Ogura Yoji, Gum Jeffrey L, Soroceanu Alex, Daniels Alan H, Line Breton, Protopsaltis Themistocles, Hostin Richard A, Passias Peter G, Burton Douglas C, Smith Justin S, Shaffrey Christopher I, Lafage Virginie, Lafage Renaud, Klineberg Eric O, Kim Han Jo, Harris Andrew, Kebaish Khaled, Schwab Frank, Bess Shay, Ames Christopher P, Carreon Leah Y
1Norton Leatherman Spine Center, Louisville, Kentucky.
2Department of Orthopedics, University of Calgary, Alberta, Canada.
J Neurosurg Spine. 2020 Oct 16;34(2):218-227. doi: 10.3171/2020.6.SPINE20363. Print 2021 Feb 1.
The shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery.
From a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval.
Of 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows:1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%.2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level.3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance.4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively.5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication.6. Will I need another surgery? 25.0% will have a reoperation within 2 years.7. Will I regret having surgery? 6.5% would not choose the same treatment.8. Will I get a blood transfusion? 73.7% require a blood transfusion.9. How long will I stay in the hospital? You need to stay 8.1 days on average.10. Will I have to go to the ICU? 76.0% will have to go to the ICU.11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively.12. Will I be taller after surgery? You will be 1.1 cm taller on average.
The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.
共同决策（SDM）过程提供了回答常见问题（FAQs）的机会。作者旨在列出一份常见问题的简明答案清单，以帮助进行成人脊柱畸形（ASD）手术的共同决策。
从一个前瞻性、多中心的ASD数据库中，纳入2008年至2016年期间接受5个或更多节段融合且至少随访2年的患者。纳入所有畸形类型以确保普遍适用性。作者汇总了接受ASD手术患者的常见问题清单，并通过回顾性分析提供答案。所有回答均报告为在2年随访期达到最小临床重要差异的均值或比例。
在689例符合2年随访条件的ASD患者中，521例（76%）在随访时具有健康相关生活质量评分。初次手术时的平均年龄为58.2岁，78%的患者为女性。大多数（73%）患者采用单纯后路手术。平均融合节段数为12.2个。翻修手术占患者的48%。作者对12个常见问题的回答如下：1. 我的疼痛会改善吗？腰背痛和腿痛都会减轻约50%。2. 我的活动水平会提高吗？约65%的患者感觉活动水平有所改善。3. 我会自我感觉更好吗？超过70%的患者感觉外貌有所改善。4. 我有变差的可能吗？4.1%的患者术后2年感觉变差。5. 我发生并发症的可能性有多大？67.8%的患者会发生严重或轻微并发症，其中47.8%会发生严重并发症。6. 我需要再次手术吗？25.0%的患者在2年内需要再次手术。7. 我会后悔做手术吗？6.5%的患者不会选择相同的治疗方法。8. 我需要输血吗？73.7%的患者需要输血。9. 我要住院多久？平均需要住院8.1天。10. 我需要进重症监护室吗？76.0%的患者需要进重症监护室。11. 我能回去工作吗？超过70%的患者术后1年能工作。12. 术后我会变高吗？平均会高1.1厘米。
上述清单为在为ASD手术患者提供咨询时，共同决策过程中遇到的常见问题提供了简明、实用的答案。
