Liu Shian, Diebo Bassel G, Henry Jensen K, Smith Justin S, Hostin Richard, Cunningham Matthew E, Mundis Gregory, Ames Christopher P, Burton Douglas, Bess Shay, Akbarnia Behrooz, Hart Robert, Passias Peter G, Schwab Frank J, Lafage Virginie
Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA.
Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 800212, USA.
Spine J. 2016 Feb;16(2):210-8. doi: 10.1016/j.spinee.2015.10.043. Epub 2015 Oct 31.
Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of nonoperative patients and proposes predictors of those most likely to benefit.
The study aims to determine the factors that affect likelihood of nonoperative patients to reach MCID.
STUDY DESIGN/SETTING: This is a retrospective review of a prospective, multicenter database.
The study includes nonoperative ASD patients.
Health-related quality-of-life measures, including the Scoliosis Research Society (SRS)-22 questionnaire, were used.
The study used a multicenter database of 215 nonoperative patients with ASD and with minimum 2-year follow-up. Using a multivariate analysis, two groups were compared to identify possible predictors: those who reached MCID in the SRS pain or activity (N=86) at 2 years and those who did not reach MCID (N=129). A subgroup multivariate analysis of patients with a deficit (potential improvement) in both SRS pain and activity (N=84) was performed. Data collection was supported by a grant from DePuy for the International Spine Study Group Foundation.
At baseline, the nonoperative patients who reached MCID had a significantly lower SRS pain score (3.0 vs. 3.6), smaller thoracolumbar Cobb (TL Cobb) angle (29.6° vs. 36.5°; 87 patients with SRS-Schwab classification of lumbar or double), lower sacral slope (33.1° vs. 36.4°), and less lumbar lordosis (46.5° vs. 52.8°) (all p<.05). The SRS pain and TL Cobb were significant predictors for reaching MCID. The pelvic incidence minus lumbar lordosis (PI-LL) was significant on univariate analysis but not on multivariate analysis (7.5° vs. 2.6°; p=.14). In the subset of severely disabled patients, worse vertebral obliquity was a predictor for not achieving MCID (p<.05).
Nonoperative ASD patients who achieved MCID in SRS activity or pain had a lower baseline SRS pain score and less coronal deformity in the TL region. Greater baseline pain offers significant room for potential improvement, which may be important in identifying ASD patients who have the potential to reach MCID nonoperatively. Coronal deformities in the TL region and associated vertebral obliquity may negatively impact potential for improvement in nonoperative care.
成人脊柱畸形（ASD）患者在未经手术干预的情况下，可能在一种或多种健康相关生活质量指标上获得最小临床重要差异（MCID）。本研究确定了这一非手术患者亚组的基线特征，并提出了最可能从中受益的患者的预测因素。
本研究旨在确定影响非手术患者达到MCID可能性的因素。
研究设计/地点：这是一项对前瞻性多中心数据库的回顾性研究。
本研究纳入非手术ASD患者。
采用了与健康相关的生活质量指标，包括脊柱侧弯研究学会（SRS）-22问卷。
本研究使用了一个包含215例非手术ASD患者且至少随访2年的多中心数据库。通过多变量分析，比较了两组患者以确定可能的预测因素：在2年时SRS疼痛或活动方面达到MCID的患者（N = 86）和未达到MCID的患者（N = 129）。对SRS疼痛和活动均有缺陷（有潜在改善空间）的患者亚组（N = 84）进行了多变量分析。数据收集得到了DePuy公司为国际脊柱研究组基金会提供的资助。
在基线时，达到MCID的非手术患者的SRS疼痛评分显著更低（3.0对3.6），胸腰段Cobb角更小（29.6°对36.5°；87例SRS-Schwab分类为腰椎型或双主弯型），骶骨倾斜度更低（33.1°对36.4°），腰椎前凸更小（46.5°对52.8°）（所有p <.05）。SRS疼痛评分和胸腰段Cobb角是达到MCID的显著预测因素。骨盆入射角减去腰椎前凸（PI-LL）在单变量分析中具有显著性，但在多变量分析中不具有显著性（7.5°对2.6°；p = 0.14）。在严重残疾患者亚组中，更严重的椎体倾斜是未达到MCID的一个预测因素（p <.05）。
在SRS活动或疼痛方面达到MCID的非手术ASD患者基线SRS疼痛评分更低，胸腰段区域的冠状面畸形更小。更大的基线疼痛提供了显著的潜在改善空间，这对于识别有可能非手术达到MCID的ASD患者可能很重要。胸腰段区域的冠状面畸形及相关椎体倾斜可能对非手术治疗的改善潜力产生负面影响。
