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

Abstract

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.