Activities of daily living and patient satisfaction after long fusion for adult spinal deformity: a retrospective study

  • Yoshinori IshikawaEmail author
  • Naohisa Miyakoshi
  • Takashi Kobayashi
  • Toshiki Abe
  • Hiroaki Kijima
  • Eiji Abe
  • Yoichi Shimada
Original Article



Spinal instrumented arthrodesis improves health-related quality of life (HRQOL), although mobility is impaired. This study evaluates activities of daily livings after thoracolumbosacroiliac arthrodesis for adult spinal deformity and patient satisfaction.


Fifty patients who underwent surgery filled self-administered questionnaires (1-year preoperative and postoperative conditions), and 36 patients (3 men and 33 women; mean age 71.4 years) participated in the study. Twenty-five activities, including weeding, snow shoveling, toilet activities, and sleeping postures, were examined. Spinal alignment with Scoliosis Research Society (SRS)—Schwab classification, HRQOL with SRS-22, complications, and patient satisfaction were evaluated. Pre- and postoperative conditions were statistically compared.


Spinal alignment improved postoperatively. Comparison data revealed that strenuous activities, such as weeding and farm work, significantly deteriorated postoperatively in 42.1–87.5% patients. Other basic activities, excluding Western toilet usage, sleeping supine, laundry and kitchen chores, and changing jacket/pants, also significantly deteriorated in 21–88% patients. Only activities such as sleeping supine, standing upright, vacuuming, doing laundry, and reaching for objects placed at heights became possible with significant difference postoperatively among activities that could not be performed preoperatively. Light activities were continued, but strenuous activities were restricted. Nevertheless, the patient satisfaction rate was 70%. Six patients exhibited complications; however, none were dissatisfied with surgery outcomes. Instrumentation or proximal junctional failures were associated with at least one strenuous work activity.


Thoracolumbosacroiliac arthrodesis does not always improve activities postoperatively. Therefore, surgical indication for patients who continue activities preoperatively should be carefully decided.

Level of Evidence

Level 3.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Adult spinal deformity Thoracolumbosacroiliac arthrodesis Spinal mobility Quality of life Activities of daily living 


Compliance with ethical standards

Conflict of interest

All authors declare that they have no conflict of interest.

Supplementary material

586_2019_5893_MOESM1_ESM.pptx (857 kb)
Supplementary material 1 (PPTX 856 kb)


  1. 1.
    Glassman SD, Berven S, Bridwell K, Horton W, Dimar JR (2005) Correlation of radio-graphic parameters and clinical symptoms in adult scoliosis. Spine 30:682–688CrossRefGoogle Scholar
  2. 2.
    Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30:2024–2029CrossRefGoogle Scholar
  3. 3.
    Lafage V, Schwab F, Patel A, Hawkinson N, Farcy JP (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34:E599–E606. CrossRefGoogle Scholar
  4. 4.
    Schwab FJ, Smith VA, Biserni M, Gamez L, Farcy JP, Pagala M (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27:387–392CrossRefGoogle Scholar
  5. 5.
    Schwab F, Patel A, Ungar B, Farcy JP, Lafage V (2010) Adult spinal deformity-postoperative standing imbalance: how much can you tolerate? An overview of key parameters in assessing alignment and planning corrective surgery. Spine 35:2224–2231. CrossRefGoogle Scholar
  6. 6.
    Ishikawa Y, Miyakoshi N, Kasukawa Y, Hongo M, Shimada Y (2009) Spinal curvature and postural balance in patients with osteoporosis. Osteoporos Int 20:2049–2053. CrossRefGoogle Scholar
  7. 7.
    Ishikawa Y, Miyakoshi N, Hongo M, Kasukawa Y, Kudo D, Shimada Y (2017) Relationships among spinal mobility and sagittal alignment of spine and lower extremity to quality of life and risk of falls. Gait Posture 53:98–103. CrossRefGoogle Scholar
  8. 8.
    Kimura H, Fujibayashi S, Otsuki B, Takahashi Y, Nakayama T, Matsuda S (2016) Effects of lumbar stiffness after lumbar fusion surgery on activities of daily living. Spine 41:719–727. CrossRefGoogle Scholar
  9. 9.
    Hart RA, Marshall LM, Hiratzka SL, Kane MS, Volpi J, Hiratzka JR (2014) Functional limitations due to stiffness as a collateral impact of instrumented arthrodesis of the lumbar spine. Spine 39:E1468–E1474. CrossRefGoogle Scholar
  10. 10.
    Asher M, Min Lai S, Burton D, Manna B (2003) The reliability and concurrent validity of the scoliosis research society-22 patient questionnaire for idiopathic scoliosis. Spine 28:63–69. CrossRefGoogle Scholar
  11. 11.
    Kanda Y (2012) Investigation of the freely-available easy-to-use software “EZR” (Easy R) for medical statistics. Bone Marrow Transplant 48:452–458. CrossRefGoogle Scholar
  12. 12.
    United Nations, Department of Economic and Social Affairs, Population Division (2017) World Population Prospects: The 2017 Revision, Key Findings and Advance Tables. Working paper no. ESA/P/WP/248Google Scholar
  13. 13.
    Djurasovic M, Glassman SD (2007) Correlation of radiographic and clinical findings in spinal deformities. Neurosurg Clin N Am 18:223–227. CrossRefGoogle Scholar
  14. 14.
    Schwab FJ, Blondel B, Bess S, Hostin R, Shaffrey CI, Smith JS, Boachie-Adjei O, Burton DC, Akbarnia BA, Mundis GM, Ames CP, Kebaish K, Hart RA, Farcy JP, Lafage V, International Spine Study Group (ISSG) (2013) Radiographical spinopelvic parameters and disability in the setting adult spinal deformity. Spine 38:803–812. CrossRefGoogle Scholar
  15. 15.
    Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D, DeWald C, Mehdian H, Shaffrey C, Tribus C, Lafage V (2012) Scoliosis Research Society—Schwab adult spinal deformity classification. Spine 37:1077–1082. CrossRefGoogle Scholar
  16. 16.
    Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP, Fu KM, Burton D, Hostin R, Klineberg E, Gupta M, Deviren V, Mundis G, Hart R, Bess S, Lafage V, International Spine Study Group (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73:559–568. CrossRefGoogle Scholar
  17. 17.
    Smith JS, Klineberg E, Schwab F, Shaffrey CI, Moal B, Ames CP, Hostin R, Fu KM, Burton D, Akbarnia B, Gupta M, Hart R, Bess S, Lafage V, International Spine Study Group (2013) Change in classification grade by the SRS-Schwab adult spinal deformity classification predicts impact on health-related quality of life measures. Spine 38:1663–1671. CrossRefGoogle Scholar
  18. 18.
    Faraj SSA, van Hooff ML, Holewijn RM, Polly DW Jr, Haanstra TM, de Kleuver M (2017) Measuring outcomes in adult spinal deformity surgery: a systematic review to identify current strengths, weaknesses and gaps in patient-reported outcome measures. Eur Spine J 26:2084–2093. CrossRefGoogle Scholar
  19. 19.
    Miyakoshi N, Hongo M, Kobayashi T, Abe T, Abe E, Shimada Y (2015) Improvement of spinal alignment and quality of life after corrective surgery for spinal kyphosis in patients with osteoporosis: a comparative study with non-operated patients. Osteoporos Int 26:2657–2664. CrossRefGoogle Scholar
  20. 20.
    Miyakoshi N, Itoi E, Kobayashi M, Kodama H (2003) Impact of postural deformities and spinal mobility on quality of life in postmenopausal osteoporosis. Osteoporos Int 14:1007–1012. CrossRefGoogle Scholar
  21. 21.
    Martín-Buitrago MP, Pizones J, Sánchez Pérez-Grueso FJ, Díaz Almirón M, Vila-Casademunt A, Obeid I, Alanay A, Kleinstück F, Acaroglu ER, Pellisé F, ESSG European Spine Study Group (2018) Impact of iliac instrumentation on the quality of life of patients with adult spine deformity. Spine 43:913–918. CrossRefGoogle Scholar
  22. 22.
    Sciubba DM, Scheer JK, Smith JS, Lafage V, Klineberg E, Gupta M, Mundis GM, Protopsaltis TS, Kim HJ, Hiratzka JR, Koski T, Shaffrey CI, Bess S, Hart RA, Ames CP, International Spine Study Group (ISSG) (2015) Which daily functions are most affected by stiffness following total lumbar fusion: comparison of upper thoracic and thoracolumbar proximal endpoints. Spine 40:1338–1344. CrossRefGoogle Scholar
  23. 23.
    Yoshida G, Boissiere L, Larrieu D, Bourghli A, Vital JM, Gille O, Pointillart V, Challier V, Mariey R, Pellisé F, Vila-Casademunt A, Perez-Grueso FJ, Alanay A, Acaroglu E, Kleinstück F, Obeid I, ESSG, European Spine Study Group (2017) Advantages and disadvantages of adult spinal deformity surgery and its impact on health-related quality of life. Spine 42:411–419. CrossRefGoogle Scholar
  24. 24.
    De la Garza Ramos R, Goodwin CR, Elder BD, Boah AO, Miller EK, Jain A, Klineberg EO, Ames CP, Neuman BJ, Kebaish KM, Lafage V, Schwab F, Bess S, Sciubba DM (2017) Preoperative functional status as a predictor of short-term outcome in adult spinal deformity surgery. J Clin Neurosci 39:118–123CrossRefGoogle Scholar
  25. 25.
    Hongo M, Miyakoshi N, Shimada Y, Sinaki M (2012) Association of spinal curve deformity and back extensor strength in elderly women with osteoporosis in Japan and the United States. Osteoporos Int 23:1029–1034. CrossRefGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  1. 1.Department of Orthopedic SurgeryAkita University Graduate School of MedicineAkitaJapan
  2. 2.Department of Orthopedic SurgeryAkita Kousei Medical CenterAkitaJapan

Personalised recommendations