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The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement?

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Abstract

Purpose

Objectives in scoliosis corrective surgery include restoration of normal sagittal and coronal parameters to achieve patient satisfaction. HRQLs improvements remain limited after corrective surgery. The aim of this study was to evaluate the HRQL subclass variability specific to the sagittal and coronal correction in adult scoliosis surgery.

Methods

This multi-centre prospective analysis of consecutive adult spinal deformity (ASD) patients, from five European centres, only included multilevel instrumentation for scoliosis. d-(delta) values for each parameter represented pre to post-operative changes. Parameters included demographics, baseline, 1- and 2-year. HRQL outcomes (Oswestry disability index (ODI), Scoliosis Research Society (SRS)-22 and Short Form (SF36)), sagittal correction including relative spinopelvic alignment (dRSA) and coronal correction including major Cobb (dCobb) angles.

Results

A total of 353 patients reached 1-year and 2-year follow up. All HRQL total scores significantly improved postoperatively, including ODI, SRS-22 and SF36. HRQL subclasses which displayed persistent improvements correlated to dRSA included sex-life, self-image, fatigue, vitality, social functioning. The only HRQL subclass improvement that correlated with dCobb was self-image.

Conclusion

Adult scoliosis surgery improves overall HRQL, having a minimal effect on each variable. Importantly, greater coronal deformity correction affects only greater self-image scores, whereas with greater sagittal correction there are many greater HRQL sub-class impacts. Correction and restoration of coronal balance is one of the surgical goals in adult scoliosis but the degree to which Cobb angle is corrected, apart from self-image, does not correlate with gains in sub-classes of HRQL. These results need to be taken into account when planning surgery.

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Abbreviations

ASD:

Adult spinal deformity

BMI:

Indicates body mass index

COMI:

Core Outcome Measures Index

GT:

Global tilt; LL, lumbar lordosis

MCS:

Mental Component Summary

ODI:

Oswestry Disability Index

PCS:

Physical Component Summary

PI:

Pelvic incidence

PT:

Pelvic tilt

SF36:

Short Form 36

SRS-22:

Scoliosis Research Society 22-question Questionnaire

SVA:

Sagittal vertical axis

PI-LL:

Pelvic incidence minus lumbar lordosis

RSA:

Relative spinopelvic alignment

BMI:

Body mass index

SVA:

Sagittal vertical axis

TK:

Thoracic kyphosis

PT:

Pelvic tilt

References

  1. Acaroglu RE, Dede O, Pellise F, Guler UO, Domingo-Sabat M, Alanay A, Pérez-Grueso FS (2016) Adult spinal deformity: a very heterogeneous population of patients with different needs. Acta Orthop Traumatol Turc 50(1):57–62

    PubMed  Google Scholar 

  2. Bridwell KH, Glassman S, Horton W et al (2009) Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine 34(20):2171–2178

    Article  Google Scholar 

  3. Yoshida G, Boissiere L, Larrieu D et al (2017) Advantages and disadvantages of adult spinal deformity surgery and its impact on health-related quality of life. Spine 42(6):411–419

    Article  Google Scholar 

  4. Paul JC, Lonner BS, Goz V et al (2015) Complication rates are reduced for revision adult spine deformity surgery among high-volume hospitals and surgeons. Spine J 15(9):1963–1972

    Article  Google Scholar 

  5. Fujishiro T, Boissière L, Cawley DT, et al (2019) Adult spinal deformity surgical decision- making score. Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 40 years with adult spinal deformity. Eur Spine J

  6. Acaroglu E, Yavuz AC, Guler UO et al (2016) A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden? Eur Spine J 25(8):2390–2400

    Article  Google Scholar 

  7. Acaroglu E, Guler UO, Cetinyurek-Yavuz A et al (2017) Decision analysis to identify the ideal treatment for adult spinal deformity: what is the impact of complications on treatment outcomes? Acta Orthop Traumatol Turc 51(3):181–190

    Article  Google Scholar 

  8. Boissiere L, Takemoto M, Bourghli A et al (2017) Global tilt and lumbar lordosis index: two parameters correlating with health-related quality of life scores-but how do they truly impact disability? Spine J 17:480–488

    Article  Google Scholar 

  9. Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (GAP) score development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99(19):1661–1672

    Article  Google Scholar 

  10. Kieser DC, Boissiere L, Yilgor CC et al (2019) A single sagittal parameter for decision making in adult spinal deformity. J Spine Neurosurg 8:3

    Google Scholar 

  11. Bridwell KH, Cats-Baril W, Harrast J et al (2005) The validity of the SRS-22 instrument in an adult spinal deformity population compared with the Oswestry and SF-12: a study of response distribution, concurrent validity, internal consistency, and reliability. Spine 30:455–461

    Article  Google Scholar 

  12. Pellisé F, Vila-Casademunt A, Ferrer M et al (2015) Impact on health-related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24(1):3–11

    Article  Google Scholar 

  13. Theis J, Gerdhem P, Abbott A (2015) Quality of life outcomes in surgically treated adult scoliosis patients: a systematic review. Eur Spine J 24(7):1343–55. doi: https://doi.org/10.1007/s00586-014-3593-3.

  14. Núñez-Pereira S, Vila-Casademunt A, Domingo-Sàbat M et al (2018) Impact of early unanticipated revision surgery on health-related quality of life after adult spinal deformity surgery. Spine J 18(6):926–934

    Article  Google Scholar 

  15. Kieser DC, Yuksel S, Boissiere L et al. (2020) Impact of radiologic variables on item responses Of ODI and SRS22 in adult spinal deformity patients: differential item functioning (DIF) analysis results from a multi-center database. In press

  16. Takemoto M, Boissière L, Novoa F et al (2016) Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients. Eur Spine J 25(8):2442–2451

    Article  Google Scholar 

  17. Bess S, Boachie-Adjei O, Burton D et al (2009) Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine 34:2186–2190

    Article  Google Scholar 

  18. Fujishiro T, Boissière L, Cawley DT et al (2020) Adult spinal deformity surgical decision-making score: Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity. Eur Spine J. 29(1):45–53. https://doi.org/10.1007/s00586-019-06068-0

    Article  PubMed  Google Scholar 

  19. Obeid I, Berjano P, Lamartina C et al (2019) Classification of coronal imbalance in adult scoliosis and spine deformity: a treatment-oriented guideline. Eur Spine J 28:94–113

    Article  Google Scholar 

  20. New classification of coronal malalignment for adult spinal deformity: a validation and the role of lateral bending films. In press.

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Authors and Affiliations

  1. Institut de La Colonne Vertébrale, CHU Pellegrin, Bordeaux, France

    D. T. Cawley, L. Boissiere, D. Larrieu, J. M. Vital & I. Obeid

  2. Mater Private Hospital, Dublin 1, Ireland

    D. T. Cawley

  3. Kyoto City Hospital, Kyoto, Japan

    M. Takemoto

  4. Christchurch School of Medicine, University of Otago, Dunedin, New Zealand

    D. C. Kieser

  5. Osaka Medical College, Takatsuki-shi, Osaka, Japan

    T. Fujishiro

  6. Osaka City University Graduate School of Medicine, Juso Hospital, Osaka, Japan

    K. Hayashi

  7. Kingdom Hospital, Riyadh, Saudi Arabia

    A. Bourghli

  8. Acibadem University School of Medicine, Istanbul, Turkey

    C. Yilgor & A. Alanay

  9. Hospital Universitario La Paz, Madrid, Spain

    F. J. Perez Grueso

  10. Hospital Universitario Val Hebron, Barcelona, Spain

    F. Pelisse

  11. Schulthess Klinik, Zurich, Switzerland

    F. Kleinstück

Authors
  1. D. T. Cawley
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  2. M. Takemoto
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  3. L. Boissiere
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  4. D. Larrieu
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  5. D. C. Kieser
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  6. T. Fujishiro
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  7. K. Hayashi
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  8. A. Bourghli
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  9. C. Yilgor
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  10. A. Alanay
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  11. F. J. Perez Grueso
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  12. F. Pelisse
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  13. F. Kleinstück
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  14. J. M. Vital
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  15. I. Obeid
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Consortia

European Spine Study Group, ESSG

Corresponding author

Correspondence to D. T. Cawley.

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Cawley, D.T., Takemoto, M., Boissiere, L. et al. The Impact of Corrective Surgery on Health-Related Quality of Life Subclasses in Adult Scoliosis: Will Degree of Correction Prognosticate Degree of Improvement?. Eur Spine J 30, 2033–2039 (2021). https://doi.org/10.1007/s00586-021-06786-4

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  • DOI: https://doi.org/10.1007/s00586-021-06786-4

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