Browsing by Author "Hiratzka, Jayme"

Filter results by typing the first few letters
Now showing 1 - 4 of 4
  • Thumbnail Image
    ItemOpen Access
    Functional Limitations Due to Lumbar Stiffness in Adults With and Without Spinal Deformity.
    (Spine, 2015-10) Daniels, Alan H; Smith, Justin S; Hiratzka, Jayme; Ames, Christopher P; Bess, Shay; Shaffrey, Christopher I; Schwab, Frank J; Lafage, Virginie; Klineberg, Eric O; Burton, Doug; Mundis, Greg M; Line, Breton; Hart, Robert A; International Spine Study Group (ISSG)

    Study design

    Cross-sectional analysis.

    Objective

    To compare Lumbar Stiffness Disability Index (LSDI) scores between asymptomatic adults and patients with spinal deformity.

    Summary of background data

    The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. Baseline disability levels of patients with adult spinal deformity (ASD) are high as measured by multiple validated outcome tools. Baseline lumbar stiffness-related disability has not been assessed in adults with and without spinal deformity.

    Methods

    The LSDI and Scoliosis Research Society-22r (SRS-22r) were submitted to a group of asymptomatic adult volunteers. Additionally, a multicenter cross-sectional cohort analysis of patients with ASD from 10 centers was conducted. Baseline LSDI and SRS-22r were completed for both operatively and nonoperatively treated patients with deformity.

    Results

    The LSDI was completed by 176 asymptomatic volunteers and 693 patients with ASD. Mean LSDI score for asymptomatic volunteers was 3.4 +/- 6.3 out of a maximum score of 100, with significant correlation between increasing age and higher (worse) LSDI score (r = 0.30, P = 0.0001). Of the patients with spinal deformity undergoing analysis, 301 subsequently underwent surgery and 392 were subsequently treated nonoperatively. Operative patients had significantly higher preoperative LSDI scores than both nonoperative patients and asymptomatic volunteers (29.9 vs. 17.3 vs. 3.4, P < 0.0001 for both). For patients with ASD, significant correlations were found between LSDI and SRS-22 Pain and Function subscales (r = -0.75 and -0.76, respectively; P < 0.0001 for both).

    Conclusion

    LSDI scores are low among asymptomatic volunteers, although stiffness-related disability increases with increasing age. Patients with ASD report substantial stiffness-related disability even prior to surgical fusion. Stiffness-related disability correlates with pain- and function-related disability measures among patients with spinal deformity.
  • Thumbnail Image
    ItemOpen Access
    Patient Satisfaction After Adult Spinal Deformity Surgery Does Not Strongly Correlate With Health-Related Quality of Life Scores, Radiographic Parameters, or Occurrence of Complications.
    (Spine, 2017-05) Hamilton, David Kojo; Kong, Christopher; Hiratzka, Jayme; Contag, Alec G; Ailon, Tamir; Line, Breton; Daniels, Alan; Smith, Justin S; Passias, Peter; Protopsaltis, Themistocles; Sciubba, Daniel; Burton, Douglas; Shaffrey, Christopher; Klineberg, Eric; Mundis, Gregory; Kim, Han-Jo; Lafage, Virginie; Lafage, Renaud; Scheer, Justin; Boachie-Adjei, Oheneba; Bess, Shay; Hart, Robert A

    Study design

    This is a multicenter retrospective review of prospectively collected cases.

    Objective

    Our objective was to evaluate the relationship between patient satisfaction, health-related quality of life (HRQoL) scores, complications, and radiographic measures at 2 years postoperative follow-up.

    Summary of background data

    For patients receiving operative management for adult spine deformity (ASD), the relationship between HRQoL measures, radiographic parameters, postoperative complications, and self-reported satisfaction remains unclear.

    Methods

    Data from 248 patients across 11 centers within the United States who underwent thoracolumbar fusion for ASD and had a minimum of 2 years follow-up was collected. Pre- and postoperative scores were obtained from the Scoliosis Research Society 22-item (SRS-22r), the Oswestry Disability Index (ODI), the 36-Item Short Form Health Survey (SF-36), and the Visual Analogue Scale. Sagittal vertical axis, coronal C7 plumbline, lumbar lordosis, pelvic tilt, T1 pelvic angle, and the difference between pelvic incidence and lumbar lordosis were assessed using postoperative radiographic films. Satisfaction (SAT) was assessed using the SRS-22r; patients were categorized as highly satisfied (HS) or less satisfied (LS). The correlation between SAT and HRQoL scores, radiographic parameters, and complications was determined.

    Results

    When compared with LS (n = 60) patients, HS (n = 188) patients demonstrated greater improvement in final ODI, SF-36 component scores, SRS-Total, and Visual Analogue Scale back scores (P < 0.05). The correlations between SAT and the final follow-up and 2 year change from baseline values were moderate for Mental Component Summary, Physical Component Summary, and ODI or weak for HRQoL scores (P < 0.0001). The HS and LS groups were equal in pre- or final postoperative radiographic parameters. Occurrence of complications had no effect on satisfaction.

    Conclusion

    Among operatively treated ASD patients, satisfaction was moderately correlated with some HRQoL measures, and not with radiographic changes or postoperative complications. Other factors, such as patient expectations and relationship with the surgeon, may be stronger drivers of patient satisfaction.

    Level of evidence

    3.
  • Thumbnail Image
    ItemOpen Access
    Selecting caudal fusion levels: 2 year functional and stiffness outcomes with matched pairs analysis in multilevel fusion to L5 versus S1.
    (European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2017-06) Daniels, Alan H; Koller, Heiko; Hiratzka, Shannon L; Mayer, Michael; Meier, Oliver; Contag, Alec Gabriel; Eltorai, Adam EM; Hiratzka, Jayme; Kojo Hamilton, D; Shaffrey, Christopher I; Smith, Justin S; Bess, Shay; Klineberg, Eric O; Ames, Christopher P; Lafage, Virginie; Line, Breton; Schwab, Frank J; Hart, Robert A; Group, International Spine Study

    Purpose

    Controversy persists as to whether to end multilevel thoracolumbar fusions caudally at L5 or S1. Some argue that stopping at L5 may preserve greater function, but there are few data comparing functional limitations due to lumbar stiffness in patients with fusion to L5 versus S1. The aim of this study was to evaluate whether patients undergoing multilevel thoracolumbar fusions with an L5 caudal endpoint have a better lumbosacral function than patients with an S1 caudal endpoint.

    Methods

    Patients undergoing successful thoracolumbar fusion of 5 or more levels to L5 or S1, with solid fusion at 2 year follow-up, were examined from a single European center in addition to a multi-center North American database of 237 patients. In total, 40 patients with a distal stopping point of L5 were matched with a subset of 40 patients with a distal endpoint of S1 ± pelvic fixation. The L5 and S1 groups were matched for the final Oswestry Disability Index (ODI), Sagittal Vertical Axis (SVA C7-S1), number of fusion levels, and age. Impacts of lumbar stiffness on function as measured by the Lumbar Stiffness Disability Index (LSDI) were compared using the conditional logistic regression.

    Results

    After matching, there was no significant difference between the S1 and L5 groups for the final ODI (29.22 ± 21.6 for S1 versus 29.21 ± 21.7 for L5; p = 0.98), SVA (29.5 ± 40.3 mm for S1 versus 33.7 ± 37.1 mm for L5; p = 0.97), mean age (61.6 ± 11.0 years for S1 versus 58.3 ± 12.6 years for L5; p = 0.23), and number of fusion levels (9.7 ± 3.3 levels for S1 versus 9.0 ± 3 levels for L5; p = 0.34). The final 2-year postoperative LSDI scores were not significantly different between the S1 group (28.08 ± 21.47) and L5 group (29.21 ± 21.66) (hazard ratio 0.99, 95 % CI 0.97-1.03, p = 0.81).

    Conclusion

    The analysis of patients with multilevel thoracolumbar fusions demonstrated that after minimum 2 year follow-up, self-reported functional impacts of lumbar stiffness were not significantly different between the patients with distal endpoints of L5 versus S1. The choice of distal fusion level of L5 does not appear to retain sufficient spinal flexibility to substantially affect postoperative function.

    Level of evidence

    Level III.
  • Thumbnail Image
    ItemOpen Access
    Stiffness After Pan-Lumbar Arthrodesis for Adult Spinal Deformity Does Not Significantly Impact Patient Functional Status or Satisfaction Irrespective of Proximal Endpoint.
    (Spine, 2017-08) Hart, Robert A; Hiratzka, Jayme; Kane, Marie S; Lafage, Virginie; Klineberg, Eric; Ames, Christopher P; Line, Breton G; Schwab, Frank; Scheer, Justin K; Bess, Shay; Hamilton, David K; Shaffrey, Christopher I; Mundis, Greg; Smith, Justin S; Burton, Douglas C; Sciubba, Daniel M; Deviren, Vedat; Boachie-Adjei, Oheneba; International Spine Study Group

    Study design

    Prospective, multicenter.

    Objective

    To determine if stiffness significantly affects function or satisfaction after pan-lumbar arthrodesis.

    Summary of background data

    The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. Data suggests that patients undergoing fusion of the entire lumbar spine are at greatest risk of functional limitations from stiffness.

    Methods

    The LSDI, Short Form 36, Scoliosis Research Society-22, and Oswestry Disability Index were administered preoperatively and at 2-year minimum follow-up to 103 spinal deformity patients from 11 centers. Patients were separated according to the proximal arthrodesis level; upper thoracic (T2-5) to pelvis (UT-Pelvis) or thoraco-lumbar (T10-T12) to pelvis (TL-Pelvis). Outcome scores were compared using Student t test or Tukey-Kramer Honest Significant Difference Analysis of Variance. Regression analysis of final LSDI scores versus Scoliosis Research Society-22 Satisfaction scores was performed.

    Results

    Mean ages, baseline values, and final scores of all outcome parameters were statistically equivalent in the two groups. Final LSDI scores did not change significantly from baseline in the UT-Pelvis (P = 0.478) or TL-Pelvis (P = 0.301) groups. In contrast, highly significant improvements (P ≤ 0.0001) from baseline were seen in both groups for other health-related QoL measures. The 2-year Satisfaction scores were statistically equivalent in the two groups, and the correlation between final LSDI and Satisfaction scores in the entire cohort was not significant (R = 0.013, P = 0.146).

    Conclusion

    Patients undergoing pan-lumbar arthrodesis for adult spinal deformity did not experience substantial increases in disability due to stiffness of the low back, although they did report significant improvements in other health-related QoL measures. Further, LSDI scores did not correlate with patient satisfaction. There were no significant differences in perceived stiffness effects whether arthrodesis stopped in the thoracolumbar or upper thoracic regions. We hope these results will be useful to spine surgeons and patients during preoperative planning and discussions.

    Level of evidence

    2.