Individual differences in postoperative recovery trajectories for adult symptomatic lumbar scoliosis.

dc.contributor.author

Greenberg, Jacob K

dc.contributor.author

Kelly, Michael P

dc.contributor.author

Landman, Joshua M

dc.contributor.author

Zhang, Justin K

dc.contributor.author

Bess, Shay

dc.contributor.author

Smith, Justin S

dc.contributor.author

Lenke, Lawrence G

dc.contributor.author

Shaffrey, Christopher I

dc.contributor.author

Bridwell, Keith H

dc.date.accessioned

2023-06-15T18:06:22Z

dc.date.available

2023-06-15T18:06:22Z

dc.date.issued

2022-03

dc.date.updated

2023-06-15T18:06:22Z

dc.description.abstract

Objective

The Adult Symptomatic Lumbar Scoliosis-1 (ASLS-1) trial demonstrated the benefit of adult symptomatic lumbar scoliosis (ASLS) surgery. However, the extent to which individuals differ in their postoperative recovery trajectories is unknown. This study's objective was to evaluate variability in and factors moderating recovery trajectories after ASLS surgery.

Methods

The authors used longitudinal, multilevel models to analyze postoperative recovery trajectories following ASLS surgery. Study outcomes included the Oswestry Disability Index (ODI) score and Scoliosis Research Society-22 (SRS-22) subscore, which were measured every 3 months until 2 years postoperatively. The authors evaluated the influence of preoperative disability level, along with other potential trajectory moderators, including radiographic, comorbidity, pain/function, demographic, and surgical factors. The impact of different parameters was measured using the R2, which represented the amount of variability in ODI/SRS-22 explained by each model. The R2 ranged from 0 (no variability explained) to 1 (100% of variability explained).

Results

Among 178 patients, there was substantial variability in recovery trajectories. Applying the average trajectory to each patient explained only 15% of the variability in ODI and 21% of the variability in SRS-22 subscore. Differences in preoperative disability (ODI/SRS-22) had the strongest influence on recovery trajectories, with patients having moderate disability experiencing the greatest and most rapid improvement after surgery. Reflecting this impact, accounting for the preoperative ODI/SRS-22 level explained an additional 56%-57% of variability in recovery trajectory, while differences in the rate of postoperative change explained another 7%-9%. Among the effect moderators tested, pain/function variables-such as visual analog scale back pain score-had the biggest impact, explaining 21%-25% of variability in trajectories. Radiographic parameters were the least influential, explaining only 3%-6% more variance than models with time alone. The authors identified several significant trajectory moderators in the final model, such as significant adverse events and the number of levels fused.

Conclusions

ASLS patients have highly variable postoperative recovery trajectories, although most reach steady state at 12 months. Preoperative disability was the most important influence, although other factors, such as number of levels fused, also impacted recovery.
dc.identifier

2022.2.SPINE211233

dc.identifier.issn

1547-5654

dc.identifier.issn

1547-5646

dc.identifier.uri

https://hdl.handle.net/10161/28030

dc.language

eng

dc.publisher

Journal of Neurosurgery Publishing Group (JNSPG)

dc.relation.ispartof

Journal of neurosurgery. Spine

dc.relation.isversionof

10.3171/2022.2.spine211233

dc.subject

adult spinal deformity

dc.subject

longitudinal data analysis

dc.subject

lumbar

dc.subject

multilevel models

dc.subject

scoliosis

dc.subject

spine surgery

dc.title

Individual differences in postoperative recovery trajectories for adult symptomatic lumbar scoliosis.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

1

pubs.end-page

10

pubs.issue

3

pubs.organisational-group

Duke

pubs.organisational-group

School of Medicine

pubs.organisational-group

Clinical Science Departments

pubs.organisational-group

Orthopaedic Surgery

pubs.organisational-group

Neurosurgery

pubs.publication-status

Published

pubs.volume

37

Files

Original bundle

Now showing 1 - 1 of 1
Loading...
Thumbnail Image
Name:
j-neurosurg-spine-article-p429.pdf
Size:
2 MB
Format:
Adobe Portable Document Format