The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference

OBJECTIVEThe Scoliosis Research Society-22r questionnaire (SRS-22r) has been shown to be reliable, valid, and responsive to change in patients with adult spinal deformity (ASD) undergoing surgery. The minimal clinically important difference (MCID) is the smallest difference in a health-related quality of life score that is considered to be worthwhile or clinically important to the individual. The authors hypothesized that the proportion of patients with ASD achieving an MCID in the SRS-22r score would be different between two culturally different cohorts. The purpose of this study was to compare the proportion of patients with ASD achieving MCID for the SRS-22r domains in North American (NA) and Japanese cohorts.METHODSA total of 137 patients from North America (123 women, mean age 60.0 years) and 60 patients from Japan (56 women, mean age 65.5 years) with at least 2 years of follow-up after corrective spine surgery for ASD were included. Except for self-image, published Japanese MCID values of SRS-22r for ASD were higher (function = 0.90, pain = 0.85, self-image = 1.05, subtotal = 1.05) than the published NA MCID values (function = 0.60, pain = 0.40, self-image = 1.23, subtotal = 0.43).RESULTSThere was a statistically significant improvement in all SRS-22r domain scores at 2 years compared to baseline in both cohorts. Except for mental health (NA = 0.32, Japanese = 0.72, p = 0.005), the mean improvement from baseline to 2 years was similar between the NA and Japanese cohorts. The proportion of patients achieving MCID was higher in North America for function (NA = 51%, Japanese = 30%, p = 0.006), pain (NA = 80%, Japanese = 47%, p < 0.001), and subtotal (NA = 72%, Japanese = 35%, p < 0.001), while there was no significant difference for self-image (NA = 53%, Japanese = 58%, p = 0.454).CONCLUSIONSDespite similar improvements in SRS-22r domain scores from baseline to 2 years postoperatively, the proportion of patients reaching SRS-22r MCID for function, pain, and subtotal after ASD surgery was higher in the NA cohort than in the Japanese cohort. This may imply that patients in North America and Japan may value observed changes in clinical status differently.

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Development of a Preoperative Predictive Model for Reaching the Oswestry Disability Index Minimal Clinically Important Difference for Adult Spinal Deformity Patients

Spine Deformity ◽

10.1016/j.jspd.2018.02.010 ◽

2018 ◽

Vol 6 (5) ◽

pp. 593-599 ◽

Cited By ~ 10

Author(s):

Justin K. Scheer ◽

Joseph A. Osorio ◽

Justin S. Smith ◽

Frank Schwab ◽

Robert A. Hart ◽

...

Keyword(s):

Predictive Model ◽

Spinal Deformity ◽

Oswestry Disability Index ◽

Minimal Clinically Important Difference ◽

Adult Spinal Deformity ◽

Clinically Important Difference

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Likelihood of Reaching Minimal Clinically Important Difference in Health-Related Quality of Life Measures: Prospective Analysis of Operative and Nonoperative Treatment of Adult Spinal Deformity

The Spine Journal ◽

10.1016/j.spinee.2012.08.069 ◽

2012 ◽

Vol 12 (9) ◽

pp. S17-S18

Author(s):

Virginie Lafage ◽

Justin S. Smith ◽

Frank J. Schwab ◽

Bertrand Moal ◽

Eric O. Klineberg ◽

...

Keyword(s):

Minimal Clinically Important Difference ◽

Adult Spinal Deformity ◽

Nonoperative Treatment ◽

Prospective Analysis ◽

Health Related Quality ◽

Quality Of Life Measures ◽

Clinically Important Difference ◽

Related Quality ◽

Health Related

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Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective Multicenter, Propensity-Matched Cohort Assessment with Minimum 2-Year Follow-Up *

50 Landmark Papers ◽

10.1201/9781315154053-41 ◽

2018 ◽

pp. 211-215

Author(s):

Ryan P. McLynn ◽

Jonathan N. Grauer

Keyword(s):

Spinal Deformity ◽

Adult Spinal Deformity ◽

Nonoperative Treatment ◽

Matched Cohort

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Treatment strategy for rod fractures following corrective fusion surgery in adult spinal deformity depends on symptoms and local alignment change

Journal of Neurosurgery Spine ◽

10.3171/2017.9.spine17525 ◽

2018 ◽

Vol 29 (1) ◽

pp. 59-67 ◽

Cited By ~ 7

Author(s):

Yu Yamato ◽

Tomohiko Hasegawa ◽

Sho Kobayashi ◽

Tatsuya Yasuda ◽

Daisuke Togawa ◽

...

Keyword(s):

Spinal Deformity ◽

Revision Surgery ◽

Treatment Strategy ◽

Time Course ◽

Clinical Symptoms ◽

Adult Spinal Deformity ◽

Nonoperative Treatment ◽

Local Alignment ◽

Fusion Surgery

OBJECTIVEDespite the significant incidence of rod fractures (RFs) following long-segment corrective fusion surgery, little is known about the optimal treatment strategy. The objectives of this study were to investigate the time course of clinical symptoms and treatments in patients with RFs following adult spinal deformity (ASD) surgery and to establish treatment recommendations.METHODSThis study was a retrospective case series of patients with RFs whose data were retrieved from a prospectively collected single-center database. The authors reviewed the cases of 304 patients (mean age 62.9 years) who underwent ASD surgery. Primary symptoms, time course of symptoms, and treatments were investigated by reviewing medical records. Standing whole-spine radiographs obtained before and after RF development and at last follow-up were evaluated. Osseous union was assessed using CT scans and intraoperative findings.RESULTSThere were 54 RFs in 53 patients (mean age 68.5 years [range 41–84 years]) occurring at a mean of 21 months (range 6–47 months) after surgery. In 1 patient RF occurred twice, with each case at a different time and level, and the symptoms and treatments for these 2 RFs were analyzed separately (1 case of revision surgery and 1 case of nonoperative treatment). The overall rate of RF observed on radiographs after a minimum follow-up of 1 year was 18.0% (54 of 300 cases). The clinical symptoms at the time of RF were pain in 77.8% (42 of 54 cases) and no onset of new symptoms in 20.5% (11 of 54 cases). The pain was temporary and had subsided in 19 of 42 cases (45%) within 2 weeks. In 36 of the 54 cases (66.7%) (including the first RF in the patient with 2 RFs), patients underwent revision surgery at a mean of 116 days (range 5–888 days) after diagnosis. In 18 cases patients received only nonoperative treatment as of the last follow-up, including 17 cases in which the patients experienced no pain and no remarkable progression of deformity (mean 18.5 months after RF development).CONCLUSIONSThis analysis of 54 RFs in 53 patients following corrective fusion surgery for ASD demonstrates a relationship between symptoms and alignment change. Revision surgeries were performed in a total of 36 cases. Nonoperative care was offered in 18 (33.3%) of 54 cases at the last follow-up, with no additional symptoms in 17 of the 18 cases. These data offer useful information regarding informed decision making for patients in whom an RF occurs after ASD surgery.

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