Professor Duke University Duke University Heath System New Canaan, CT, US
Introduction: Previous research has demonstrated that ASD corrective surgery can significantly improve patients’ quality of life and reduce disability with durable results. Yet, there remains a paucity of literature assessing long-term effects of such interventions.
Methods: Operative ASD patients ≥18yrs with complete BL and 10Y) postop radiographic/HRQL data were identified from a single-surgeon cohort. Demographics, patient-reported outcomes and complication rates were collected and reported. Complications and mortality data were recorded as of the last clinical follow-up. Rates of meeting minimal clinically important difference (MCID) were reported for collected HRQLs [Oswestry Disability Index (ODI), SRS-22, SF-36] routinely obtained at each follow-up. Mixed-effect models analyzed longitudinal trends in patient-reported outcomes over the ten-year follow-up window while accounting for age, gender, BMI, CCI, and mFI.
Results: 82 (60.3±14.8 years, 75.6 % female, 26.4±5.1 kg/m2) included. When assessing HRQLs, 43.0% of patients met MCID by ODI, 56.0% met MCID by SRS-22 Activity, 60.0% met MCID by SRS-22 Pain, 57.0% met MCID by SRS-22 Appearance, and 22.0% met MCID by SRS-22 Mental. In terms of postoperative complications by 10Y, 82.9% sustained complications of any type, 20.7% experienced major complications, 14.6% medical complications, 15.9% neurological complications, 26.8% mechanical complications (instrumentation failure, screw fracture), 50.0% PJK, 12.2% radiographic PJF, and 29.3% required reoperation. Mixed effects models identified significant effects of time on improvement in ODI and SRS-22 total and sub-domains (all p<.001). Pairwise comparisons showed significant reduction in ODI scores over 10 years (β = -15.017, [-20.9, -9.1], p<.001) and significant increase in SRS-22 total scores over (β = 0.771, [-1.04, -0.50], p<.001).
Conclusion : Here, we present ten-year outcomes following adult spinal deformity surgery in a single-surgeon cohort. The observed rates of complications underly the high-intensity nature of these interventions. By ten-year follow-up, improvement in patient-reported outcomes remained robust.