Stiffness after Pan-Lumbar Arthrodesis for Adult Spinal Deformity Does Not Significantly Impact Patient Functional Status or Satisfaction Irrespective of Proximal Endpoint

the International Spine Study Group

Research output: Contribution to journalArticle

Abstract

STUDY DESIGN.: Prospective, multi-center OBJECTIVE.: To determine if stiffness significantly affects function or satisfaction after pan-lumbar arthrodesis. SUMMARY OF BACKGROUND DATA.: The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. Data suggests that patients undergoing fusion of the entire lumbar spine are at greatest risk of functional limitations from stiffness. METHODS.: The LSDI, Short Form 36 (SF-36), Scoliosis Research Society-22 (SRS-22), and Oswestry Disability Index (ODI) were administered pre-operatively and at 2-year minimum follow-up to 103 spinal deformity patients from 11 centers. Patients were separated according to the proximal arthrodesis level; upper thoracic (T2-5) to pelvis (UT-Pelvis) or thoraco-lumbar (T10-T12) to pelvis (TL-Pelvis). Outcome scores were compared using Studentʼs t-test or Tukey-Kramer HSD ANOVA. Regression analysis of final LSDI scores versus SRS-22 Satisfaction scores was performed. RESULTS.: Mean ages, baseline values and final scores of all outcome parameters were statistically equivalent in the 2 groups. Final LSDI scores did not change significantly from baseline in the UT-Pelvis (p?=?0.478) or TL-Pelvis (p?=?0.301) groups. In contrast, highly significant improvements (p?≤?0.0001) from baseline were seen in both groups for other health-related QoL measures. The 2-year Satisfaction scores were statistically equivalent in the 2 groups, and the correlation between final LSDI and Satisfaction scores in the entire cohort was not significant (R?=?0.013, p?=?0.146). CONCLUSIONS.: Patients undergoing pan-lumbar arthrodesis for adult spinal deformity did not experience substantial increases in disability due to stiffness of the low back, although they did report significant improvements in other health-related QoL measures. Further, LSDI scores did not correlate with patient satisfaction. There were no significant differences in perceived stiffness effects whether arthrodesis stopped in the thoracolumbar or upper thoracic regions. We hope these results will be useful to spine surgeons and patients during pre-operative planning and discussions.Level of Evidence: 2

Original languageEnglish (US)
JournalSpine
DOIs
StateAccepted/In press - Nov 29 2016

Fingerprint

Arthrodesis
Pelvis
Scoliosis
Spine
Thorax
Health
Patient Satisfaction
Research
Analysis of Variance
Regression Analysis
Students

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology

Cite this

@article{b9db583f84194032a2106d34cf55b122,
title = "Stiffness after Pan-Lumbar Arthrodesis for Adult Spinal Deformity Does Not Significantly Impact Patient Functional Status or Satisfaction Irrespective of Proximal Endpoint",
abstract = "STUDY DESIGN.: Prospective, multi-center OBJECTIVE.: To determine if stiffness significantly affects function or satisfaction after pan-lumbar arthrodesis. SUMMARY OF BACKGROUND DATA.: The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. Data suggests that patients undergoing fusion of the entire lumbar spine are at greatest risk of functional limitations from stiffness. METHODS.: The LSDI, Short Form 36 (SF-36), Scoliosis Research Society-22 (SRS-22), and Oswestry Disability Index (ODI) were administered pre-operatively and at 2-year minimum follow-up to 103 spinal deformity patients from 11 centers. Patients were separated according to the proximal arthrodesis level; upper thoracic (T2-5) to pelvis (UT-Pelvis) or thoraco-lumbar (T10-T12) to pelvis (TL-Pelvis). Outcome scores were compared using Studentʼs t-test or Tukey-Kramer HSD ANOVA. Regression analysis of final LSDI scores versus SRS-22 Satisfaction scores was performed. RESULTS.: Mean ages, baseline values and final scores of all outcome parameters were statistically equivalent in the 2 groups. Final LSDI scores did not change significantly from baseline in the UT-Pelvis (p?=?0.478) or TL-Pelvis (p?=?0.301) groups. In contrast, highly significant improvements (p?≤?0.0001) from baseline were seen in both groups for other health-related QoL measures. The 2-year Satisfaction scores were statistically equivalent in the 2 groups, and the correlation between final LSDI and Satisfaction scores in the entire cohort was not significant (R?=?0.013, p?=?0.146). CONCLUSIONS.: Patients undergoing pan-lumbar arthrodesis for adult spinal deformity did not experience substantial increases in disability due to stiffness of the low back, although they did report significant improvements in other health-related QoL measures. Further, LSDI scores did not correlate with patient satisfaction. There were no significant differences in perceived stiffness effects whether arthrodesis stopped in the thoracolumbar or upper thoracic regions. We hope these results will be useful to spine surgeons and patients during pre-operative planning and discussions.Level of Evidence: 2",
author = "{the International Spine Study Group} and Hart, {Robert A.} and Jayme Hiratzka and Kane, {Marie S.} and Virginie Lafage and Eric Klineberg and Ames, {Christopher P.} and Line, {Breton G.} and Frank Schwab and Scheer, {Justin K.} and Shay Bess and Hamilton, {Kojo K.} and Shaffrey, {Christopher I.} and Greg Mundis and Smith, {Justin S.} and Burton, {Douglas C.} and Daniel Sciubba and Vedat Deviren and Oheneba Boachie-Adjei",
year = "2016",
month = "11",
day = "29",
doi = "10.1097/BRS.0000000000002006",
language = "English (US)",
journal = "Spine",
issn = "0362-2436",
publisher = "Lippincott Williams and Wilkins",

}

TY - JOUR

T1 - Stiffness after Pan-Lumbar Arthrodesis for Adult Spinal Deformity Does Not Significantly Impact Patient Functional Status or Satisfaction Irrespective of Proximal Endpoint

AU - the International Spine Study Group

AU - Hart, Robert A.

AU - Hiratzka, Jayme

AU - Kane, Marie S.

AU - Lafage, Virginie

AU - Klineberg, Eric

AU - Ames, Christopher P.

AU - Line, Breton G.

AU - Schwab, Frank

AU - Scheer, Justin K.

AU - Bess, Shay

AU - Hamilton, Kojo K.

AU - Shaffrey, Christopher I.

AU - Mundis, Greg

AU - Smith, Justin S.

AU - Burton, Douglas C.

AU - Sciubba, Daniel

AU - Deviren, Vedat

AU - Boachie-Adjei, Oheneba

PY - 2016/11/29

Y1 - 2016/11/29

N2 - STUDY DESIGN.: Prospective, multi-center OBJECTIVE.: To determine if stiffness significantly affects function or satisfaction after pan-lumbar arthrodesis. SUMMARY OF BACKGROUND DATA.: The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. Data suggests that patients undergoing fusion of the entire lumbar spine are at greatest risk of functional limitations from stiffness. METHODS.: The LSDI, Short Form 36 (SF-36), Scoliosis Research Society-22 (SRS-22), and Oswestry Disability Index (ODI) were administered pre-operatively and at 2-year minimum follow-up to 103 spinal deformity patients from 11 centers. Patients were separated according to the proximal arthrodesis level; upper thoracic (T2-5) to pelvis (UT-Pelvis) or thoraco-lumbar (T10-T12) to pelvis (TL-Pelvis). Outcome scores were compared using Studentʼs t-test or Tukey-Kramer HSD ANOVA. Regression analysis of final LSDI scores versus SRS-22 Satisfaction scores was performed. RESULTS.: Mean ages, baseline values and final scores of all outcome parameters were statistically equivalent in the 2 groups. Final LSDI scores did not change significantly from baseline in the UT-Pelvis (p?=?0.478) or TL-Pelvis (p?=?0.301) groups. In contrast, highly significant improvements (p?≤?0.0001) from baseline were seen in both groups for other health-related QoL measures. The 2-year Satisfaction scores were statistically equivalent in the 2 groups, and the correlation between final LSDI and Satisfaction scores in the entire cohort was not significant (R?=?0.013, p?=?0.146). CONCLUSIONS.: Patients undergoing pan-lumbar arthrodesis for adult spinal deformity did not experience substantial increases in disability due to stiffness of the low back, although they did report significant improvements in other health-related QoL measures. Further, LSDI scores did not correlate with patient satisfaction. There were no significant differences in perceived stiffness effects whether arthrodesis stopped in the thoracolumbar or upper thoracic regions. We hope these results will be useful to spine surgeons and patients during pre-operative planning and discussions.Level of Evidence: 2

AB - STUDY DESIGN.: Prospective, multi-center OBJECTIVE.: To determine if stiffness significantly affects function or satisfaction after pan-lumbar arthrodesis. SUMMARY OF BACKGROUND DATA.: The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. Data suggests that patients undergoing fusion of the entire lumbar spine are at greatest risk of functional limitations from stiffness. METHODS.: The LSDI, Short Form 36 (SF-36), Scoliosis Research Society-22 (SRS-22), and Oswestry Disability Index (ODI) were administered pre-operatively and at 2-year minimum follow-up to 103 spinal deformity patients from 11 centers. Patients were separated according to the proximal arthrodesis level; upper thoracic (T2-5) to pelvis (UT-Pelvis) or thoraco-lumbar (T10-T12) to pelvis (TL-Pelvis). Outcome scores were compared using Studentʼs t-test or Tukey-Kramer HSD ANOVA. Regression analysis of final LSDI scores versus SRS-22 Satisfaction scores was performed. RESULTS.: Mean ages, baseline values and final scores of all outcome parameters were statistically equivalent in the 2 groups. Final LSDI scores did not change significantly from baseline in the UT-Pelvis (p?=?0.478) or TL-Pelvis (p?=?0.301) groups. In contrast, highly significant improvements (p?≤?0.0001) from baseline were seen in both groups for other health-related QoL measures. The 2-year Satisfaction scores were statistically equivalent in the 2 groups, and the correlation between final LSDI and Satisfaction scores in the entire cohort was not significant (R?=?0.013, p?=?0.146). CONCLUSIONS.: Patients undergoing pan-lumbar arthrodesis for adult spinal deformity did not experience substantial increases in disability due to stiffness of the low back, although they did report significant improvements in other health-related QoL measures. Further, LSDI scores did not correlate with patient satisfaction. There were no significant differences in perceived stiffness effects whether arthrodesis stopped in the thoracolumbar or upper thoracic regions. We hope these results will be useful to spine surgeons and patients during pre-operative planning and discussions.Level of Evidence: 2

UR - http://www.scopus.com/inward/record.url?scp=85000714866&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85000714866&partnerID=8YFLogxK

U2 - 10.1097/BRS.0000000000002006

DO - 10.1097/BRS.0000000000002006

M3 - Article

C2 - 27902557

AN - SCOPUS:85000714866

JO - Spine

JF - Spine

SN - 0362-2436

ER -