – 6:15 PM

Location: Salons 7-8

Co-Author(s)

PT

Peter S. Tretiakov, BS

United States
JM

Jamshaid M. Mir, MD

Research Fellow
NYU Langone Health | NY Spine Institute, United States
PD

Pooja R. Dave

Miami, Florida, United States
SO

Stephane Owusu-Sarpong, MD

Orthopedic Surgery Resident
NYU Langone Health, United States
SV

Shaleen Vira, MD

Assistant Professor, Orthopaedic Surgery & Neurosurgery
UT Southwestern Medical Center
Dallas, Texas, United States
TR

Timothy Roberts

Orthopaedic Spine Surgeon
Westbury, New York, United States
AM

Angel Macagno

United States
AD

Alexandre Demoura

United States
AS

Andrew Schoenfeld

United States

Presenting Author (Person doing the Podium Present(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Submitter(s)

PP

Peter G. Passias, M.D.

Spine Surgeon
NYU Langone Orthopedic Hospital
New York, New York, United States

View E-Poster

Disclosure(s):

Peter G. Passias, MD: No relevant disclosure to display

Background: Adult spinal deformity (ASD) has been demonstrated to negatively influence patients’ physical and mental health. Yet, previous literature has described that ASD corrective surgery to significantly improve patients’ quality of life and reduce disability with durable results. Yet, there remains a paucity of literature assessing such effects beyond short-term follow-up.

Purpose: To assess outcomes of patients who underwent ASD corrective surgery with minimum ten-year follow-up.

Methods: Operative ASD patients ≥18yrs with complete pre-(BL) and 10-year(10Y) postop radiographic/HRQL data were isolated in a single-surgeon cohort. Demographics, patient-reported outcomes and complication rates were collected and reported. Complications and mortality as recorded by last follow-up. Rates of meeting minimal clinically-important difference (MCID) were reported for collected HRQLs [Oswestry Disability Index (ODI), SRS-22, SF-36] collected at each follow-up. Post-operative complications and mortality are reported as a percentage of the studied cohort as of last follow-up.

Results: 82 patients (60.3±14.8 years, 75.6 % female, 26.4±5.1 kg/m2) were included in analysis. In terms of operative approach, 62.2% underwent posterior-only approach, 4.9% underwent anterior-only approach, and 32.9% underwent combined approach. In terms of surgical details, patients had a mean of 6.8 ± 3.5 levels fused, with the most common upper instrumented vertebra (UIV) being T4 (28.2%), and the most common lowest instrumented vertebra (LIV) being illium (69.2%). 24.3% of patients were Staged, and 75.7% were Same-Day. Mean operative time was 436.6 ± 196.5 minutes, mean blood loss was 1556.7 ± 1466.9 mL, and mean length of stay was 8.15 ± 4.5 days. 18.3% of patients underwent 3-column osteotomy. Post-operatively, 65.9% of patients were admitted to SICU. When assessing HRQLs, by 2Y 43.0% of patients met MCID by ODI, 56.0% met MCID by SRS-22 Activity, 60.0% met MCID by SRS-22 Pain, 57.0% met MCID by SRS-22 Appearance, and 22.0% met MCID by SRS-22 Mental. In terms of post-operative complications by 10Y, 82.9% suffered complications of any type, 20.7% suffered major complications, 14.6% suffered medical complications, 15.9% suffered neurological complication, 26.8% suffered mechanical complications (instrumentation failure, screw fracture), 50.0% suffered PJK, 12.2% suffered radiographic PJF, and 29.3% required reoperation. Within 10Y, 5 (6.09%) patients expired; 1 patient due to cancer-related complications, 3 due to natural causes, and 1 due to stroke-related (index surgery unrelated) complications.

Conclusions: The present study assesses outcomes ten-year outcomes of adult spinal deformity surgery in a single-surgeon cohort. Rates of complications remain in line with literature-reported values, though mortality remains significantly decreased despite a relatively frail patient cohort. By ten-year follow-up, improvement in patient-reported outcomes remains robust, with over 75.6% of patients achieved minimum clinically important difference (MCID) in minimum one disability marker.