Faculty Bibliography

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.
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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.
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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.
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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.
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BACKGROUND CONTEXT: The discussion regarding value based care has evolved in recent years, yet the ability to report Health Related Quality of Life (HRQoL) between different disease states has been limited by lack of validated standardized metrics to compare them. The recent advent of computer adaptive Patient Reported Outcome Information System (PROMIS), which allows for standardized assessment across health conditions, provides the ability to compare differing disease states and procedures. PURPOSE: To compare baseline and postoperative PROMIS scores for patients undergoing common single-level spinal surgery procedures, total hip arthroplasty (THA) and total knee arthroplasty (TKA). STUDY DESIGN/SETTING: Retrospective clinical cohort study of patients undergoing common single-level spine surgery procedures, THA and TKA at 6-month postoperative follow-up. PATIENT SAMPLE: A total of 505 orthopedic surgical patients were included who underwent either: single level anterior cervical discectomy and fusion (ACDF, N=37), lumbar laminectomy (Lami, N=31), microscopic lumbar discectomy (MLD, N=58), transforaminal lumbar interbody fusion (TLIF, N=46), total hip arthroplasty (THA, N=131), or total knee arthroplasty (TKA, N=202) at a single institution. OUTCOME MEASURES: Baseline (BL) and 6 month (6M) PROMIS metrics (Physical Function, Pain Interference, Pain Intensity). Patients were compared by T-values, which is age and gender adjusted to give a normal distribution of the general population, as the mean is scored at 50, and each 10 point deviation reflects 1SD of the population in improving or worsening function.
METHOD(S): Patients>18 years old who underwent spine surgery (ACDF, Lami, MLD, TLIF) or adult reconstruction surgery (THA or TKA) with BL & 6M PROMIS scores of physical function, pain interference and pain intensity were separately grouped based on surgery type. Paired t-tests compared differences in BL, 6M and the change in PROMIS scores for spine vs adult reconstruction procedures.
RESULT(S): A total of 172 spine surgery patients (age=54.6+/-15.6; 42.9% female) and 333 adult reconstruction patients were compared (age=65.8+/-9.5; 59.8% female). Spine surgery patients were significantly younger (p<.01) than adult reconstruction patients. Spine surgery patients undergoing ACDF, laminectomy, MLD or TLIF all had more disability and pain at baseline than THA and TKA patients, according to physical function ([20.1, 8.71, 14.2, 9.26] vs [35.9, 35.01], p<.01), pain interference ([84.1, 89.8, 91.8, 91.0)]vs [63.9, 63.8], p<.01) and pain intensity metrics ([53.6, 58.1, 58.2, 56.1] vs [53.4, 53.8], p<.01). At 6M, spine surgery patients remained more disabled and had more pain compared to adult reconstruction patients; However, patients across all spine procedures experienced greater improvements than THA and TKA patients in terms of physical function ([+8.1, +12.1, +15.2, +12.9] vs [+5.24, +3.9], p<.01) and pain interference scores ([-15.1, -14.1, -12.5, -11.9] vs [-8.1, -6.0] p<.01). Similar improvements in pain intensity scores were seen.
CONCLUSION(S): Patients undergoing single level spinal surgery had lower initial and 6 month postoperative PROMIS scores compared to those undergoing total hip and knee arthroplasty. All procedure cohorts demonstrated meaningful improvement after orthopaedic surgical treatment, but spinal surgery patients demonstrated more improvement in physical function and pain interference scores compared to arthroplasty patients. Future study is required to assess the value base of spinal and adult reconstruction surgery, including durability. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Prior literature in patients with adult spine deformity has found that poor mental health at baseline is associated with worse postoperative outcomes. PURPOSE: The purpose of this study is to demonstrate that adolescent idiopathic scoliosis (AIS) patients with poor mental health at baseline can experience significant improvements with surgery. We hypothesize that in AIS, low SRS-22r mental health scores are largely due to the presence of deformity. The purpose of this study is determine if the correction of the deformity would potentially improve mental health scores. STUDY DESIGN/SETTING: Retrospective review of prospective AIS registry. PATIENT SAMPLE: Adolescents with idiopathic scoliosis. OUTCOME MEASURES: Mental health scores and percent of patients reaching minimum clinically important difference (MCID) at 2 years postoperative.
METHOD(S): A total of 1,532 (1,261 girls, 271 boys) with available baseline and 2-years follow-up SRS-22r scores were included. Patients with baseline mental health domain scores who were 1 standard deviation below the mean (< 3.3) were classified as "low mental health" score (LMH) group, and patients who were 1 standard deviation above the mean (> 4.7) were classified as "high mental health" score (HMH) group. The remaining patients were classified as "intermediate mental health" score (IMH). A minimal clinically important difference (MCID) of 0.6 was used for SRS-22r for analysis RESULTS: There were 247 patients in the LMH group, 1,015 in the MMH group, and 270 in the HMH group. Compared to baseline, all 3 groups demonstrated significant improvements in the overall SRS-22r scores at the 2-year follow-up: 0.8 +/-0.5 in the LMH group, 0.5 +/-0.4 in the IMH group, and 0.29 +/-0.35 in the HMH group (P<0.001 each). Further, at the 2-year follow-up, 72% of patients in the LMH group, 40% of patients in the IMH group, and 17% of patients in the HMH group reached MCID for SRS-22r. At the 2-year follow-up, there was no significant difference in the final SRS-22r score of the 3 groups.
CONCLUSION(S): In distinction from adult deformity patients, in the AIS population, alterations in normal body image may results in low mental health at baseline. These patients can experience significant benefit with surgery, and majority of these patients achieve MCID for the SRS-22r at the 2-year follow-up. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: The Miller et al adult spinal deformity frailty index (ASD-FI) correlates with increased complication risk after surgery; however, its development was not rooted in clinical outcomes, and the 40 factors needed for its calculation limit the index's utility in a clinical setting. PURPOSE: Develop a simplified, weighted frailty index for ASD patients. STUDY DESIGN/SETTING: Retrospective review of prospective ASD database. PATIENT SAMPLE: A total of 50 ASD patients. OUTCOME MEASURES: Health-related quality of life questionnaires: Oswestry Disability Index (ODI), SRS-22r, pain catastrophizing scale, Numerif Rating Scale (NRS) for Leg Pain.
METHOD(S): ASD patients (scoliosis>=20degree, SVA>=5cm, PT>=25degree, or TK >=60degree) with baseline ASD-FI component factors. Component ASD-FI parameters contributing to overall ASD-FI score were assessed via Pearson correlation. Top significant, clinically relevant factors were regressed against ASD-FI score to generate the modified ASD-FI (mASD-FI). Factors comprising the mASD-FI were regressed against the incidence of medical complications; weights for mASD-FI factors were calculated from these regression coefficients via the beta/Sullivan method. Total mASD-FI score was calculated by summing weights of expressed parameters, resulting in a score ranging from 0 to 21. Linear regression correlated ASD-FI and mASD-FI scores, and previously published ASD-FI cutoffs were used to generate corresponding mASD-FI frailty cutoffs: not frail (NF,<7), frail (7-12), severely frail (SF,>12). Analysis of variance assessed the relationship between increasing frailty category and validated baseline measures of patient pain and disability.
RESULT(S): Included: 50 ASD patients (52+/-20yrs, 78% female). All the following preoperative factors correlated with ASD-FI score (all p<0.039), and combined, accounted for 85.0% (p<0.001) of the variation in ASD-FI score: BMI <18.5 kg/m2 or >30 kg/m2 (weight: 5), depression (weight: 5), difficulty climbing stairs (3), presence of >3 medical comorbidities (2), leg weakness (2), difficulty getting dressed (1), bladder incontinence (1), and patient-reported deterioration in health within the past year (1). These factors were used to calculate the overall population's mean mASD-FI score: 5.7+/-5.2. Combined, these factors comprising the mASD-FI showed a trend of predicting the incidence of medical complications (Nagelkerke R2=0.558, Cox & Snell R2=0.399, p=0.065). Overall patient breakdown by mASD-FI frailty category: NF (70%), frail (12%), SF (18%). Increasing frailty category was associated with significant impairments in validated measures of disability, including ODI score (NF: 23.4, frail: 45.0, SF: 49.3, p<0.001), SRS-22r score (NF: 3.5, frail: 2.6, SF: 2.4, p=0.001), pain catastrophizing scale score (NF: 41.9, frail: 32.4, SF: 27.6, p<0.001), and NRS Leg Pain (NF: 2.3, frail: 7.2, SF: 5.6, p=0.001).
CONCLUSION(S): This study modifies an existing ASD frailty index and proposes a weighted, shorter mASD-FI. The mASD-FI relies less on patient-reported variables, and weights component factors by their contribution to adverse outcomes. As increasing mASD-FI score is associated with inferior clinical measures of pain and disability, the mASD-FI may serve as a valuable tool for preoperative risk assessment. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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BACKGROUND CONTEXT: Surgical correction of adolescent idiopathic scoliosis is advocated for severe curves to preserve or improve pulmonary function, prevent progressive deformity and pain, and improve self-appearance. Restoration of sagittal and 3D alignment, in particular thoracic kyphosis (TK), has become increasingly emphasized in efforts to improve pulmonary function, thoracic volumes, provide improved sagittal balance, and prevent adjacent segment degeneration and deformity. PURPOSE: To study the effects of thoracic kyphosis restoration in AIS type 1 and 2 curves on postoperative thoracic volume and pulmonary function. STUDY DESIGN/SETTING: Retrospective review of prospective multicenter database. PATIENT SAMPLE: Thirty-nine AIS patients with Type 1 and 2 curves with 5Y postoperative stereo-radiographic data and pulmonary function tests (PFTs). OUTCOME MEASURES: Five-year spinal and rib cage measures and PFTs.
METHOD(S): A multicenter prospective registry of patients undergoing surgical correction of Type 1- and 2- AIS curves was queried for patients with 5-year postoperative visits including stereoradiographic assessment and PFTs. 3-dimensional (3D) radiographic analysis was performed to assess spinal alignment and chest wall dimensions at preoperative, first erect and 5 year postoperative time points. Variables were analyzed between time points with a one-way ANOVA and post-hoc Tukey analysis, and between variables with linear regression analysis.
RESULT(S): A total of 39 patients met the inclusion criteria (37F, age 14.4+/-2.2). 3D spine alignment analyses demonstrated significant reduction in pre-op to 1st erect upper thoracic (41.3degree to 11.6degree), mid-thoracic (48.6degree to 9.55degree) and lumbar Cobb angles (19.7degree to 8.9degree), an increase in TK:T2-12 (20.0degree to 39.8degree) and TK:T5-12 (9.8 to 28.2degree), and reduction in proximal and mid-thoracic apical vertebral rotation (9.5degree to 2.1degree) from preoperative to 1st erect postoperative (p<0.001 for all). 3D spinal alignment remained stable from 1st erect to 5 years (p>0.05 for all). 3D rib cage analysis demonstrated there was a small reduction in maximal depth (144 mm to 138 mm), maximum width (235 mm to 232 mm), and increase in thoracic height (220 mm to 230 mm, p<0.01 for all), but no significant change in rib cage volume (5136 to 5202 cm³ p=0.184). There was no correlation between change in coronal or sagittal alignment parameters and perioperative change in rib cage volume. From first erect to 5-year a significant increase in max depth (138 mm to 144 mm), width (232 mm to 242 mm), thoracic height (230 mm to 233 mm) and rib cage volume (5202 cm to 5912 cm, p<0.001 for all) occurred. Pulmonary function analysis showed significant improvement in FEV1 (2.73 to 2.98 L, p=0.003) and FVC (3.22 to 3.46 L, p=0.006) from preoperative to 5-year, however, TLC did not change (4.54 to 4.59 L, p=0.517). Percent predicted TLC was reduced (Pre:101.3% to 5Y:89.1%, p<0.001), however, % predicted FEV and FVC did not (89% to 86.4%, p=0.227 & 92.5% to 87.7%, p=0.10 respectively). PFTs at 5-year follow-up correlated most closely with rib cage volume at 5-year follow-up (FEV r=0.643, FVC r=0.800, TLC r=0.73, p<0.001).
CONCLUSION(S): While thoracic kyphosis increases, coronal Cobb and apical vertebral rotation decrease postoperatively, these do not directly influence chest wall volume. Chest wall volume continues to increase between from first erect to 5 years due to presumed growth, which corresponds with an improvement in FEV1 and FVC at 5 year follow-up. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.
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Background/UNASSIGNED:Regional and segmental changes of the lumbar spine have previously been described as patients transition from standing to sitting; however, alignment changes in the cervical and thoracic spine have yet to be investigated. So, the aim of this study was to assess cervical and thoracic regional and segmental changes in patients with thoracolumbar deformity versus a nondeformed thoracolumbar spine population. Methods/UNASSIGNED:This study was a retrospective cohort study of a single center's database of full-body stereoradiographic imaging and clinical data. Patients were ≥ 18 years old with nondeformed spines (nondegenerative, nondeformity spinal pathologies) or thoracolumbar deformity (ASD: PI-LL > 10°). Patients were propensity-score matched for age and maximum hip osteoarthritis grade and were stratified by Scoliosis Research Society (SRS)-Schwab classification by PI-LL, SVA, and PT. Patients with lumbar transitional anatomy or fusions were excluded. Outcome measures included changes between standing and sitting in global alignment parameters: sagittal vertical axis (SVA), pelvic incidence minus lumbar lordosis (PI-LL), pelivc tilt (PT), thoracic kyphosis, cervical alignment, cervical SVA, C2-C7 lordosis (CL), T1 slop minus CL (TS-CL), and segmental alignment from C2 to T12. Another analysis was performed using patients with cervical and thoracic segmental measurements. Results/UNASSIGNED: = .009) segments. Conclusions/UNASSIGNED:Nondeformity patients and ASD patients have significant differences in mobility of global spinopelvic parameters as well as segmental regions in the cervical and thoracic spine between sitting and standing. This study aids in our understanding of flexibility and compensatory mechanisms in deformity patients, as well as the possible impact on unfused segments when considering deformity corrective surgery.

MINI: The ability of PROMIS to capture disability from cervical sagittal malalignment is unknown. Correlations between PROMIS domains and legacy outcome metrics with cervical sagittal alignment parameters were analyzed. PROMIS domains correlated strongly with legacy outcomes and PROMIS Pain Intensity correlated with worsening sagittal alignment in patients with cervical sagittal deformity.