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Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis.

Publication ,  Journal Article
Wondra, JP; Kelly, MP; Yanik, EL; Greenberg, JK; Smith, JS; Bess, S; Shaffrey, CI; Lenke, LG; Bridwell, K
Published in: J Neurosurg Spine
January 14, 2022

OBJECTIVE: Adult symptomatic lumbar scoliosis (ASLS) is a widespread and debilitating subset of adult spinal deformity. Although many patients benefit from operative treatment, surgery entails substantial cost and risk for adverse events. Patient-reported outcome measures (PROMs) are patient-centered tools used to evaluate the appropriateness of surgery and to assist in the shared decision-making process. Framing realistic patient expectations should include the possible functional limitation to improvement inherent in surgical intervention, such as multilevel fusion to the sacrum. The authors' objective was to predict postoperative ASLS PROMs by using clustering analysis, generalized longitudinal regression models, percentile analysis, and clinical improvement analysis of preoperative health-related quality-of-life scores for use in surgical counseling. METHODS: Operative results from the combined ASLS cohorts were examined. PROM score clustering after surgery investigated limits of surgical improvement. Patients were categorized by baseline disability (mild, moderate, moderate to severe, or severe) according to preoperative Scoliosis Research Society (SRS)-22 and Oswestry Disability Index (ODI) scores. Responder analysis for patients achieving improvement meeting the minimum clinically important difference (MCID) and substantial clinical benefit (SCB) standards was performed using both fixed-threshold and patient-specific values (MCID = 30% of remaining scale, SCB = 50%). Best (top 5%), worst (bottom 5%), and median scores were calculated across disability categories. RESULTS: A total of 171/187 (91%) of patients with ASLS achieved 2-year follow-up. Patients rarely achieved a PROM ceiling for any measure, with 33%-43% of individuals clustering near 4.0 for SRS domains. Patients with severe baseline disability (< 2.0) SRS-pain and SRS-function scores were often left with moderate to severe disability (2.0-2.9), unlike patients with higher (≥ 3.0) initial PROM values. Patients with mild disability according to baseline SRS-function score were unlikely to improve. Crippling baseline ODI disability (> 60) commonly left patients with moderate disability (median ODI = 32). As baseline ODI disability increased, patients were more likely to achieve MCID and SCB (p < 0.001). Compared to fixed threshold values for MCID and SCB, patient-specific values were more sensitive to change for patients with minimal ODI baseline disability (p = 0.008) and less sensitive to change for patients with moderate to severe SRS subscore disability (p = 0.01). CONCLUSIONS: These findings suggest that ASLS surgeries have a limit to possible improvement, probably due to both baseline disability and the effects of surgery. The most disabled patients often had moderate to severe disability (SRS < 3, ODI > 30) at 2 years, emphasizing the importance of patient counseling and expectation management.

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Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

January 14, 2022

Start / End Page

1 / 12

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences
 

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Wondra, J. P., Kelly, M. P., Yanik, E. L., Greenberg, J. K., Smith, J. S., Bess, S., … Bridwell, K. (2022). Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis. J Neurosurg Spine, 1–12. https://doi.org/10.3171/2021.11.SPINE21949
Wondra, James P., Michael P. Kelly, Elizabeth L. Yanik, Jacob K. Greenberg, Justin S. Smith, Shay Bess, Christopher I. Shaffrey, Lawrence G. Lenke, and Keith Bridwell. “Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis.J Neurosurg Spine, January 14, 2022, 1–12. https://doi.org/10.3171/2021.11.SPINE21949.
Wondra JP, Kelly MP, Yanik EL, Greenberg JK, Smith JS, Bess S, et al. Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis. J Neurosurg Spine. 2022 Jan 14;1–12.
Wondra, James P., et al. “Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis.J Neurosurg Spine, Jan. 2022, pp. 1–12. Pubmed, doi:10.3171/2021.11.SPINE21949.
Wondra JP, Kelly MP, Yanik EL, Greenberg JK, Smith JS, Bess S, Shaffrey CI, Lenke LG, Bridwell K. Patient-reported outcome measure clustering after surgery for adult symptomatic lumbar scoliosis. J Neurosurg Spine. 2022 Jan 14;1–12.

Published In

J Neurosurg Spine

DOI

EISSN

1547-5646

Publication Date

January 14, 2022

Start / End Page

1 / 12

Location

United States

Related Subject Headings

  • Orthopedics
  • 3209 Neurosciences
  • 1109 Neurosciences
  • 1103 Clinical Sciences