PMID- 29171797
OWN - NLM
STAT- MEDLINE
DCOM- 20180726
LR  - 20190104
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 28
IP  - 2
DP  - 2018 Feb
TI  - Health-related quality of life outcomes in complex adult spinal deformity 
      surgery.
PG  - 194-200
LID - 2017.6.SPINE17357 [pii]
LID - 10.3171/2017.6.SPINE17357 [doi]
AB  - OBJECTIVE Significant health-related quality of life (HRQOL) benefits have been 
      observed for patients undergoing primary and revision adult spinal deformity 
      (ASD) surgery. The purpose of this study was to report changes in HRQOL measures 
      in a consecutive series of patients undergoing complex spinal reconstructive 
      surgery, using Scoli-RISK-1 (SR-1) inclusion criteria. METHODS This was a 
      single-center, retrospective cohort study. The SR-1 inclusion criteria were used 
      to define patients with complex ASD treated between June 1, 2009, and June 1, 
      2011. Standard preoperative and perioperative data were collected, including the 
      Scoliosis Research Society (SRS)-22r instrument. The HRQOL changes were evaluated 
      at a minimum 2-year follow-up. Standardized forms were used to collect 
      surgery-related complications data for all patients. Complications were defined 
      as minor, transient major, or permanent major. Patients who achieved a minimum 
      2-year follow-up were included in the analysis. RESULTS Eighty-four patients 
      meeting SR-1 criteria were identified. Baseline demographic and surgical data 
      were available for 74/84 (88%) patients. Forty-seven of 74 (64%) patients met the 
      additional HRQOL criteria with a minimum 2-year follow-up (mean follow-up 3.4 
      years, range 2-6.5 years). Twenty-one percent of patients underwent posterior 
      fusion only, 40% of patients had a posterior column osteotomy, and 38% had a 
      3-column osteotomy. Seventy-five percent of patients underwent a revision 
      procedure. Significant improvements were observed in all SRS-22r domains: Pain: 
      +0.8 (p < 0.001); Self-Image: +1.4 (p < 0.001); Function: +0.46 (p < 0.001); 
      Satisfaction: +1.6 (p < 0.001); and Mental Health: +0.28 (p = 0.04). With the 
      exception of Mental Health, more than 50% of patients achieved a minimum 
      clinically important difference (MCID) in SRS-22r domain scores (Mental Health: 
      20/47, 42.6%). A total of 65 complications occurred in 31 patients. This includes 
      29.8% (14/47) of patients who suffered a major complication and 17% (8/47) who 
      suffered a postoperative neurological deficit, most commonly at the root level 
      (10.6%, 5/47). Of the 8 patients who suffered a neurological deficit, 1 (13%) was 
      able to achieve MCID in the SRS Function domain. CONCLUSIONS The majority of 
      patients experienced clinically relevant improvement in SRS-22r HRQOL scores 
      after complex ASD surgery. The greatest improvements were seen in the SRS Pain 
      and SRS Self-Image domains. Although 30% of patients suffered a major or 
      permanent complication, benefits from surgery were still attained. Patients 
      sustaining a neurological deficit or major complication were unlikely to achieve 
      HRQOL improvements meeting or exceeding MCID for the SRS Function domain.
FAU - Riley, Max S
AU  - Riley MS
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri; and.
FAU - Bridwell, Keith H
AU  - Bridwell KH
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri; and.
FAU - Lenke, Lawrence G
AU  - Lenke LG
AD  - 2Department of Orthopedic Surgery, Columbia University College of Physicians and 
      Surgeons, New York, New York.
FAU - Dalton, Jonathan
AU  - Dalton J
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri; and.
FAU - Kelly, Michael P
AU  - Kelly MP
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri; and.
LA  - eng
PT  - Journal Article
DEP - 20171124
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Female
MH  - Follow-Up Studies
MH  - Humans
MH  - Male
MH  - Mental Health
MH  - Middle Aged
MH  - Osteotomy
MH  - Pain/surgery
MH  - Patient Satisfaction
MH  - Postoperative Complications/epidemiology/psychology
MH  - *Quality of Life
MH  - Retrospective Studies
MH  - Self Concept
MH  - Spinal Curvatures/psychology/*surgery
MH  - Treatment Outcome
OTO - NOTNLM
OT  - 3-CO = 3-column osteotomy
OT  - ASD = adult spinal deformity
OT  - HRQOL = health-related quality of life
OT  - IOM = intraoperative neurophysiological monitoring
OT  - MCID = minimum clinically important difference
OT  - SR-1 = Scoli-RISK-1
OT  - SRS = Scoliosis Research Society
OT  - Scoli-RISK-1
OT  - adult spinal deformity
OT  - complex
OT  - osteotomy
OT  - outcomes
OT  - scoliosis
OT  - subtraction
EDAT- 2017/11/25 06:00
MHDA- 2018/07/27 06:00
CRDT- 2017/11/25 06:00
PHST- 2017/11/25 06:00 [pubmed]
PHST- 2018/07/27 06:00 [medline]
PHST- 2017/11/25 06:00 [entrez]
AID - 2017.6.SPINE17357 [pii]
AID - 10.3171/2017.6.SPINE17357 [doi]
PST - ppublish
SO  - J Neurosurg Spine. 2018 Feb;28(2):194-200. doi: 10.3171/2017.6.SPINE17357. Epub 
      2017 Nov 24.