Durability of substantial clinical benefit leading to optimal outcomes in adult spinal deformity corrective surgery: a minimum 5-year analysis.

IF 2.9 2区 医学 Q2 CLINICAL NEUROLOGY Journal of neurosurgery. Spine Pub Date : 2024-08-30 Print Date: 2024-12-01 DOI:10.3171/2024.5.SPINE2456
Jamshaid M Mir, Matthew S Galetta, Nima Alan, Oluwatobi O Onafowokan, Ankita Das, Pooja Dave, Peter Tretiakov, Nathan A Lorentz, Renaud Lafage, Bassel Diebo, M Burhan Janjua, Dean Chou, Justin S Smith, Virginie Lafage, Andrew J Schoenfeld, Daniel Sciubba, Andreas K Demetriades, Peter G Passias
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Abstract

Objective: The objective was to evaluate factors associated with the long-term durability of outcomes in adult spinal deformity (ASD) patients.

Methods: Operative ASD patients fused from at least L1 to the sacrum with baseline (BL) to 5-year (5Y) follow-up were included. Substantial clinical benefit (SCB) in Oswestry Disability Index (ODI), numeric rating scale (NRS)-back, NRS-leg, and Scoliosis Research Society (SRS)-22r scores and physical component score were assessed on the basis of previously published values. Factors were evaluated on the basis of meeting optimal outcomes (OO) at 2 years (2+) and 5 years (5+). Furthermore, 2+ patients were isolated and evaluated on the basis of meeting OO at 5 years (2+5+) or not at 5 years (2+5-). OO were defined as follows: no reoperation, major mechanical failure, proximal junctional failure, and meeting either 1) SCB in terms of ODI score (decrease > 18.8) or 2) ODI < 15 and SRS-22r total > 4.5.

Results: In total, 330 ASD patients met the inclusion criteria, with 45.5% meeting SCB for ODI at 2 years, while 46.0% met SCB at 5 years; 79% of those who achieved 2-year (2Y) SCB went on to achieve 5Y SCB. This rate was lower for OO, with 41% achieving 2Y OO (2+), while 37% met 5Y OO (5+) and 80% of 2+ patients had durable outcomes until 5+ (32% of the total cohort). Of the patient factors, frailty was significantly different among groups at 2 years, while comorbidity burden was significantly different at 5 years and the combination thereof differed in those with durable outcomes. Those who regained their level of activity postoperatively had 4 times higher odds of maintaining OO from 2 years to 5 years (p < 0.05). Osteoporosis rates, although equivocal at BL, were higher at the last follow-up in those who met 2Y OO but failed to meet 5Y OO. The odds of achieving OO at 5 years in 2+ patients decreased by 47% for each additional comorbidity and decreased by 74% in those who had lower-extremity paresthesias at BL (both p < 0.05). Controlling for patient factors and BL disability found fewer levels fused, decreased correction of sagittal vertical axis, and increased correction of pelvic incidence-lumbar lordosis mismatch to be predictive of maintaining 2Y OO until 5 years (p < 0.05).

Conclusions: SCB was met in 46% of ASD patients at 5 years. The durability of OO was seen in a third of patients until 5 years postoperatively. Higher rates of medical complications were seen in those who failed to achieve and maintain OO until 5 years. Frailty and comorbidity burden were significant factors associated with the achievement and durability of OO until 5 years.

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成人脊柱畸形矫正手术中获得最佳疗效的实质性临床益处的持久性:至少 5 年的分析。
目的:评估与成人脊柱畸形(ASD)患者长期疗效持久性相关的因素:目的是评估与成人脊柱畸形(ASD)患者长期疗效持久性相关的因素:方法:纳入至少从 L1 到骶骨融合的 ASD 手术患者,进行基线(BL)至 5 年(5Y)随访。根据之前公布的数值评估了Oswestry残疾指数(ODI)、背部数字评分量表(NRS)、腿部数字评分量表(NRS)、脊柱侧弯研究学会(SRS)-22r评分和体能成分评分的实质性临床获益(SCB)。根据 2 年(2+)和 5 年(5+)达到最佳治疗效果(OO)的情况对各因素进行评估。此外,2+患者被分离出来,并根据其在 5 年(2+5+)时是否达到最佳结果(2+5-)进行评估。OO的定义如下:无再次手术、主要机械故障、近端连接失败,以及符合以下任一条件:1)ODI评分为SCB(下降>18.8)或2)ODI<15且SRS-22r总分>4.5:共有 330 名 ASD 患者符合纳入标准,其中 45.5% 的患者在 2 年时 ODI 达到了 SCB,46.0% 的患者在 5 年时达到了 SCB;79% 的 2 年 SCB 患者在 5 年后达到了 SCB。OO的这一比例较低,41%的患者在2年后达到OO(2+),而37%的患者在5年后达到OO(5+),80%的2+患者在5+前有持久的疗效(占队列总数的32%)。在患者因素中,虚弱程度在 2 年时各组间存在显著差异,而合并症负担在 5 年时存在显著差异,两者的组合在获得持久疗效的患者中也存在差异。术后恢复活动水平的患者从 2 年到 5 年保持 OO 的几率要高出 4 倍(P < 0.05)。骨质疏松症发生率虽然在基础阶段不明确,但在最后一次随访中,达到 2 年 OO 但未能达到 5 年 OO 的患者的骨质疏松症发生率更高。合并症每增加一种,2 岁以上患者在 5 年后达到 OO 的几率就会降低 47%,而在基础阶段出现下肢麻痹的患者,达到 OO 的几率会降低 74%(P 均 < 0.05)。在对患者因素和BL残疾进行控制后发现,较少的融合水平、矢状垂直轴校正的减少以及骨盆入射角-腰椎前凸不匹配校正的增加是维持2Y OO直至5年的预测因素(P < 0.05):46%的ASD患者在5年后达到了SCB标准。结论:46%的 ASD 患者在术后 5 年达到了 SCB,三分之一的患者在术后 5 年仍能保持 OO。未能达到并维持 OO 至 5 年的患者出现医疗并发症的比例较高。体质虚弱和合并症负担是影响OO的实现和维持至5年的重要因素。
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来源期刊
Journal of neurosurgery. Spine
Journal of neurosurgery. Spine 医学-临床神经学
CiteScore
5.10
自引率
10.70%
发文量
396
审稿时长
6 months
期刊介绍: Primarily publish original works in neurosurgery but also include studies in clinical neurophysiology, organic neurology, ophthalmology, radiology, pathology, and molecular biology.
期刊最新文献
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