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Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity?

Publication ,  Journal Article
Passias, PG; Williamson, TK; Krol, O; Tretiakov, PS; Joujon-Roche, R; Imbo, B; Ahmad, S; Bennett-Caso, C; Owusu-Sarpong, S; Lebovic, JB ...
Published in: Spine (Phila Pa 1976)
July 1, 2023

STUDY DESIGN: Retrospective cohort study. OBJECTIVE: Assess whether modifying spinal alignment goals to accommodate frailty considerations will decrease mechanical complications and maximize clinical outcomes. SUMMARY OF BACKGROUND DATA: The Global Alignment and Proportion (GAP) score was developed to assist in reducing mechanical complications, but has had less success predicting such events in external validation. Higher frailty and many of its components have been linked to the development of implant failure. Therefore, modifying the GAP score with frailty may strengthen its ability to predict mechanical complications. MATERIALS AND METHODS: We included 412 surgical ASD patients with two-year follow-up. Frailty was quantified using the modified Adult Spinal Deformity Frailty Index (mASD-FI). Outcomes: proximal junctional kyphosis and proximal junctional failure (PJF), major mechanical complications, and "Best Clinical Outcome" (BCO), defined as Oswestry Disability Index<15 and Scoliosis Research Society 22-item Questionnaire Total>4.5. Logistic regression analysis established a six-week score based on GAP score, frailty, and Oswestry Disability Index US Norms. Logistic regression followed by conditional inference tree analysis generated categorical thresholds. Multivariable logistic regression analysis controlling for confounders was used to assess the performance of the frailty-modified GAP score. RESULTS: Baseline frailty categories: 57% not frail, 30% frail, 14% severely frail. Overall, 39 of patients developed proximal junctional kyphosis, 8% PJF, 21% mechanical complications, 22% underwent reoperation, and 15% met BCO. The mASD-FI demonstrated a correlation with developing PJF, mechanical complications, undergoing reoperation, and meeting BCO at two years (all P <0.05). Regression analysis generated the following equation: Frailty-Adjusted Realignment Score (FAR Score)=0.49×mASD-FI+0.38×GAP Score. Thresholds for the FAR score (0-13): proportioned: <3.5, moderately disproportioned: 3.5-7.5, severely disproportioned: >7.5. Multivariable logistic regression assessing FAR score demonstrated associations with mechanical complications, reoperation, and meeting BCO by two years (all P <0.05), whereas the original GAP score was only significant for reoperation. CONCLUSION: This study demonstrated adjusting alignment goals in adult spinal deformity surgery for a patient's baseline frailty status and disability may be useful in minimizing the risk of complications and adverse events, outperforming the original GAP score in terms of prognostic capacity. LEVEL OF EVIDENCE: III.

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Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

July 1, 2023

Volume

48

Issue

13

Start / End Page

930 / 936

Location

United States

Related Subject Headings

  • Spinal Fusion
  • Retrospective Studies
  • Postoperative Complications
  • Orthopedics
  • Kyphosis
  • Humans
  • Frailty
  • Adult
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences
 

Citation

APA
Chicago
ICMJE
MLA
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Passias, P. G., Williamson, T. K., Krol, O., Tretiakov, P. S., Joujon-Roche, R., Imbo, B., … Lafage, V. (2023). Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity? Spine (Phila Pa 1976), 48(13), 930–936. https://doi.org/10.1097/BRS.0000000000004501
Passias, Peter G., Tyler K. Williamson, Oscar Krol, Peter S. Tretiakov, Rachel Joujon-Roche, Bailey Imbo, Salman Ahmad, et al. “Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity?Spine (Phila Pa 1976) 48, no. 13 (July 1, 2023): 930–36. https://doi.org/10.1097/BRS.0000000000004501.
Passias PG, Williamson TK, Krol O, Tretiakov PS, Joujon-Roche R, Imbo B, et al. Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity? Spine (Phila Pa 1976). 2023 Jul 1;48(13):930–6.
Passias, Peter G., et al. “Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity?Spine (Phila Pa 1976), vol. 48, no. 13, July 2023, pp. 930–36. Pubmed, doi:10.1097/BRS.0000000000004501.
Passias PG, Williamson TK, Krol O, Tretiakov PS, Joujon-Roche R, Imbo B, Ahmad S, Bennett-Caso C, Owusu-Sarpong S, Lebovic JB, Robertson D, Vira S, Dhillon E, Schoenfeld AJ, Janjua MB, Raman T, Protopsaltis TS, Maglaras C, O’Connell B, Daniels AH, Paulino C, Diebo BG, Smith JS, Schwab FJ, Lafage R, Lafage V. Should Global Realignment Be Tailored to Frailty Status for Patients Undergoing Surgical Intervention for Adult Spinal Deformity? Spine (Phila Pa 1976). 2023 Jul 1;48(13):930–936.

Published In

Spine (Phila Pa 1976)

DOI

EISSN

1528-1159

Publication Date

July 1, 2023

Volume

48

Issue

13

Start / End Page

930 / 936

Location

United States

Related Subject Headings

  • Spinal Fusion
  • Retrospective Studies
  • Postoperative Complications
  • Orthopedics
  • Kyphosis
  • Humans
  • Frailty
  • Adult
  • 4201 Allied health and rehabilitation science
  • 3209 Neurosciences