Adogwa Owoicho, Karikari Isaac O, Elsamadicy Aladine A, Sergesketter Amanda R, Galan Diego, Bridwell Keith H
1Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois.
2Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina; and.
J Neurosurg Spine. 2018 Oct;29(4):422-428. doi: 10.3171/2018.2.SPINE171142. Epub 2018 Jul 6.
Patient-reported outcomes (PROs) are often measured up to 2 years after surgery; however, prospective collection of longitudinal outcomes for 5 years postoperatively can be challenging due to lack of patient follow-up. The aim of this study was to determine whether PROs collected at 2-year follow-up accurately predict long-term PROs 5 years after complex spinal fusion (≥ 5 levels).
This was an ambispective study of 118 adult patients (≥ 18 years old) undergoing ≥ 5-level spinal arthrodesis to the sacrum with iliac fixation from January 2002 to December 2011. Patient demographics and radiographic parameters as well as intraoperative variables were collected. PRO instruments (Scoliosis Research Society [SRS]-22r function, self-image, mental health, pain, and Oswestry Disability Index [ODI]) were completed before surgery then at 2 and 5 years after surgery. Primary outcome investigated in this study was the correlation between SRS-22r domains and ODI collected at 2- and 5-year follow-up.
Of the 118 patients, 111 patients had baseline PROs, 105 patients had 2-year follow-up data, and 91 patients had 5-year follow-up PRO data with 72% undergoing revision surgery. The average pre- and postoperative major coronal curve Cobb angles for the cohort were 32.1° ± 23.7° and 19.8° ± 19.3°, respectively. There was a strong correlation between 2- and 5-year ODI (r = 0.80, p < 0.001) and between 2- and 5-year SRS-22r domains, including function (r = 0.79, p < 0.001), self-image (r = 0.82, p < 0.001), mental health (r = 0.77, p < 0.001), and pain (r = 0.79, p < 0.001). Of the PROs, ODI showed the greatest absolute change from baseline to 2- and 5-year follow-up (2-year Δ 17.6 ± 15.9; 5-year Δ 16.5 ± 19.9) followed by SRS-22r self-image (2-year Δ 1.4 ± 0.96; 5-year Δ 1.3 ± 1.0), pain (2-year Δ 0.94 ± 0.97; 5-year Δ 0.80 ± 1.0), function (2-year Δ 0.60 ± 0.62; 5-year Δ 0.49 ± 0.79), and mental health (2-year Δ 0.49 ± 0.77; 5-year Δ 0.38 ± 0.84).
Patient-reported outcomes collected at 2-year follow-up may accurately predict long-term PROs (5-year follow-up).
患者报告结局（PROs）通常在术后长达2年时进行测量；然而，由于缺乏患者随访，术后5年纵向结局的前瞻性收集可能具有挑战性。本研究的目的是确定在2年随访时收集的PROs是否能准确预测复杂脊柱融合术（≥5个节段）后5年的长期PROs。
这是一项对2002年1月至2011年12月期间接受≥5节段骶骨脊柱融合术并采用髂骨固定的118例成年患者（≥18岁）进行的回顾性研究。收集患者的人口统计学和影像学参数以及术中变量。PRO工具（脊柱侧弯研究学会[SRS]-22r功能、自我形象、心理健康、疼痛和奥斯维斯特残疾指数[ODI]）在手术前、术后2年和5年完成。本研究调查的主要结局是在2年和5年随访时收集的SRS-22r各领域与ODI之间的相关性。
118例患者中，111例患者有基线PROs，105例患者有2年随访数据，91例患者有5年随访PRO数据，其中72%接受了翻修手术。该队列术前和术后主要冠状面 Cobb角的平均值分别为32.1°±23.7°和19.8°±19.3°。2年和5年的ODI之间存在强相关性（r = 0.80，p < 0.001），2年和5年的SRS-22r各领域之间也存在强相关性，包括功能（r = 0.79，p < 0.001）、自我形象（r = 0.82，p < 0.001）、心理健康（r = 0.77，p < 0.001）和疼痛（r = 0.79，p < 0.001）。在PROs中，ODI从基线到2年和5年随访的绝对变化最大（2年变化量Δ 17.6 ± 15.9；5年变化量Δ 16.5 ± 19.9），其次是SRS-22r自我形象（2年变化量Δ 1.4 ± 0.96；5年变化量Δ 1.3 ± 1.0）、疼痛（2年变化量Δ 0.94 ± 0.97；5年变化量Δ 0.80 ± 1.0）、功能（2年变化量Δ 0.）。
在2年随访时收集的患者报告结局可能准确预测长期PROs（5年随访）。
