Faculty Bibliography

BACKGROUND CONTEXT: VBT takes advantage of the Hueter-Volkmann principle, and modulates growth across intervertebral disc spaces with a tensioned tether secured at the lateral aspects of vertebral bodies. Cervical deformity in AIS patients is associated with lower health related quality of life. PSF constructs have been shown to improve cervical deformity, however, to date, these relationships have not been described in patients treated with VBT. PURPOSE: Determine if cervical sagittal alignment parameters following VBT for correction of AIS are similar to what is observed following PSF. STUDY DESIGN/SETTING: Multi-center retrospective cohort study. PATIENT SAMPLE: Patients with AIS that undergo correction surgeries with LIV in the lumbar spine from 2013 to 2021 with pre- and 2-year postop standing full body plain films available. OUTCOME MEASURES: Outcome measures: Age, height, weight, BMI, Risser score, LIV and levels instrumented. Radiographic analysis included pre- and postop C2 to C7 sagittal vertical axis (cSVA), cervical lordosis angle (CL), T1 slope and thoracic kyphosis (TK).
METHOD(S): Measures were compared using independent samples t-tests, significance set at p<0.05.
RESULT(S): A total of 99 patients: 49 VBT and 50 fusions. The VBT cohort Lenke class breakdown is 23% 1A, 13% 1C, 31% 3C; 18% 5C, and 15% 6C, while the PSF cohort consisted of 42% 1A, 6% 1B, 2% 2C, 2% 3B, 12% 3C, 2% 5B, 24% 5C, and 10% 6C. There were no significant differences with regard to patient age or number of levels instrumented. Patients included in the VBT cohort had a lower level of bone maturity as defined by Risser class (1.6+/-0.9 vs 2.6+/-1.8, p=0.001). The VBT cohort had higher baseline cSVA (3.4mm+/-1.6 vs -1.0mm+/-3.1, 0.001) and less CL (-0.6degree+/-18.2 vs 11.6degree+/-12.8, p=0.001) than the fusion cohort. No differences in baseline T1 slope or Thoracic Kyphosis was observed. VBT patients also had higher 2-year cSVA (3.4mm+/-1.4 vs -3.7mm+/-2.1, p=0.001) and less CL (-4.0+/-18.5 vs 7.0+/-12.2, p=0.001) compared to fusion patients. The PSF group had a significantly greater correction in cSVA than the VBT group (2.8mm+/-4.0 vs 0mm+/-1.6, p=0.001). Both groups displayed improvement in radiographic parameters of cervical and thoracic alignment including CL (VBT 3.3degreevs 4.3degree, p=0.74), T1 slope (VBT -4.3degreevs -4.9degree, p=0.81) and TK (VBT -6.1degreevs -3.9degree, p=0.47). After PSM for Lenke classification, 66 patients remained: 33 VBT, 33 PSF. The PSF group continued to demonstrate greater improvement in cSVA than the VBT group (3.2mm+/-3.0 vs -0.3+/-1.8, p=0.001.
CONCLUSION(S): VBT and PSF both improve radiographic parameters of cervical alignment in AIS patients; however, PSF showed greater correction of cSVA at 2-year followup. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Prophylaxis usage has been established in literature as an important component of minimizing the risk of proximal junctional kyphosis (PJK) and proximal junctional failure (PJF) development. However, literature is scarce on the effects of prophylaxis in patients who have achieved adequate postoperative alignment and those who maintained poor alignment postoperatively. PURPOSE: To investigate how PJK prophylaxis impacts rates of PJK and PJF with and without ideal alignment and the associated cost/cost-effectiveness. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective adult thoracolumbar deformity database. PATIENT SAMPLE: This study included 1,541 patients. OUTCOME MEASURES: Radiographic alignment, patient-reported outcome measures (ODI), cost per QALY.
METHOD(S): Operative adult spinal deformity patients (scoliosis >20degree, SVA>5cm, PT>25degree, or TK>60degree) with an UIV at L1 or below and available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. "Matched" and "unmatched" alignment refers to the age-adjusted alignment criteria. PJK prophylaxis was defined by usage of cement, hooks or tethers. PJF was defined as PJK with reoperation. Costs were calculated using the PearlDiver database, accounting for additional costs of prophylaxis when applicable, through estimates from Medicare pay scales for services within a 30-day window, including estimates regarding costs of postoperative complications, outpatient healthcare encounters, revisions and medical related readmissions. QALY was calculated using SF6D.
RESULT(S): A total of 738 ASD patients or below met inclusion criteria (59.9yrs+/-14.0, 79%F, BMI: 27.7 kg/m2 +/-6.0, CCI: 1.8 +/-1.7). Surgically, patients had a mean level fused of 11.1+/-4.4, LOS of 7.9 days+/-4.4, EBL of 1577 mL, operative time of 377 min, with 63% undergoing an osteotomy. Forty percent of patients had PJK prophylaxis. Controlling for age, CCI, BL osteoporosis, levels fused, usage of 3CO, UIV, BL SVA and BL PI-LL, patients who were matched postoperatively in PT, SVA, or PI-LL had lowered PJF rates (OR:.5, 95% CI:.28-.86, p=.01) with prophylaxis. Among those unmatched in either SVA, PILL, or PT by 6W, prophylaxis significantly reduced the rates of PJK and PJF as well (p <0.05). ANCOVA controlling for age, CCI, BL osteoporosis, levels fused, usage of 3CO, UIV, BL SVA and BL PI-LL shows patients with ideal age-adjusted alignment and prophylaxis resulted in a lower cost per QALY by 2Y ($399,948 vs $514,228, p <.001). Similarly, in unmatched patients, prophylaxis resulted in a substantially lower cost per QALY by 2Y ($466,409 vs 672, 024, p <.001), primarily due to decreased costs of reoperation and greater improvements in QALY among prophylaxis cohorts.
CONCLUSION(S): Despite additional surgical cost, optimization of radiographic realignment in conjunction with utilization of proximal junctional failure prophylactic techniques achieves ideal cost utility, predominately due to the minimization of mechanical failure related reoperations. Even among those not achieving optimal alignment, junctional prophylactic measures improved cost utility, emphasizing its critical role of minimization of junctional failures to achieve cost efficiency in adult spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Previous orthopedic literature has shown that patients with diabetes mellitus (DM) are more likely to develop complications in the postoperative period. To date, however, no study has assessed the specific pre- and postoperative risk factors that may contribute to this association for diabetic patients undergoing adult spinal deformity surgery. PURPOSE: Establish relevant risk factors for postoperative complications in a cohort of diabetic patients undergoing spinal deformity surgery. STUDY DESIGN/SETTING: Single-center retrospective cohort study. PATIENT SAMPLE: A total of 138 patients with DM who underwent spinal deformity surgery at a single academic hospital from 2012-2019. OUTCOME MEASURES: Primary outcomes were the development of any post-operative complications. These complications included the development of neurologic complications, urinary complications, cardiac complications, pulmonary complications, venous thromboembolism (VTE) and surgical site infections (SSI).
METHOD(S): This study is a retrospective cohort review of diabetic patients undergoing spinal deformity surgery, with 5 levels fused at a single academic medical center. Patients' age, BMI, levels fused, pre- and postoperative hemoglobin (Hgb), hematocrit (HCT) and preoperative HbA1C were collected. T-test and chi-square analyses were used to compare relevant outcomes. Significance was set to p<0.05.
RESULT(S): A total of 138 patients with DM met the inclusion criteria and were included in the analysis. Of these, 50.7% of the total cohort developed a postoperative complication within 90 days of the index surgery. Patients who developed postoperative complications were noted to have significantly lower postoperative Hgb (9.82+/-1.46 g/dL vs 10.72+/-1.76 g/dL, p=0.002) postoperative HCT (28.8+/-3.92% vs 32.60+/-4.61%, p<0.001) and significantly greater number of levels fused (9.49+/-3.74 vs 7.47+/-3.16, p=0.001). Diabetic patients who developed cardiac complications had significantly lower postoperative Hgb (9.47+/-1.50 g/dL vs 10.40+/-1.66 g/dL, p=0.021) and HCT (27.87+/-3.16% vs 31.15+/-4.72%, p=0.003) compared with those who did not. Diabetic patients who developed urinary complications were noted to be older on average (72.56+/-8.20 vs 64.43+/-11.70 years, p=0.043), while patients who developed VTE and pulmonary complications were noted to have significantly higher numbers of levels fused (VTE: 14.00+/-3.61 vs 8.37+/-3.51, p=0.007; PC: 10.82+/-4.14 vs 8.29+/-3.49, p=0.025)Finally, diabetic patients who developed a surgical site infection had significantly lower postoperative HCT (26.74+/-3.27% vs 30.86+/-4.64%, p=0.022) than those who did not. Multivariate logistic regression analysis showed that postoperative HCT (OR: 0.765 [0.613-1.098], p=0.001) and number of levels fused (OR: 1.243 [1.084-1.425], p=0.002) were predictive of development of any postoperative complication, when controlled for BMI, age, and and postoperative Hgb. Postoperative HCT was an independent predictor of the development of cardiac complications (OR: 0.827 [0.692-0.989], p=0.037) and SSI (OR: 0.709 [0.528-0.952], p=0.022).
CONCLUSION(S): Postoperative HCT is predictive of the development of postoperative complications in general, and more specifically the development of cardiac complications and surgical site infections. Along with blood-glucose and HbA1C, it should be closely monitored perioperatively in diabetic patients undergoing spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: While reimbursement is centered on 90-day outcomes, some patients persevere through these short-term, transient complications and manage to still achieve optimal, long-term outcomes. PURPOSE: Assess whether achieving optimal alignment suffering similar perioperative complications compared to suboptimally-aligned peers are inhibited from reaching long-term clinical success and better cost-utility. STUDY DESIGN/SETTING: Retrospective cohort study of a prospective adult spinal deformity (ASD) database. PATIENT SAMPLE: A total of 1,541 patients. OUTCOME MEASURES: Cost-per-QALY, radiographic realignment, clinical outcomes.
METHOD(S): Operative ASD pts with 2Y data were included. Optimal radiographic outcome was defined by SRS-Schwab low deformity in PI-LL, matched in T1PA and being aligned in PI-based PT at 6 weeks. After stratifying pts based on meeting optimal outcome, multivariate analysis controlling for baseline demographics was used to determine significance for complications and hospital-acquired conditions (HACs; DVT/PE, UTI, deep/superficial infection). Calculated Cost per QALY for each time point by 2Y.
RESULT(S): There were 917 ASD pts included. Regarding approach, 69% posterior approach, 31% combined. Groups: 131 were "optimal" (O) and 786 were "not optimal" (NO). Means comparison tests revealed significant differences in age, BMI, but not gender or frailty. The NO group had fewer osteotomies and a lower Invasiveness Index. Analysis of perioperative complications showed that the O group suffered equivocal perioperative complications (58.0% vs 52.2% in the NO group; p=.173) and rates of HACs (9.0% vs. 8.9%, p=.810). Analysis of long-term complications showed that patients in the NO group suffered more major neurological (p=.015) and major mechanical complications (p=.025), and more reoperations (28.7% vs 19.9%; p=.037). When controlling for baseline deformity, age, BMI and frailty, Optimal Outcome patients more often met Best Clinical Outcome (21.5% vs. 11.7%, p=.002). Cost-utility adjusted analysis with determined no difference in the two groups by 6 weeks and 6 months. However, the O group generated significantly better cost-utility by one year, which maintained lower Costs per QALY (p=.005) at two years in favor of the O group.
CONCLUSION(S): Despite incurring equivocal perioperative complications, patients who met our optimal outcome criteria experienced significantly less mechanical complications and reoperations by 2 years, leading to a better long-term cost-utility overall. Accordingly, a higher, transient perioperative complication profile should not preclude surgical correction and future policy efforts should place more consideration on the long-term for outcome measures in adult spinal deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The ACS-NSQIP and SpineSage are both easy to use and readily available online perioperative risk calculators The ACS-NSQIP calculator predicts perioperative complications after surgery, but lacks more spine-specific predictors. The SpineSage platform was developed as a tool built for predicting complications in spine surgery. While a limited number of studies have shown it be predictive of both overall and major medical complications in spine surgery, large external validation studies are limited and none have directly compared NSQIP against SpineSage in the same cohort of spine surgery patients. PURPOSE: Assess the ACS-NSQIP Risk Calculator and SpineSage informatics platform for prediction of perioperative complications in spine surgery STUDY DESIGN/SETTING: Retrospective. PATIENT SAMPLE: A total of 440 patients undergoing thoracolumbar spine with or without fusion. OUTCOME MEASURES: Any complication, serious complication, pneumonia, cardiac, dural tear, SSI, UTI, VTE, reoperation, death and LOS METHODS: Each patient was entered into the ACS-NSQIP and SpineSage calculators and predicted risk for specific complications were directly compared to actual risks. Paired t-tests compared the differences between calculators and their predictability of complications. Patients were ranked based on risk predicted for each complication and the highest tertile for each was isolated. Multivariate regression controlling for age and gender was used to determine if the highest tertile for each risk calculator had predictability in complications following spine surgery.
RESULT(S): Mean LOS 4.2+3 days, EBL 444+300 mL, operative time 256+240 min, and levels instrumented 2.1+2.3. When assessing the four complications predicted by SpineSage there were significant differences in three of the four variables, as SpineSage underpredicted the risk of all and serious-complications (p.5). Both calculator tertiles were trending towards significance for major medical complications (SpineSage: OR: 2.0, [0.94-4.23], p=.073; ACS-NSQIP: OR: 1.8,[0.96-3.48],p=.067). When examining any medical risk, only ACS NSQIP had significant predictability for any medical complication (OR: 2.1, [1.3-3.3]; p=.003).
CONCLUSION(S): Similar to previous studies, the ACS-NSQIP score underpredicted most complications, with the exception of LOS and death. In contrast to previous studies, our data suggest SpineSage was not predictive of actual rates of complications. As both calculators are highly accessible and provide at least some objective perioperative risk data points, we recommend them as a guiding tool but not as an absolute endpoint for clinical decision making as they may be inaccurate and insensitive. Further, higher powered studies elucidating the findings in this study should be conducted. Additionally, the assessment of these calculators for a specific subset of patients, such as deformity, degenerative or pediatrics, can further help guide clinicians regarding the utility of these calculators for their particular patient populations. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Previous reports indicate postoperative complications have minimal impact on long-term outcomes after ASD surgery. Little data has evaluated the impact of complications on specific heath domains during postoperative period. PURPOSE: To evaluate the impact of specific complications on patient reported health domains compared to patients with no complications. STUDY DESIGN/SETTING: Prospective, multicenter, propensity score matched analysis. PATIENT SAMPLE: ASD patients enrolled into a prospective multi-center study. OUTCOME MEASURES: Oswestry Disability Index, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), postoperative complications.
METHOD(S): Surgically treated ASD patients enrolled into a multicenter study were assessed for postoperative complications requiring surgery including wound (WOUND), pseudoarthrosis (PSEUDO), neurologic (NEURO) and malalignment (MAL) and matched to patients with no complications (NOCOMP) using inverse probability weighting for demographic, radiographic and surgical variables. Health domains for SRS-22r, and SF-36 were evaluated at regular time intervals, domain scores normalized to the date of revision surgery, and compared to patients with no complications at minimum 2-year follow-up.
RESULT(S): A total of 566 of 1130 were analyzed, average 3.6 yrs (range: 1.9 to 9). WOUND (n=12) compared to NOCOMP (n=390) had worse SF-36 physical function(21.7 vs 27.4), social function(19.6 vs 28.9), general health (-7.3 vs 8.9) and vitality (-0.9 vs 26.6,p < 0.05). PSEUDO (n=64) was worse than NOCOMP for SRS-22r function, 1.4 vs 2.1, and SF-36 social function, (17.1 vs 28.9) (p < 0.05). NEURO (n=28) was worse than NOCOMP for SRS-22r (0.9 vs 2.1), SF-36 bodily pain (14.7 vs 35.7) and social function (13.4 vs 28.9) (p < 0.05). MAL (n=72) was worse than NOCOMP for SRS-22r pain, (2.7 vs 3.4), function (1.2 vs 2.1), self-image (3.0 vs 3.9), SF-36 bodily pain (27.6 vs 35.7), physical function (18.7 vs 27.4), and social function (11.6 vs 28.9) (p < 0.05).
CONCLUSION(S): Counter to previous reports, specific postoperative complications requiring surgery uniquely impact specific health domains, resulting in worse patient reported quality of life compared to ASD patients with no complications. Social function was negatively impacted for all complications, while wound complications negatively impacted patient perceived general health and vitality and patients with malalignment requiring surgery reported worse self-image. These data highlight new findings that postoperative complications have a negative impact on specific aspects of ASD quality of life that can undermine the potential benefits of ASD surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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PURPOSE/OBJECTIVE:This study compares perioperative and 1-year outcomes of lateral decubitus single position circumferential fusion (L-SPS) versus minimally invasive transforaminal lumbar interbody fusion (MIS TLIF) for degenerative pathologies. METHODS:Multicenter retrospective chart review of patients undergoing AP fusion with L-SPS or MIS TLIF. Demographics and clinical and radiographic outcomes were compared using independent samples t tests and chi-squared analyses with significance set at p < 0.05. RESULTS:A total of 445 patients were included: 353 L-SPS, 92 MIS TLIF. The L-SPS cohort was significantly older with fewer diabetics and more levels fused. The L-SPS cohort had significantly shorter operative time, blood loss, radiation dosage, and length of stay compared to MIS TLIF. 1-year follow-up showed that the L-SPS cohort had higher rates of fusion (97.87% vs. 81.11%; p = 0.006) and lower rates of subsidence (6.38% vs. 38.46%; p < 0.001) compared with MIS TLIF. There were significantly fewer returns to the OR within 1 year for early mechanical failures with L-SPS (0.0% vs. 5.4%; p < 0.001). 1-year radiographic outcomes revealed that the L-SPS cohort had a greater LL (56.6 ± 12.5 vs. 51.1 ± 15.9; p = 0.004), smaller PI-LL mismatch (0.2 ± 13.0 vs. 5.5 ± 10.5; p = 0.004). There were no significant differences in amount of change in VAS scores between cohorts. Similar results were seen after propensity-matched analysis and sub-analysis of cases including L5-S1. CONCLUSIONS:L-SPS improves perioperative outcomes and does not compromise clinical or radiographic results at 1-year follow-up compared with MIS TLIF. There may be decreased rates of early mechanical failure with L-SPS.

BACKGROUND CONTEXT: Numerous studies have reported the interplay between spinal deformity and pelvis compensatory mechanisms, but little data exist evaluating the contribution of lower extremity compensation (LE) to maintain upright posture. We hypothesis that hip, knee and ankle compensation is proportional to the severity of the spinal deformity and varies by demographics. PURPOSE: Evaluate the association between spinal alignment and lower limbs compensation. STUDY DESIGN/SETTING: Multicenter, prospective cohort. PATIENT SAMPLE: This study included 288 patients treated for complex adult spinal deformity (ASD) with full body images available. OUTCOME MEASURES: Pelvic retroversion (PT), hip extension (SFA), knee flexion (KA), ankle dorsiflexion (AA), pelvic translation (P.Shift) and patient reported outcomes (ODI, PROMIS and SRS-22).
METHOD(S): Surgical ASD patients were enrolled into a prospective study based on three criteria: deformity severity (PI-LL>25degree, TPA>30degree, SVA>15cm, TCobb>70degree or TLCobb>50degree), procedure complexity (>12 levels fused, 3CO or ACR) and/or age (>65 and >7 levels fused). Associations between lower extremity compensation (hip extension, knee flexion, and ankle dorsiflexion) and the magnitude of spinal deformity, patient demographics, patient frailty, and patient-reported outcomes (ODI, SRS, PROMIS-CAT) were assessed via regressions and partial correlations.
RESULT(S): A total of 288/329 patients met inclusion criteria (60+/-15yo, 70.5% female), had moderate to severe spinal deformity (PI-LL:15+/-24, TPA:24+/-14, SVA:65+/-69mm, lumbar Cobb:34+/-24), and reported high pain (PROMIS pain interference; PI=62.7+/-7.8) and reduced physical function (PROMIS physical function; PF=35.6+/-7.6). Lower extremity compensation included pelvic retroversion (PT:24.1+/- 11.8), hip extension (SFA: 203+/-10.5), knee flexion (KA:5.5+/- 9.6), ankle dorsiflexion (AA: 5.3+/-4.5), and posterior pelvic translation (P.Shift: 30+/-51mm). Overall, lower extremity compensation increased with age (all p <0.001), BMI and frailty (all p <0.001, except SFA). For a similar PT, women had greater hip extension than men (SFA: 206 vs 200, p <0.001), with less KA (3.6 vs. 10.1, p <0.001), AA, and P.Shift. Lower extremity compensation increased with PI (r=0.2-0.45, p <0.001), TPA (r=0.5-0.9, p <0.001) and correlated with PROMS (ODI:0.26 - 0.37, PROMIS PF: -0.28 - -0.39, SRS Acti.: -0.20 - -0.33). When controlling for deformity severity and PI, most associations between lower limbs compensation and PROMS were lost. However, P.Shift and SFA remained weakly correlated with physical scores (ODI and PROMIS PF).
CONCLUSION(S): The recruitment of LE compensation is overall proportional to the severity of adult spinal deformity, with different patterns observed between men and women. Patients achieved similar PT by recruiting different patterns of LE compensation. Hip extension and posterior pelvic translation are independently associated with impairment in patient-reported outcomes. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Evidence on long-term maintenance of health status in adult spinal deformity (ASD) patients who improve above MCID threshold (MCID+) at 2 years following surgery is limited. PURPOSE: This study aims to: (1) evaluate whether patients who reached MCID+ status at two years postoperatively will maintain MCID+ status at 5 years, (2) identify risk factors associated with maintaining MCID+ status, and (3) Assess whether maintaining MCID+ status at 5 years is associated with satisfaction with surgery. STUDY DESIGN/SETTING: Retrospective review. PATIENT SAMPLE: Patients who underwent adult spinal deformity (ASD) surgery with minimum 5-year follow-up who achieved 2-year MCID in ODI were identified. OUTCOME MEASURES: Maintenance of MCID+ status at 5 years for Oswestry Diability Index (ODI).
METHOD(S): Patients who maintained MCID+ status at 5 years and those who did not formed the comparison groups. Multivariable logistic regression, controlling for age, complications after two years and two-year alignment, was used to identify risk factors associated with the inability to maintain MCID+ status. In a separate multivariable logistic regression, whether maintaining MCID+ status was associated with 5-year surgical satisfaction was assessed.
RESULT(S): Of 633 eligible patients, 339 had 5-year data. Of 133 with both 2- and 5-year data, 70 who achieved 2-year MCID in ODI were included. 30% (21) failed to maintain MCID+ status at 5 years. Preoperatively, 33% (23) were narcotic users, 47% (33) were frail and mean surgical invasiveness was 96.6+/-36.02. On multivariable logistic regression, preoperative variables were assessed: CCI > 3 (OR 5.75; p=0.026), ASA grade > 2 (OR 5.25; p=0.015), anemia (OR 19.74; p=0.009), and cancer (OR 6.46; p=0.015) were associated with increased odds of failure to maintain MCID+ status at 5-year follow-up. Patients who failed to maintain MCID+ status at 5 years had a higher odds of being unsatisfied with the surgery (OR 15.66; p=0.001). Frailty and surgical invasiveness had no significant impact on MCID+ status at 5 years.
CONCLUSION(S): Preoperative comorbid conditions significantly impact patient's long-term ability to maintain the positive gains in health-related quality of life measures from the surgery. Surgeons should continue to monitor and treat the chronic conditions to ensure maintenance of long-term recovery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Adult spinal deformity (ASD) patients undergoing surgery risk neurological decline following surgery. However, surgery may be the key in improving outcomes in patients starting with lower extremity motor deficits at baseline (BL). We aim to analyze the improvement in neurological outcomes of ASD patients undergoing spinal reconstruction with BL and 6-week postoperative lower extremity motor scores (LEMS). PURPOSE: The aim of this study is to analyze the improvement in neurological outcomes of adult patients undergoing deformity surgery with baseline abnormal LEMS. STUDY DESIGN/SETTING: Multicenter, prospective cohort. PATIENT SAMPLE: A total of 205 patients were included in the study. OUTCOME MEASURES: Patient and procedural factors that lead to the improvement in neurological outcomes of adult patients undergoing deformity surgery with baseline abnormalLEMS.
METHOD(S): ASD patients ages = 18 were prospectively studied from 2018-2021. All patients underwent an instrumented PSF with a few also having an ASF of the lumbar spine. Patients were dichotomized based on BL LEMS (NML = 50, ABML < 50). The ABNML group was then dichotomized based on whether LEMS improved overall from BL or experienced no change or declined by first postoperative follow-up (PO) and various factors were analyzed and compared using standard statistical tests.
RESULT(S): Of the 205 patients evaluated, 134 (65.4%) were NML and 71 were ABNML (34.3%) at BL. Among the 71 patients with ABML LEMS at BL, 49% (N=35) improved to NML levels, 21% (N=15) improved from BL levels but not to NML, 20% (N=14) remained the same, and 10% (N=7) declined further at 6week PO. Compared to ABNML patients with no change or a decline in LEMS at first PO, patients who improved overall (70%; N=50) had significantly more decompressions performed (86% vs 57%; p=0.0092), and had more PCOs performed intraoperatively (90% vs 62%, p=0.0074). There were no statistical differences between the groups in age, BL LEMS, BMI, total instrumented vertebrae (TIV), EBL, and OR time. Overall, the number of patients with NML LEMS at 6 weeks PO increased by 7.5% (65.4% to 70.2%; p<.0001).
CONCLUSION(S): Seventy percent of patients with ABML LEMS at BL improved their motor strength by the first PO visit, while 30% stayed the same or declined. ABNML patients who improved from BL had significantly more decompressions performed and, surprisingly, more PCOs performed. Interestingly, patient factors between the two groups demonstrated no statistical differences further highlighting that improvement may be influenced by the differences in surgical techniques. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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