Spine Surgeon NYU School of Medicine New Canaan, Connecticut, United States
Introduction: ASD is a debilitating disease of the lumbar and thoracic spine that significantly impacts patient quality of life. Surgical correction is a proven treatment option that provides functional restoration and pain relief. Preoperative rehabilitation programs have recently been implemented to prepare patients for surgery and to promote patient health. The purpose of this study was to identify the effect of preoperative rehabilitation on surgical ASD patient outcomes.
Methods: ASD patients with baseline (BL) and two-year (2Y) follow-up were included if they had preoperative rehabilitation data. Patients were divided into 2 groups: those who had preoperative rehabilitation [Prehab] and those who did not [no Prehab]. Prehab consisted of physical and mental components. Physical therapy for 3 months, 3 days a week for core, paraspinal and leg strengthening, with a review of post-op protocols to do at home, including gait and balance training. Patients were also referred for cognitive behavioral therapy for 2 weeks to prepare for the stress of surgery. Patients were excluded if they presented with any of the following at BL: severe neurological deficit ( < 3/5), minimal ambulation, or current depression/anxiety. Means comparison tests and multivariable logistic regression analysis controlling for age, CCI, ASA grade, and invasiveness assessed differences between patient groups.
Results: 183 patients met inclusion criteria (52 Prehab, 131 no Prehab). The cohort was 50% female, mean age of 58.8 yrs and 6.9 levels fused and 159 (87.0%) undergoing an osteotomy. There was a significant difference in LOS for patients who had (3.9 days) and didn’t have (6.2 days) Prehab, p<.05. Multivariate regression showed that Prehab was an independent predictor of a shorter LOS (OR .756 [CI .600-.954], p=.018). By 2Y, Prehab patients had lower rates of readmissions (7.7% vs 16.0%) than no Prehab patients, but not significantly different. Controlling for BL, Prehab patients were more likely to report better ODI scores than no Prehab patients at 2Y follow-up (OR .960 [CI .926-.996], p=.028).
Conclusion : Preoperative rehabilitation appears to be independently associated with a shorter length of stay compared following adult spinal deformity-corrective surgery. Patients who had preoperative rehabilitation also had better reported clinical outcomes by two-years postoperatively.
