PMID- 26091440 OWN - NLM STAT- MEDLINE DCOM- 20151120 LR - 20211022 IS - 1547-5646 (Electronic) IS - 1547-5646 (Linking) VI - 23 IP - 3 DP - 2015 Sep TI - The likelihood of reaching minimum clinically important difference and substantial clinical benefit at 2 years following a 3-column osteotomy: analysis of 140 patients. PG - 340-8 LID - 10.3171/2014.12.SPINE141031 [doi] AB - OBJECT: Three-column osteotomies (3COs) are technically challenging techniques for correcting severe rigid spinal deformities. The impact of these interventions on outcomes reaching minimum clinically important difference (MCID) or substantial clinical benefit (SCB) is unclear. The objective of this study was to determine the rates of MCID and SCB in standard health-related quality of life (HRQOL) measures after 3COs in patients with adult spinal deformity (ASD). The impacts of location of the uppermost instrumented vertebra (UIV) on clinical outcomes and of maintenance on sagittal correction at 2 years postoperatively were also examined. METHODS: The authors conducted a retrospective multicenter analysis of the records from adult patients who underwent 3CO with complete 2-year radiographic and clinical follow-ups. Cases were categorized according to established radiographic thresholds for pelvic tilt (> 22 degrees ), sagittal vertical axis (> 4.7 cm), and the mismatch between pelvic incidence and lumbar lordosis (> 11 degrees ). The cases were also analyzed on the basis of a UIV in the upper thoracic (T1-6) or thoracolumbar (T9-L1) region. Patient-reported outcome measures evaluated preoperatively and 2 years postoperatively included Oswestry Disability Index (ODI) scores, the Physical Component Summary and Mental Component Summary (MCS) scores of the 36-Item Short Form Health Survey, and Scoliosis Research Society-22 questionnaire (SRS-22) scores. The percentages of patients whose outcomes for these measures met MCID and SCB were compared among the groups. RESULTS: Data from 140 patients (101 women and 39 men) were included in the analysis; the average patient age was 57.3 +/- 12.4 years (range 20-82 years). Of these patients, 94 had undergone only pedicle subtraction osteotomy (PSO) and 42 only vertebral column resection (VCR); 113 patients had a UIV in the upper thoracic (n = 63) orthoracolumbar region (n = 50). On average, 2 years postoperatively the patients had significantly improved in all HRQOL measures except the MCS score. For the entire patient cohort, the improvements ranged from 57.6% for the SRS-22 pain score MCID to 24.4% for the ODI score SCB. For patients undergoing PSO or VCR, the likelihood of their outcomes reaching MCID or SCB ranged from 24.3% to 62.3% and from 16.2% to 47.8%, respectively. The SRS-22 self-image score of patients who had a UIV in the upper thoracic region reached MCID significantly more than that of patients who had a UIV in the thoracolumbar region (70.6% vs 41.9%, p = 0.0281). All other outcomes were similar for UIVs of upper thoracic and thoracolumbar regions. Comparison of patients whose spines were above or below the radiographic thresholds associated with disability indicated similar rates of meeting MCID and SCB for HRQOL at the 2-year follow-up. CONCLUSIONS: Outcomes for patients having UIVs in the upper thoracic region were no more likely to meet MCID or SCB than for those having UIVs in the thoracolumbar region, except for the MCID in the SRS-22 self-image measure. The HRQOL outcomes in patients who had optimal sagittal correction according to radiographic thresholds determined preoperatively were not significantly more likely to reach MCID or SCB at the 2-year follow-up. Future work needs to determine whether the Schwab preoperative radiographic thresholds for severe disability apply in postoperative settings. FAU - Fakurnejad, Shayan AU - Fakurnejad S AD - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; FAU - Scheer, Justin K AU - Scheer JK AD - Department of Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois; FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York; FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; FAU - Deviren, Vedat AU - Deviren V AD - Departments of 4 Orthopaedic Surgery and. FAU - Hostin, Richard AU - Hostin R AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas; FAU - Mundis, Gregory M Jr AU - Mundis GM Jr AD - San Diego Center for Spinal Disorders, La Jolla; FAU - Burton, Douglas C AU - Burton DC AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; FAU - Klineberg, Eric AU - Klineberg E AD - Department of Orthopaedic Surgery, University of California, Davis, California; FAU - Gupta, Munish AU - Gupta M AD - Department of Orthopaedic Surgery, University of California, Davis, California; FAU - Kebaish, Khaled AU - Kebaish K AD - Department of Orthopaedic Surgery, Johns Hopkins University, Baltimore, Maryland; and. FAU - Shaffrey, Christopher I AU - Shaffrey CI AD - Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; FAU - Bess, Shay AU - Bess S AD - Rocky Mountain Hospital for Children, Denver, Colorado. FAU - Schwab, Frank AU - Schwab F AD - Department of Orthopaedic Surgery, New York University Hospital for Joint Diseases, New York, New York; FAU - Ames, Christopher P AU - Ames CP AD - Neurological Surgery, University of California, San Francisco; CN - International Spine Study Group LA - eng PT - Journal Article PT - Multicenter Study DEP - 20150619 PL - United States TA - J Neurosurg Spine JT - Journal of neurosurgery. Spine JID - 101223545 SB - IM MH - Adult MH - Aged MH - Aged, 80 and over MH - Female MH - Health Status MH - Humans MH - Lordosis/diagnostic imaging/*surgery MH - Lumbar Vertebrae/diagnostic imaging/*surgery MH - Male MH - Middle Aged MH - Osteotomy/*methods MH - Quality of Life MH - Radiography MH - Retrospective Studies MH - Scoliosis/diagnostic imaging/*surgery MH - Spinal Fusion/*methods MH - Surveys and Questionnaires MH - Thoracic Vertebrae/diagnostic imaging/*surgery MH - Treatment Outcome MH - Young Adult OTO - NOTNLM OT - 3-column osteotomy OT - 3CO = 3-column osteotomy OT - ASD = adult spinal deformity OT - HRQOL = health-related quality of life OT - ISSG = International Spine Study Group OT - MCID = minimum clinically important difference OT - MCS = Mental Component Summary OT - ODI = Oswestry Disability Index OT - PCS = Physical Component Summary OT - PI-LL = mismatch between pelvic incidence and lumbar lordosis OT - PSO = pedicle subtraction osteotomy OT - SCB = substantial clinical benefit OT - SF-36 = 36-Item Short Form Health Survey OT - SRS-22 = Scoliosis Research Society-22 questionnaire OT - SVA = sagittal vertical axis OT - UIV = uppermost instrumented vertebra OT - VCR = vertebral column resection OT - minimum clinically important difference OT - pedicle subtraction osteotomy OT - spinal deformity OT - spinal disorders OT - substantial clinical benefit OT - vertebral column resection EDAT- 2015/06/20 06:00 MHDA- 2015/12/15 06:00 CRDT- 2015/06/20 06:00 PHST- 2015/06/20 06:00 [entrez] PHST- 2015/06/20 06:00 [pubmed] PHST- 2015/12/15 06:00 [medline] AID - 10.3171/2014.12.SPINE141031 [doi] PST - ppublish SO - J Neurosurg Spine. 2015 Sep;23(3):340-8. doi: 10.3171/2014.12.SPINE141031. Epub 2015 Jun 19.