Faculty Bibliography

BACKGROUND CONTEXT: Often patients with cervical deformity (CD) require extensive fusions that extend into the thoracic spine. However, factors that influence the treatment approach and level selection are poorly understood. PURPOSE: To examine if there are significant differences between patients with CD who have a lowest instrumented vertebrae (LIV) to the upper thoracic (UT) vs the midthoracic (MT) spine. STUDY DESIGN/SETTING: Comparative cohort study. PATIENT SAMPLE: Prospective adult cervical deformity database. OUTCOME MEASURES: NDI, mJOA, SWAL-QOL.
METHOD(S): A prospective CD database was analyzed for the following inclusion criteria: LIV between C7-T5 and a UIV of C2, and 1 yr min follow-up (f/u). Patient demographics, operative details, radiographic parameters and clinical outcomes were compared between those with a LIV from C7-T2 (UT) vs T3-T5 (MT). X2 and independent samples T-Tests were performed for statistical analysis RESULTS: A total of 64 patients met inclusion criteria for the study and 46 were included in the analysis (avg. age 62, 58% female, avg 1yr f/u) with 22 in UT vs 24 in the MT groups. No differences were seen in age or revision case prevalence, EBL, operative time or surgical approach (anterior, posterior, combined) types between groups. MT patients had a higher pre-op cSVA, TS-CL, Max Kyphosis and T9PA and were treated with a larger number of PSOs (p<0.01). There was a larger correction in Cervical Lordosis (CL) seen in the MT group (29 vs 17, p=0.04) and larger changes in T4-T12 (9.6 vs 0.0, p<0.01). No differences were seen in DJK (p=0.22) or rates of revision surgery (5% vs 21%, p=0.19,

BACKGROUND CONTEXT: Choosing the surgical approach and osteotomy type is challenging when surgically treating cervical deformity. Preoperative assessment of flexibility and final alignment would be useful for surgeons treating this complex problem. Currently extension lateral XR are inconstantly taken for the management of cervical deformity for planning purposes. PURPOSE: Investigate the relationship of surgical procedure choice and the pre-operative flexibility of the cervical spine. Determine if extension lateral XR (ELXR) can also predict the final postoperative alignment. STUDY DESIGN/SETTING: Retrospective review of prospective, consecutively enrolled multicenter cervical deformity database PATIENT SAMPLE: A total of 106 cervical deformity patients OUTCOME MEASURES: Surgical treatment, radiographic alignment parameters (SS, T1S-CL, cSVA, C2 slope, T1 slope) METHODS: A prospective database of operative cervical deformity patients was analyzed. Inclusion was cervical kyphosis>10degree, cervical scoliosis>10degree, C2-C7 SVA>4cm or chin-brow vertical angle>25degree. Patients were excluded if they did not have neutral and ELXR or did not have deformity limited to the cervical or cervicothoracic spine. The ELXR was compared to preoperative neutral lateral, and 3 mo alignment XR and type of surgical osteotomy based upon the Ames Classification. Statistical analysis included t-test and chi-squared.
RESULT(S): A total of 106 from 164 patients met the inclusion criteria. Mean age of 60 yo, with 58% females. Of the study population, 43.4% of patients had prior cervical surgery. The evaluation of ELXR in patients who received grade 1-2 osteotomies (as compared to those who received grade 5,6 or 7), shows they have statistically lower T1S (23.06 vs 35.46; p=.021), lower T1S-CL (20.90 vs 36.29; p=.033), lower cSVA (24.66 vs 48.35; p<.001) and lower C2Slope (18.69 vs 37.46; p=.008). Subsequent analysis revealed the anterior approach chosen over the post approach when, in extension, patients achieved more normal radiographic alignment T1S (21.17 vs 31.59; p=.018), lower cSVA (11.18 vs 36.44; p<.001), lower T1S-CL (13.68 vs 28.13; p=.014) and lower C2 slope (8.49 vs 28.28; p<.001). Patients were more likely to have a post approach when they had larger than normativeT1S-CL>17 in the ELXR (46.77% vs 36.36%; p=.033). Overall, while surgery created a significant change in all radiographic parameters; the 3 month lateral XR and baseline ELXR were statistically similar for T1S-CL (26.04 vs 24.83; p=.542) and C2Slope (23.27 vs 22.87; p=.839).
CONCLUSION(S): Preoperative ELXR had a significant association with surgical approach and grade of osteotomy. The ELXR was statistically similar to the post-operative 3-month lateral XR and should be used to predict final cervical alignment. Obtaining ELXR is a critical alignment tool, and should be obtained as a part of the preoperative surgical plan. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: The Patient-Reported Outcomes Measurement Information System (PROMIS) is a comprehensive self-report measurement tool with patient functions, symptoms, behaviors, and mental health outcomes. Little work has been done correlating PROMIS physical health domain metrics with established adult spinal deformity (ASD) classifications such as SRS-Schwab. PURPOSE: To correlate sagittal alignment components via the SRS-Schwab classification system with established PROMIS domains in a cohort of ASD patients. STUDY DESIGN/SETTING: Retrospective review of a single-center stereoradiographic database. PATIENT SAMPLE: A total of 41 ASD patients with complete baseline radiographic and PROMIS data. OUTCOME MEASURES: PROMIS physical health domain metrics (Pain Intensity [PI], Physical Function [PF], Pain Interference [Interference]), SRS-Schwab modifiers (SVA, PI-LL, PT) METHODS: Surgical ASD patients (SVA>=5cm, PT>=25degree or TK >=60degree) >=18 years old with available baseline (BL) radiographic and PROMIS data were isolated in the single-center comprehensive Spine Quality Database (Quality). Patients were classified according to SRS-Schwab deformity modifiers(0,+,++) for SVA, PI-LL and PT. Descriptives and univariate analyses compared population-weighted PROMIS scores for PI, PF and Interference across ASD deformity modifiers. Conditional Tree Analysis (CTA) with logistic regression sampling established cut-off points for PROMIS scores predicting severe malalignment (++) at BL compared to mild or moderate (0,+).
RESULT(S): A total of 41 patients (58.95 yrs,75.6%F,29.1kg/m2) met inclusion criteria. BL SRS modifiers were as follows: SVA 51.2%, 2.4%, 46.3% (0,+,++); PI-LL 27.3%, 12.1%, 60.6%(0,+,++); PT 18.2%, 36.4%, 45.5% (0,+,++). Mean cohort PI score was 94.2+/-6.0, mean PF score 8.95+/-10.1, mean Inter score 57.84+/-5.46. PF and Interference differed significantly across low and high SVA groups, with low SVA having significantly higher PF (13.50 vs 3.68,p<0.001) and lower Inter (59.62 vs 56.30, p=0.05). PI did not differ across SVA groups (p>0.05). Low PI-LL pts had significantly higher PF than pts with ++PI-LL (19.3 vs 4.15,p=0.001) and trended lower PI and Inter without significance. No significant differences in PI, PF or Inter were found across PT groups (all p>0.05). CTA found a PI score>98 or PF score <6 were independent predictors of Severe (++) SVA as opposed to Mild/Moderate SVA. For example, a PF score<6 increased odds of ++SVA by at least 2.7x compared to 0/+SVA. Similarly, significant thresholds for PI (>98) and PF (<8) scores were found for ++PI-LL, but not ++PT (p>0.05). Pain Interference did not predict SRS metrics to a significant degree (all p>0.05).
CONCLUSION(S): Inferior PROMIS scores of pain intensity and physical function predicted increasingly severe SRS sagittal modifiers at baseline, specifically severe sagittal vertical axis and lumbopelvic mismatch. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: The opioid crisis in the US is currently catastrophic. A large number of patients use opioids preoperatively. PURPOSE: The goal of this study is to look at a group of patients who were on opioids prior to adult spinal deformity surgery, and compare outcomes in those who ceased and those who continued opioid use post operatively. We also aim to identify factors associated with postoperative opioid cessation. STUDY DESIGN/SETTING: Retrospective review of a prospective multicenter database of ASD patients. PATIENT SAMPLE: A total of 296 surgical ASD patients who were using opioids (daily or weekly) prior to surgical intervention. OUTCOME MEASURES: Post-operative opioid cessation or decreased use, HRQOL (SF-36, ODI, back pain, leg pain), and patient satisfaction.
METHOD(S): A multicenter prospective database of surgical ASD patients was reviewed. Opioid use was measured using the SRS-22r Q11. We included all surgical ASD patients who using opioids pre-operatively (daily or weekly) and completed 2-year follow up. Patients were divided based on 2-year opioid use: decreased/ceased vs continued. Groups were compared in regards to demographics, radiographic parameters, HRQL, invasiveness of surgery, complications, re-operations, and satisfaction.
RESULT(S): Our database had a total of 1,281 surgical patients, out of which 760 were eligible for 2-year follow up. Of those eligible, 578 (76.05%) completed their 2-year follow up. A total of 547 of these patients answered SRS22R-Q11 at baseline at 2-years (with the remainder choosing to not answer this question). There were 296 (54.11%) of 547 ASD patients undergoing surgery reported using opioids preoperatively. Of those, 171 (57.8%) had decreased or ceased opioids 2 years after surgical intervention. Those who decreased/ceased had a higher proportion of females (83.83% vs 72.00%, p=0.014). There was no other statistically significant difference in demographics (BMI, co-morbidities, age, prior spine surgery, smoking) or radiographic parameters (PI-LL, SVA, PT). Those who decreased/ceased opioids had higher baseline SF-36 M

BACKGROUND CONTEXT: The Adult Spinal Deformity Frailty Index (ASD-FI), a validated modality for quantifying frailty, stratifies patients into categories not frail (NF), frail (F) and severely frail (SF). However, the cost of treating each frailty state is unknown. PURPOSE: Investigate the cost utility of treating not frail versus frail or severely frail ASD patients. STUDY DESIGN/SETTING: Retrospective review of a prospective single center adult spinal deformity database. PATIENT SAMPLE: A total of 79 operative and non operative ASD patients >=18 years old, with baseline and 2Y ASD-FI and Oswestry Disability Index (ODI) scores. OUTCOME MEASURES: ODI, SF-6D, Cost per quality adjusted life years (QALY), Incremental Cost Effectiveness, Ratio (ICER).
METHOD(S): Inclusion criteria was surgical ASD (scoliosis>=20degree, SVA>=5cm, PT>=25degree, or thoracic kyphosis >=60degree) patients >18 years with available frailty and ODI data at BL and 2-years post op. Independent T-Tests assessed baseline radiographic differences in PT, PI-LL, and Schwab SVA modifier status between NF vs. F/SF patients. Utility data was calculated using the ODI converted to the SF-6D using published conversion methods. QALYs utilized a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs were calculated using the PearlDiver database. After accounting for complications, LOS, revisions, and death, cost per QALY at 2Y and life expectancy were calculated for NF, and F/SF patients. ICER was compared between non op and operative NF and F/SF patients at 2Y and life expectancy.
RESULT(S): Seventy-nine ASD patients met inclusion criteria. Descriptive statistics for the cohort were: age 51.0+/-6.8, 76% women, BMI 26.7+/-6.8, 54% osteotomy, 54% decompression, and 11.6+/-4.2 average levels fused. At BL, there were 48 NF, 26 F, and 4 SF pts. The average BL frailty for NF pts was 0.13+/-0.08, 0.39+/-0.06 for F, and 0.59+/-0.08 for SF pts. There were no differences in PT, PI-LL, or severe SVA Schwab modifier grades between NF or F/SF pts (all p>0.05). At 2-year follow up, there was no difference in the average cost of ASD surgery, $91,068.98 for NF patients and $90,888.53 for F/SF pts (p>0.05). The cost per QALY was higher for NF pts at 2 years vs F/SF pts ($464,239.62 vs. $321,107.89, p<0.05). If the utility gained was sustained to life expectancy, the cost per QALY was $70,796.43 for NF and $48,968.88 for F/SF (p<0.05). When compared to non op ASD pts, the ICER was $447,943.96 vs. $313,211.01 for NF and F/SF at 2 years, and $68,311.35 vs. $47,764.61 for NF and F/SF at life expectancy.
CONCLUSION(S): Frail and severely frail patients had lower cost per QALY compared to not frail patients at 3 years and life expectancy. In addition, when compared to a non operative cohort of ASD patients, frail and severely frail patients had lower ICER values. While these results support operative correction of frail and severely frail patients, it is important to note that these patients are often at worse baseline disability, which is closely related to frailty scores, and have more opportunity to improve postoperatively. In addition, there may be a threshold of frailty that is not operable due to the risk of severe complications that is not captured by this analysis. While future research should investigate economic outcomes at extended follow-up times, these findings support the cost effectiveness of ASD surgery at all frailty states. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: As the opioid crisis has gained national attention, there has been an increasing effort to decrease opioid usage. Simultaneously, patient satisfaction is a crucial metric in the American health care system, and has been closely linked to effective pain management in surgical patients. PURPOSE: Examine rates of pain medication prescription and concurrent patient satisfaction in spine surgery patients. STUDY DESIGN/SETTING: Retrospective cohort study. PATIENT SAMPLE: A total of 1,729 patients undergoing any spine surgery. OUTCOME MEASURES: Rates of non-opioid pain medication prescriptions during hospitalization as part of a multimodal analgesia regimen, morphine milligram equivalents (MME) of opioids used during hospitalization, Press Ganey Satisfaction Survey data.
METHOD(S): Patients >=18yo undergoing spine surgery between 6/25/2017-6/30/2018 at a single institution by spine surgeons performing >=20 surgeries/quarter and who had medication data during hospitalization available included. Additional data collected included physician and procedure type. All data analyzed by quarter. Chi-squared test to compare percentages and ANOVA to compare means across quarters. Multivariate regression used to compare procedure-specific trends, controlling for age, revision and level of pain. Significance set at p<0.05.
RESULT(S): A total of 1,759 patients were included, 427 in Quarter 1 (Q1), 439 in Q2, 453 in Q3 and 440 in Q4. Mean total MME per patient hospitalization was 574.46, no significant difference between quarters (p=0.116). Mean MME/day per patient decreased between quarters (p=0.048), with highest mean 91.84 in Q2 and lowest 77.50 in Q4. From Q1 to Q4, three physicians had decreased mean MME/day (75.47->50.92, p=0.023; 115.70->46.05, p=0.013; 92.89->69.53, p=0.42, respectively) and two physicians had decreased total MME (815.88->243.15, p=0.004; 706.79->451.72, p=0.014, respectively). MME/day decreased (74.78->52.37, p=0.046) for discectomy cases. Controlling for age, revision and level of pain, total MME decreased for discectomies (p=0.006). Among all procedures, acetaminophen, NSAID and steroid prescription rates increased (9.13%->17.05%, p=0.001; 6.32%->9.77%, p=0.048; 9.13%->17.05%, p=0.001, respectively). This was also the case in fusion patients specifically (9.09%->17.99%, p=0.002; 2.77%->5.76%, p=0.024; 9.09%->17.99%, p=0.002, respectively). NSAID prescription in laminectomy patients also increased (3.23%->4.89%, p=0.041). Concurrently, benzodiazepine and GABA analog prescriptions decreased among all procedures (19.20%->10.68%, p<0.001; 9.84%->4.77%, p=0.025, respectively). Benzodiazepine prescriptions in fusion patients also decreased (24.51%->12.23%, p<0.001). No significant differences between quarters for mean pain ratings (p=0.521). Also no differences between quarters for responses to questions from Press Ganey Satisfaction Survey regarding how often staff talk about pain (p=0.164), whether staff talk about pain treatment (p=0.595) or recommending the hospital (p=0.096). This was also the case for top box ratings for the same questions (p=0.381, 0.837, 0.610, respectively). No significant differences between quarters for responses in all other patient satisfaction questions (range p=0.359-0.988) or their top box ratings (range p=0.359-0.988).
CONCLUSION(S): Over the studied time period, opioid use decreased and nonopioid prescriptions increased during hospitalization, while satisfaction scores remained unchanged. These findings indicate an increasing effort in reducing opioid use amongst providers, and suggest the ability to do so without impacting overall satisfaction rates. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Numerous advances have been made in the field of spine fusion, such as minimally invasive (MIS) or robotic assisted spine surgery. However, it is unknown how these advances have impacted the cost of care. PURPOSE: Compare the economic outcomes of lumbar spine fusion between open, MIS and robotic assisted surgery patients. STUDY DESIGN/SETTING: Retrospective review of a single center spine surgery database. PATIENT SAMPLE: A total of 360 propensity matched patients. OUTCOME MEASURES: Costs, EuroQol-5D (EQ5D), Cost per quality adjusted life years (QALY).
METHOD(S): Inclusion criteria: surgical patients >18 years undergoing lumbar fusion surgery. Patients were categorized into 3 groups based on procedure type: open, MIS or robotic. Open patients undergoing poster spinal fusion were considered as the control group. MIS patients included those undergoing transforaminal or lateral lumbar interbody fusion with percutaneous screws. Robotic patients were those undergoing robot assisted fusion. Propensity score matching was performed between all groups for the number of levels fused. Costs were calculated using the PearlDiver database, which reflects both private insurance and Medicare reimbursement claims for ICD-9 codes. For robot cases, costs were reflective of operational fees and initial purchase cost. Complications and comorbidities (CC) and major complications and comorbidities (MCC) were assessed according to CMS.gov manual definitions. QALYs and cost per QALY were calculated using a 3% discount rate to account for residual decline to life expectancy (78.7 years). Costs per QALY were calculated for both 1 year and life expectancy, assuming no loss of benefit.
RESULT(S): A total of 360 propensity matched patients (120 open, 120 MIS, 120 robot) met inclusion. Descriptive statistics for the cohort were: age 58.8+/-13.5, 50% women, BMI 29.4+/-6.3, op time 294.4+/-119.0, LOS 4.56+/-3.31 days, EBL 515.9+/-670.0 cc, and 2.3+/-2.2 average levels fused. Rates of postop complications were significantly higher in robotic cases versus open and MIS (43% vs. 21% and 22% for open and MIS, p<0.05). However, revision rates were comparable between all groups (3% open, 3% MIS, 5% robotic, p>0.05). After factoring in complications, revisions, and purchasing and operating fees, the costs of robotic cases was significantly higher than both open and MIS surgery ($60,047.01 vs. $42,538.98 open and $41,471.21 MIS). In a sub analysis of 42 patients with BL and 1Y EQ5D data, the cost per QALY at 1Y for open, MIS, and robot assisted cases was $296,624.48, $115,911.69, and $592,734.30. If utility gained was sustained to life expectancy, the cost per QALY was $14,905.75, $5,824.71, $29,785.64 for open, MIS, and robot assisted cases.
CONCLUSION(S): Numerous advances have been made in the field of spine surgery, however, there has been limited discussion of the effect these advances have on economic outcomes. When matched for levels fused, robot assisted surgery patients had significantly higher rates of complications and 30% higher costs of surgery compared to minimally invasive and open spine surgery patients. While 1 year economic outcomes weren't optimal for robotic surgery cases, the projected costs per quality adjusted life years at life expectancy were well below established acceptable thresholds. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Although epidural steroid injection (ESI) has been shown to provide adequate pain relief for degenerative spondylolisthesis patients in treatment regimens up to months, it remains unclear whether the use of ESI affects the rate of crossover from nonoperative to operative management. PURPOSE: Investigate the relationship between epidural steroid injections and rates of surgical crossover for degenerative spondylolisthesis patients. STUDY DESIGN/SETTING: Retrospective review of prospectively collected data from 13 spine centers. PATIENT SAMPLE: Degenerative spondylolisthesis patients from both the randomized and concurrent observational cohorts of the Spine Patient Outcomes Research Trial (SPORT). OUTCOME MEASURES: Primary: Surgical crossover rates. Secondary: health related quality of life outcome (HRQL) measures (SF-36, ODI, Sciatica and Leg Pain Bothersomeness Indices), self-reported improvement METHODS: Included: surgical candidates >18yrs with degenerative spondylolisthesis. Excluded: patients receiving ESI before enrollment. Those who received ESI within 3 months of enrollment (ESI) and those who did not (no-ESI) were compared for differences in baseline characteristics. Outcomes at 1-year, 2-year, 3-year, and 4-year intervals following enrollment were assessed within operative and nonoperative groups using longitudinal mixed-effect models with random subject intercept term to account for correlations between repeated measurements. Treatment comparisons were performed at follow-up intervals. Area under the curve analysis for all time points assessed global significance of treatment.
RESULT(S): Included: 266 patients (192 no-ESI, 74 ESI). Patient groups did not differ in age, sex, BMI, or comorbidity burden (all p>0.05). No-ESI had greater baseline SF-36 body-pain scores (38+/-20 vs 30+/-16, p=0.002) and self-reported surgical preference (38% vs 11%, p<0.001). There were no differences in surgical rates within 4-years of enrollment between no-ESI and ESI patients (61% vs 62%, p=0.97). Surgical ESI and no-ESI patients did not differ in op-time, blood loss, rates of decompression, multilevel fusion or levels decompressed (all p>0.05). Surgical ESI and no-ESI patients showed no differences in postoperative HRQL changes at any follow-up interval, or in 4-year average HRQL outcomes. Non-operative no-ESI patients showed greater 4-year average improvement in SF-36 body pain (no-ESI: 17.8, ESI: 7.8, p=0.004) and physical function (no-ESI: 13.1, ESI: 4.3, p=0.005) than non-operative ESI patients. These improvements in SF-36 body pain were greater for non-operative no-ESI patients at 1-year (p=0.002) and 3-years (p=0.005); improvements in SF-36 physical function were greater for non-operative no-ESI patients at 1-year (p=0.030) and 2-years (p=0.002). Of patients that were initially non-operative, there was no difference between ESI and no-ESI groups in surgical crossover rates (ESI: 52%, no-ESI: 39%, p=0.15). For operative patients, crossover rates to non-operative treatment did not differ between ESI and no-ESI groups (ESI: 23%, no-ESI: 16%, p=0.38).
CONCLUSION(S): For surgical degenerative spondylolisthesis patients, there was no relationship between ESI and improved clinical outcomes over a 4-year study. For nonoperative patients, ESI was associated with inferior pain reduction through 3 years of follow-up; however, this was confounded by higher levels of baseline pain. ESI showed little relationship with surgical crossover. FDA DEVICE/DRUG STATUS: Unavailable from authors at time of publication.
Copyright

BACKGROUND CONTEXT: The shared decision-making (SDM) process is an opportunity to deliver answers to frequently asked questions (FAQs) in adult spinal deformity (ASD) surgery. PURPOSE: Our goal was to present a concise list of answers to these FAQs to aid in SDM counseling. STUDY DESIGN/SETTING: Retrospective analysis of a prospective multi-center ASD database. PATIENT SAMPLE: Adult spinal deformity patients undergoing surgical correction enrolled into a prospective, multicenter surgical database from 2008-2016. OUTCOME MEASURES: Health related quality of life (HRQOL) outcome measures were collected such as Oswestry Disability Index (ODI), SF-36 PCS, and SF-36 MCS.
METHOD(S): Adult patients undergoing >= 5 level fusion with minimum 2-year follow up were included. We purposely included all deformity types (heterogeneity) to provide general applicability. We compiled a list of FAQs by patients undergoing ASD surgery and utilized a retrospective analysis to provide answers. All responses are reported as either means or reaching minimal clinically important difference (MCID) at the 2-year follow-up interval.
RESULT(S): Out of 689 ASD patients eligible for 2-year follow-up, 521 (76%) had complete follow-up. The majority were female (77%) with mean age of 58.5 years and BMI of 27.5. Mean levels fused were 11.3 with 52% being primary vs 48% revision surgeries. Will my pain improve? Back (7.2 to 3.6) and leg (4.7 to 2.6) pain were both reduced by ~50%. Will my activity level improve? A total of 63.9% reached MCID for SRS-22r activity. Will I feel better about myself? A total of 71.2% reached MCID for SRS-22r appearance. Is there a chance I'm worse? A total of 4.1% of patients were worse (ODI). What is the likelihood I have a complication? A total of 52.9% of patients have at least 1 complication and 29.6% have a major complication. Will I need another surgery? A total of 29.6% of patients have a reoperation within 2 years. Will I regret having surgery? A total of 32% would not choose the same treatment. Will I get a blood transfusion? A total of 79.1% of patients receive a blood transfusion. How long will I stay in the hospital? Study showed 9.9 days. Will I have to go to the ICU? A total of 79.1% of patients require an ICU stay. Will I be able to return to work? A total of 71% returned to full-time work at 2 years. Will I be taller after surgery? Yes, 1.4cm was the average
CONCLUSION(S): The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright

BACKGROUND CONTEXT: Proximal junctional kyphosis (PJK) is a devastating complication of adult spinal deformity (ASD) surgery. Optimal alignment specifications to maximize quality of life while limiting PJK have yet to be defined. Previous studies have primarily examined sagittal vertical axis (SVA) to determine likelihood of PJK. More recently, other alignment parameters such as thoracic-pelvic angles (TPAs) and age-adjusted alignment have been examined. PURPOSE: The goal of this study is to examine the relationship between GAP, TPAs, and bracing with likelihood of developing PJK. STUDY DESIGN/SETTING: A retrospective chart review was conducted to identity ASD patients with at least 1 year of radiographic follow up. PATIENT SAMPLE: Patients who underwent fusions to the pelvis and >4 levels fused from 2013 to 2018 and have 1-year postoperative alignment x-rays were included. OUTCOME MEASURES: The rate of radiographic PJK (change of 10-20degree) and severe PJK (change>20degree) was determined for each group. Reoperation rates were also collected.
METHOD(S): Surgical records were reviewed to determine patient sample. Chart and X-ray review were conducted to determine spinopelvic alignment parameters, GAP scores, bracing, and reoperation. X-rays were reviewed up to one year postoperatively in order to determine PJK.
RESULT(S): A total of 81 patients were included (mean 64y 63%F); baseline and 1-year postoperative alignment did not differ between PJK and no PJK patients. There was no PJK in 53.1%, 30.9% had PJK from 10-20degree, and 16% had sPJK. Of these, 7 patients had revision surgery: 1 for PJK and 1 for rod fracture. Postop bracing was used in 54% of patients. There was no difference in sPJK according to brace use. At baseline, 79% of patients had severely disproportioned GAP, 16% moderate, 5% proportioned. Of severely disproportioned, 63% had no change in GAP at 1 year. Improved GAP was not associated with sPJK (improved: 22% vs no change: 18%, p=.72). Greater correction of the UIV-PA was associated with a larger PJK angle change (R=.26) as was the 1 year T1-UIV angle (R=.30), both p<.05.GAP change was not correlated with PJKA change. The magnitude of T1PA correction was not associated with sPJK, p>.05.
CONCLUSION(S): There was no correlation between PJK and GAP alone or change in GAP; it is notable that these patients tended to be disproportioned pre and postop. Greater correction of UIV-PA and larger postop T1-UIV was associated with greater PJKA change; suggesting that the greater alignment correction led to greater likelihood of it failing. Our data suggest bracing was not effective in preventing PJK. These parameters may help surgeons understand alignment targets in ASD. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
Copyright