Younger Patients Are Differentially Affected by Stiffness-Related Disability Following Adult Spinal Deformity Surgery.


OBJECT:The LSDI assesses the impact of lumbar stiffness on activities of daily living. We hypothesized that patients <60 years-old would perceive greater lumbar stiffness-related functional limitation following fusion for adult spinal deformity. METHODS:Patients completed the LSDI and SRS-22r questionnaires preoperatively and at 2 years postoperatively. The primary independent variable was patient age <60 vs. ≥60 years-old. Multivariable regression analyses were utilized. RESULTS:In total, 267 patients were analyzed. Patients <60 years-old (51.3%) and ≥60 years-old (48.7%) were evenly represented. In bivariable analysis, patients <60 years-old exhibited lower LSDI at baseline vs. patients ≥60 years-old (25.7 vs. 35.5, β -9.8, p<0.0001), but a directionally smaller difference at 2-years (26.4 vs. 32.3, β -5.8, p=0.0147). LSDI was associated with lower SRS-22r total score among both patients <60 and ≥60 years-old, at both baseline and 2-years (all p<0.0001); the association was stronger among patients <60 vs. ≥60 years-old at 2 years. LSDI was associated with SRS satisfaction scores at 2 years among patients <60 years-old (p<0.0001), but not patients ≥60 years-old (p=0.2250). The difference in SRS satisfaction per unit LSDI between patients <60 years-old and >60 years-old was significant (p=0.0021). CONCLUSIONS:Among ASD patients managed operatively, higher LSDI was associated with inferior SRS-22r total score and satisfaction at 2 years postoperatively. The association between increased LSDI and worse PROMs was greater among patients <60 vs. ≥60 years old. Pre-operative counseling is needed for patients <60 undergoing ASD surgery regarding the effects that lumbar stiffness may have on post-operative function and satisfaction.





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Publication Info

Durand, Wesley M, Alan H Daniels, David K Hamilton, Peter G Passias, Han Jo Kim, Themistocles Protopsaltis, Virginie Lafage, Justin S Smith, et al. (2019). Younger Patients Are Differentially Affected by Stiffness-Related Disability Following Adult Spinal Deformity Surgery. World neurosurgery. 10.1016/j.wneu.2019.08.169 Retrieved from

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Christopher Ignatius Shaffrey

Professor of Orthopaedic Surgery

I have more than 25 years of experience treating patients of all ages with spinal disorders. I have had an interest in the management of spinal disorders since starting my medical education. I performed residencies in both orthopaedic surgery and neurosurgery to gain a comprehensive understanding of the entire range of spinal disorders. My goal has been to find innovative ways to manage the range of spinal conditions, straightforward to complex. I have a focus on managing patients with complex spinal disorders. My patient evaluation and management philosophy is to provide engaged, compassionate care that focuses on providing the simplest and least aggressive treatment option for a particular condition. In many cases, non-operative treatment options exist to improve a patient’s symptoms. I have been actively engaged in clinical research to find the best ways to manage spinal disorders in order to achieve better results with fewer complications.

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