Patients with Adult Spinal Deformity with Previous Fusions Have an Equal Chance of Reaching Substantial Clinical Benefit Thresholds in Health-Related Quality of Life Measures but Do Not Reach the Same Absolute Level of Improvement
Abstract
© 2018 Elsevier Inc. Background: Substantial clinical benefit (SCB) represents a threshold
above which patients recognize substantial improvement and represents a rational target
for defining clinical success. In adult spinal deformity (ASD) surgery, previous fusions
may impact outcomes after deformity correction. Objective: To investigate the impact
of previous spinal fusion on the likelihood of reaching SCB thresholds for 2-year
health-related quality of life (HRQOL) after ASD surgery. Methods: We conducted a
retrospective review comparing baseline demographic, HRQOL, and radiographic features
for patients with ASD undergoing primary versus revision procedures. The primary outcome
measure was reaching SCB threshold in Oswestry Disability Index (ODI), SF-36 Physical
Component Summary (PCS), and back and leg pain (numeric rating scale). Secondary outcomes
included absolute and change scores in ODI, PCS, and back and leg pain. Results: In
total, 332 patients achieved 2-year follow-up (228 primary; 104 revision cases). Those
undergoing revision surgery had similar demographic features (age 58.3/55.9, female
80.8%/82.9%) to patients undergoing primary surgery. They had worse baseline HRQOL
(ODI 48.5/41.2, PCS 29.5/33.4, back 7.5/7.0, and leg pain 4.9/4.3; P < 0.001) and
radiographic deformity (sagittal vertical axis 111.4/45.1, lumbopelvic mismatch 26.7/11.0,
pelvic tilt 29.5/21.0; P < 0.0001). Nevertheless, the number of patients who reached
SCB for ODI (38.3/36.3%), PCS (48.5/53.4%), back (53.1/60.5%), and leg pain numeric
rating scale (28.6/36.9%) did not significantly differ. Revision patients had worse
2-year HRQOL for all measures. Conclusions: Patients undergoing revision surgery have
worse baseline HRQOL and deformity. Although they do not achieve the same absolute
level of 2-year HRQOL outcome, they have a similar likelihood of reaching SCB threshold
for improvement in 2-year HRQOL.
Type
Journal articlePermalink
https://hdl.handle.net/10161/17581Published Version (Please cite this version)
10.1016/j.wneu.2018.04.204Publication Info
Ailon, Tamir; Smith, Justin S; Shaffrey, Christopher I; Soroceanu, Alex; Lafage, Virginie;
Schwab, Frank; ... International Spine Study Group (2018). Patients with Adult Spinal Deformity with Previous Fusions Have an Equal Chance of
Reaching Substantial Clinical Benefit Thresholds in Health-Related Quality of Life
Measures but Do Not Reach the Same Absolute Level of Improvement. World Neurosurgery, 116. pp. e354-e361. 10.1016/j.wneu.2018.04.204. Retrieved from https://hdl.handle.net/10161/17581.This is constructed from limited available data and may be imprecise. To cite this
article, please review & use the official citation provided by the journal.
Collections
More Info
Show full item recordScholars@Duke
Christopher Ignatius Shaffrey
Professor of Orthopaedic Surgery

Articles written by Duke faculty are made available through the campus open access policy. For more information see: Duke Open Access Policy
Rights for Collection: Scholarly Articles