How is staging of ALIF following posterior spinal arthrodesis to the pelvis related to functional improvement in patients with adult spinal deformity?

Abstract

Study design

Retrospective cohort.

Objectives

To compare postoperative functional improvement in patients who underwent staged versus non-staged anterior–posterior spinal arthrodesis for adult spinal deformity (ASD).

Summary of background data

In patients with ASD, spinal arthrodesis can be performed in 2 stages to avoid the physiologic insult of a lengthy surgery. The association between staged surgery and postoperative functional improvement has not been well studied.

Methods

We included 87 patients (59 women) with ASD who underwent anterior–posterior spinal arthrodesis of > 5 levels with fixation to the pelvis from 2010–2014. Primary outcomes were the frequency of achieving at least a minimal clinically important difference (MCID) in the Scoliosis Research Society-22r (SRS-22r) Activity domain and the timeframe in which it was achieved. The secondary outcome was patient satisfaction (SRS-22r Patient Satisfaction domain). A Cox proportional hazard model was used to compare functional improvement over time between staged and non-staged groups. Our study was powered to detect a relative hazard ratio of 0.53, β = 0.20. α = 0.05.

Results

The frequency of achieving an MCID in SRS-22r Activity score did not differ significantly between the staged group (33/41 patients) and the non-staged group (34/46 patients) (hazard ratio 0.74; 95% confidence interval 0.41–1.36). Median times to achieving an MCID in SRS-22r Activity score were 191 days (interquartile range: 86–674) in the staged group and 181 days (interquartile range: 72–474) in the non-staged group (p = .75). The staged and non-staged groups had similar SRS-22r Patient Satisfaction scores at 3–9 months postoperatively and at final follow-up (both, p > .05).

Conclusion

Patients with ASD who underwent staged anterior–posterior spinal arthrodesis within 3 months after index surgery were similarly likely to experience functional improvement in the same timeframe as patients who underwent non-staged surgery. Patient satisfaction did not differ significantly between staged and non-staged groups.

Level of evidence

III.

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Funding

The authors received no financial support for the research, authorship, and/or publication of this article.

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Authors

Contributions

ABH, VP, MR: conception and design; acquisition and data; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; supervision. MM: conception and design; analysis and interpretation of data; drafting of the manuscript; statistical analysis; supervision. MR: conception and design; drafting of the manuscript; critical revision of the manuscript for important intellectual content; supervision. RLS: conception and design; acquisition and data; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; administration, technical, or material support; supervision. KMK: conception and design; analysis and interpretation of data; critical revision of the manuscript for important intellectual content; administration, technical, or material support; supervision. BJN: conception and design; analysis and interpretation of data; drafting of the manuscript; critical revision of the manuscript for important intellectual content; statistical analysis; administration, technical, or material support; supervision.

Corresponding author

Correspondence to Brian J. Neuman.

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The authors have no conflicts of interest with respect to the authorship and/or publication of this article.

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The study was approved by our institutional review board.

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Harris, A.B., Puvanesarajah, V., Raad, M. et al. How is staging of ALIF following posterior spinal arthrodesis to the pelvis related to functional improvement in patients with adult spinal deformity?. Spine Deform (2021). https://doi.org/10.1007/s43390-020-00272-5

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Keywords

  • Adult spinal deformity
  • Functional improvement
  • Quality of life
  • Satisfaction
  • Scoliosis
  • Staged spinal arthrodesis.