Improvement in Back and Leg Pain and Disability Following Adult Spinal Deformity Surgery: Study of 324 Patients With 2-year Follow-up and the Impact of Surgery on Patient-reported Outcomes.
Adolescent
Adult
Aged
Aged, 80 and over
Back Pain
/ etiology
Disability Evaluation
Female
Follow-Up Studies
Humans
Kyphosis
/ complications
Leg
Male
Middle Aged
Musculoskeletal Pain
/ etiology
Patient Reported Outcome Measures
Postoperative Period
Propensity Score
Radiculopathy
/ etiology
Radiography
Retrospective Studies
Scoliosis
/ complications
Young Adult
Journal
Spine
ISSN: 1528-1159
Titre abrégé: Spine (Phila Pa 1976)
Pays: United States
ID NLM: 7610646
Informations de publication
Date de publication:
15 02 2019
15 02 2019
Historique:
pubmed:
2
8
2018
medline:
26
7
2019
entrez:
2
8
2018
Statut:
ppublish
Résumé
A retrospective review of a prospective, multicenter adult spinal deformity (ASD) database. Our objective was to quantify the change in disability reported for patients with radiculopathy as compared with patients with back pain only following ASD realignment surgery. Studies utilizing patient-reported outcomes (PROs) have shown that ASD patients suffer from significant pain and disability. Although surgical correction has been effective at improving back and leg pain, no studies have investigated the impact of radiculopathy on pain and disability in ASD patients. Inclusion criteria were age ≥ 18 years and presence of spinal deformity as defined by coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, pelvic tilt (PT) angle ≥ 25°, or thoracic kyphosis (TK) angle ≥ 60°. Demographics and PRO were collected. Patients with radiculopathy were propensity matched with patients with back pain. Preoperative, postoperative, and 2-year follow-up radiographic parameters and PRO were analyzed. Three hundred twenty-four patients met inclusion criteria, and following propensity matching, 90 patients were placed into the radiculopathy and back pain groups. These groups showed no difference in demographic or radiographic parameters. The groups were similar in PRO, with a difference in leg pain as per design. At baseline, leg pain patients had higher disability [Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)]. Surgical strategies between the two groups showed no differences. Postoperative radiographic parameters showed no difference. Despite a significantly greater decrease in numerical rating scale (NRS) Leg for the leg pain group, postoperatively, these patients remained more disabled than the nonleg group in terms of NRS (back and leg), ODI, and most of the SRS domains. ASD patients with radiculopathy exhibit increased pain and disability when compared with patients without leg pain. This increased pain and disability persists after surgical correction in these patients. 3.
Sections du résumé
STUDY DESIGN
A retrospective review of a prospective, multicenter adult spinal deformity (ASD) database.
OBJECTIVE
Our objective was to quantify the change in disability reported for patients with radiculopathy as compared with patients with back pain only following ASD realignment surgery.
SUMMARY OF BACKGROUND DATA
Studies utilizing patient-reported outcomes (PROs) have shown that ASD patients suffer from significant pain and disability. Although surgical correction has been effective at improving back and leg pain, no studies have investigated the impact of radiculopathy on pain and disability in ASD patients.
METHODS
Inclusion criteria were age ≥ 18 years and presence of spinal deformity as defined by coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, pelvic tilt (PT) angle ≥ 25°, or thoracic kyphosis (TK) angle ≥ 60°. Demographics and PRO were collected. Patients with radiculopathy were propensity matched with patients with back pain. Preoperative, postoperative, and 2-year follow-up radiographic parameters and PRO were analyzed.
RESULTS
Three hundred twenty-four patients met inclusion criteria, and following propensity matching, 90 patients were placed into the radiculopathy and back pain groups. These groups showed no difference in demographic or radiographic parameters. The groups were similar in PRO, with a difference in leg pain as per design. At baseline, leg pain patients had higher disability [Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)]. Surgical strategies between the two groups showed no differences. Postoperative radiographic parameters showed no difference. Despite a significantly greater decrease in numerical rating scale (NRS) Leg for the leg pain group, postoperatively, these patients remained more disabled than the nonleg group in terms of NRS (back and leg), ODI, and most of the SRS domains.
CONCLUSION
ASD patients with radiculopathy exhibit increased pain and disability when compared with patients without leg pain. This increased pain and disability persists after surgical correction in these patients.
LEVEL OF EVIDENCE
3.
Identifiants
pubmed: 30067577
doi: 10.1097/BRS.0000000000002815
pii: 00007632-201902150-00010
doi:
Types de publication
Journal Article
Multicenter Study
Langues
eng
Pagination
263-269Références
Schwab F, Dubey A, Gamez L, et al. Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976) 2005; 30:1082–1085.
Duval-Beaupere G, Schmidt C, Cosson P. A Barycentremetric study of the sagittal shape of spine and pelvis: the conditions required for an economic standing position. Ann Biomed Eng 1992; 20:451–462.
Legaye J, Duval-Beaupere G, Hecquet J, et al. Pelvic incidence: a fundamental pelvic parameter for three-dimensional regulation of spinal sagittal curves. Eur Spine J 1998; 7:99–103.
Ryan DJ, Protopsaltis TS, Ames CP, et al. T1 pelvic angle (TPA) effectively evaluates sagittal deformity and assesses radiographical surgical outcomes longitudinally. Spine (Phila Pa 1976) 2014; 39:1203–1210.
Vialle R, Levassor N, Rillardon L, et al. Radiographic analysis of the sagittal alignment and balance of the spine in asymptomatic subjects. J Bone Joint Surg Am 2005; 87:260–267.
Schwab F, Ungar B, Blondel B, et al. Scoliosis Research Society-Schwab adult spinal deformity classification: a validation study. Spine (Phila Pa 1976) 2012; 37:1077–1082.
Baldus C, Bridwell KH, Harrast J, et al. Age-gender matched comparison of SRS instrument scores between adult deformity and normal adults: are all SRS domains disease specific? Spine (Phila Pa 1976) 2008; 33:2214–2218.
Terran J, Schwab F, Shaffrey CI, et al. The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 2013; 73:559–568.
Zanoli G, Stromqvist B, Jonsson B. Visual analog scales for interpretation of back and leg pain intensity in patients operated for degenerative lumbar spine disorders. Spine (Phila Pa 1976) 2001; 26:2375–2380.
Glassman SD, Copay AG, Berven SH, et al. Defining substantial clinical benefit following lumbar spine arthrodesis. J Bone Joint Surg Am 2008; 90:1839–1847.
Smith JS, Fu KM, Urban P, et al. Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 2008; 9:326–331.
Scheer JK, Smith JS, Clark AJ, et al. Comprehensive study of back and leg pain improvements after adult spinal deformity surgery: analysis of 421 patients with 2-year follow-up and of the impact of the surgery on treatment satisfaction. J Neurosurg Spine 2015; 22:540–553.
Smith JS, Shaffrey CI, Berven S, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery 2009; 65:86–93. discussion 93-94.
Smith JS, Shaffrey CI, Berven S, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976) 2009; 34:1693–1698.
Blondel B, Schwab F, Ungar B, et al. Impact of magnitude and percentage of global sagittal plane correction on health-related quality of life at 2-years follow-up. Neurosurgery 2012; 71:341–348. discussion 8.