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World Neurosurg. 2019 Dec;132:e297-e304. doi: 10.1016/j.wneu.2019.08.169. Epub 2019 Aug 31.

Younger Patients Are Differentially Affected by Stiffness-Related Disability Following Adult Spinal Deformity Surgery.

Author information

1
Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
2
Department of Orthopaedics, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA. Electronic address: alandanielsmd@gmail.com.
3
Department of Neurological Surgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, USA.
4
Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, New York, USA.
5
Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York, USA.
6
Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia, USA.
7
Spine Division, Duke University, Durham, North Carolina, USA.
8
Department of Orthopedic Surgery, Washington University, St. Louis, Missouri, USA.
9
Department of Orthopedic Surgery, University of California, Davis, Sacramento, California, USA.
10
Department of Orthopedic Surgery, University of Kansas Hospital, Kansas City, Kansas, USA.
11
Department of Orthopedic Surgery, Denver International Spine Center, Denver, Colorado, USA.
12
Department of Neurological Surgery, University of California, San Francisco, San Francisco, California, USA.
13
Department of Orthopedic Surgery, Swedish Neuroscience Institute, Seattle, Washington, USA.

Abstract

OBJECTIVE:

The Lumbar Stiffness Disability Index (LSDI) assesses impact of lumbar stiffness on activities of daily living. We hypothesized that patients <60 years old would perceive greater lumbar stiffness-related functional limitation following fusion for adult spinal deformity.

METHODS:

Patients completed the LSDI and Scoliosis Research Society 22 Questionnaire, Revised (SRS-22r) preoperatively and at 2 years postoperatively. The primary independent variable was patient age <60 versus ≥60. Multivariable regression analyses were used.

RESULTS:

Analysis included 267 patients. Patients <60 years old (51.3%) and ≥60 years old (48.7%) were evenly represented. In bivariable analysis, patients age <60 exhibited lower LSDI at baseline versus patients age ≥60 (25.7 vs. 35.5, β -9.8, P < 0.0001), but a directionally smaller difference at 2 years (26.4 vs. 32.3, β -5.8, P = 0.0147). LSDI was associated with lower SRS-22r total score among both age groups at baseline and 2 years (all P < 0.0001); the association was stronger among patients age <60 versus ≥60 at 2 years. LSDI was associated with SRS-22r satisfaction scores at 2 years among patients age <60 (P < 0.0001), but not patients age ≥60 (P = 0.2250). The difference in SRS-22r satisfaction per unit LSDI between patients <60 years old and ≥60 years old was significant (P = 0.0021).

CONCLUSIONS:

Among patients with adult spinal deformity managed operatively, higher LSDI was associated with inferior SRS-22r total score and satisfaction at 2 years postoperatively. The association between increased LSDI and worse patient-reported outcome measures was greater among patients age <60 versus ≥60. Preoperative counseling is needed for patients age <60 undergoing adult spinal deformity surgery regarding effects that lumbar stiffness may have on postoperative function and satisfaction.

KEYWORDS:

Adult spinal deformity; HRQOL; Lumbar spine stiffness

PMID:
31479783
DOI:
10.1016/j.wneu.2019.08.169
[Indexed for MEDLINE]

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