Daniels, Alan HDurand, Wesley MSteinbaum, Alyssa JLafage, RenaudHamilton, D KojoPassias, Peter GKim, Han JoProtopsaltis, ThemistoclesLafage, VirginieSmith, Justin SShaffrey, ChristopherGupta, MunishKlineberg, Eric OSchwab, FrankGum, Jeffrey LMundis, GregoryEastlack, RobertKebaish, KhaledSoroceanu, AlexHostin, Richard ABurton, DougBess, ShayAmes, ChristopherHart, Robert AISSG2023-06-162023-06-162022-020362-24361528-1159https://hdl.handle.net/10161/28046<h4>Study design</h4>Retrospective cohort study of a prospectively collected multi-center database of adult spinal deformity (ASD) patients.<h4>Objective</h4>We hypothesized that patients undergoing ASD surgery with and without previous spinal cord stimulators (SCS)/ intrathecal medication pumps (ITP) would exhibit increased complication rates but comparable improvement in health-related quality of life.<h4>Summary of background data</h4>ASD patients sometimes seek pain management with SCS or ITP before spinal deformity correction. Few studies have examined outcomes in this patient population.<h4>Methods</h4>Patients undergoing ASD surgery and eligible for 2-year follow-up were included. Preoperative radiographs were reviewed for the presence of SCS/ITP. Outcomes included complications, Oswestry Disability Index (ODI), Short Form-36 Mental Component Score, and SRS-22r. Propensity score matching was utilized.<h4>Results</h4>In total, of 1034 eligible ASD patients, a propensity score-matched cohort of 60 patients (30 with SCS/ITP, 30 controls) was developed. SCS/ITP were removed intraoperatively in most patients (56.7%, n = 17). The overall complication rate was 80.0% versus 76.7% for SCS/ITP versus control (P > 0.2), with similarly nonsignificant differences for intraoperative and infection complications (all P > 0.2). ODI was significantly higher among patients with SCS/ITP at baseline (59.2 vs. 47.6, P = 0.0057) and at 2-year follow-up (44.4 vs. 27.7, P = 0.0295). The magnitude of improvement, however, did not significantly differ (P = 0.45). Similar results were observed for SRS-22r pain domain. Satisfaction did not differ between groups at either baseline or follow-up (P > 0.2). No significant difference was observed in the proportion of patients with SCS/ITP versus control reaching minimal clinically important difference in ODI (47.6% vs. 60.9%, P = 0.38). Narcotic usage was more common among patients with SCS/ITP at both baseline and follow-up (P < 0.05).<h4>Conclusion</h4>ASD patients undergoing surgery with SCS/ITP exhibited worse preoperative and postoperative ODI and SRS-22r pain domain; however, the mean improvement in outcome scores was not significantly different from patients without stimulators or pumps. No significant differences in complications were observed between patients with versus without SCS/ITP.Level of Evidence: 3.ISSGSpinal CordHumansScoliosisPainTreatment OutcomePostoperative PeriodRetrospective StudiesQuality of LifeAdultJournal article2023-06-16