PMID- 35171837
OWN - NLM
STAT- PubMed-not-MEDLINE
LR  - 20240517
IS  - 1547-5646 (Electronic)
IS  - 1547-5654 (Print)
IS  - 1547-5646 (Linking)
VI  - 37
IP  - 1
DP  - 2022 Jul 1
TI  - Patient-reported outcome measure clustering after surgery for adult symptomatic 
      lumbar scoliosis.
PG  - 80-91
LID - 10.3171/2021.11.SPINE21949 [doi]
LID - 2021.11.SPINE21949
AB  - 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.
FAU - Wondra, James P
AU  - Wondra JP
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Kelly, Michael P
AU  - Kelly MP
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Yanik, Elizabeth L
AU  - Yanik EL
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Greenberg, Jacob K
AU  - Greenberg JK
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Smith, Justin S
AU  - Smith JS
AD  - 2Department of Neurological Surgery, University of Virginia Health System, 
      Charlottesville, Virginia.
FAU - Bess, Shay
AU  - Bess S
AD  - 3Denver International Spine Center, Denver, Colorado.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - 4Department of Neurological Surgery, Duke University, Durham, North Carolina; 
      and.
FAU - Lenke, Lawrence G
AU  - Lenke LG
AD  - 5Och Spine Hospital, Columbia University College of Physicians and Surgeons, New 
      York, New York.
FAU - Bridwell, Keith
AU  - Bridwell K
AD  - 1Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
LA  - eng
PT  - Journal Article
DEP - 20220114
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
PMC - PMC10193483
OTO - NOTNLM
OT  - adult
OT  - lumbar
OT  - patient-reported outcomes
OT  - scoliosis
OT  - spine deformity
OT  - surgery
COIS- Dr. Smith is a consultant for Zimmer Biomet, NuVasive, Carlsmed, Cerapedics, 
      DePuy Synthes, SeaSpine, and Stryker. He reports direct stock ownership in 
      NuVasive and Alphatec. He received clinical or research support for the study 
      described (includes equipment or material) from DePuy Synthes/ISSGF, and he 
      received support of a non-study-related clinical or research effort that he 
      oversaw from DePuy Synthes/ISSGF, NuVasive, and AO Spine. He receives royalties 
      from Zimmer Biomet, NuVasive, and Thieme. Dr. Bess is a consultant for Stryker, 
      Mirus, and Atec. He is a patent holder with Stryker and NuVasive. He received 
      clinical or research support for the study described (includes equipment or 
      material) from ISSFG, Medtronic, Globus, Stryker, Zimmer, and NuVasive. He 
      received support of a non-study-related clinical or research effort that he 
      oversaw from ISSGF, NuVasive, Medtronic, Stryker, Globus, SI Bone, and SeaSpine. 
      He receives royalties from Stryker and NuVasive. Dr. Shaffrey is a consultant for 
      Medtronic, NuVasive, and SI Bone. He reports direct stock ownership in NuVasive. 
      He is a patent holder with Medtronic, NuVasive, Zimmer Biomet, and SI Bone. He 
      receives royalties from Medtronic, NuVasive, and SI Bone. Dr. Lenke reports the 
      following. 1) Medtronic: paid consultant (monies donated to a charitable 
      foundation), royalties. 2) Broadwater: reimbursement for airfare/hotel. 3) 
      Scoliosis Research Society: reimbursement for airfare/hotel, grant support 
      (monies to institution). 4) Setting Scoliosis Straight Foundation: grant support 
      (monies to institution). 5) Evans Family donation: philanthropic research funding 
      from grateful patient/family. 6) Fox Family Foundation: philanthropic research 
      funding from grateful patient. 7) AO Spine: reimbursement for airfare/hotel, 
      grant support (monies to institution), and fellowship support to institution. 8) 
      Acuity Surgical: paid consultant (monies donated to charitable foundation), 
      royalties. 9) Abryx: paid consultant (monies donated to charitable foundation).
EDAT- 2022/02/17 06:00
MHDA- 2022/02/17 06:01
PMCR- 2022/01/14
CRDT- 2022/02/16 17:12
PHST- 2021/08/13 00:00 [received]
PHST- 2021/11/09 00:00 [accepted]
PHST- 2022/02/17 06:01 [medline]
PHST- 2022/02/17 06:00 [pubmed]
PHST- 2022/02/16 17:12 [entrez]
PHST- 2022/01/14 00:00 [pmc-release]
AID - 2021.11.SPINE21949 [pii]
AID - 10.3171/2021.11.SPINE21949 [doi]
PST - epublish
SO  - J Neurosurg Spine. 2022 Jan 14;37(1):80-91. doi: 10.3171/2021.11.SPINE21949. 
      Print 2022 Jul 1.