Clinical and Patient-Reported Outcomes of Adult Spinal Deformity Surgery with 10-Year Follow-Up

BACKGROUND CONTEXT: 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. STUDY DESIGN/SETTING: Retrospective review of prospective ASD database PATIENT SAMPLE: A total of 689 CD patients OUTCOME MEASURES: Complications, Health Related Quality-of-Life (HRQL) measures, outcomes 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. Postoperative complications and mortality are reported as a percentage of the studied cohort as of last follow-up. RESULTS: Eighty-two 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%). In total, 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. Postoperatively, 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 postoperative 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 10-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 10-year follow-up, improvement in patient-reported outcomes remains robust, with over 75.6% of patients achieved MCID in minimum one disability marker. FDA Device/Drug Status: This abstract does not discuss or include any applicable devices or drugs.

Duke Scholars

Author Christopher Ignatius Shaffrey Orthopaedic Surgery

Author Peter Passias Orthopaedic Surgery