Department of Orthopaedics, NYU Langone Medical Center-Orthopaedic Hospital, New York, NY.
Department of Orthopaedic Surgery, Brigham and Women's Hospital, Harvard Medical School, Boston, MA.
Spine (Phila Pa 1976). 2024 Mar 15;49(6):398-404. doi: 10.1097/BRS.0000000000004804. Epub 2023 Aug 18.
Retrospective Cohort Study.
To assess if there is a threshold of baseline disability beyond which the patient-reported outcomes after surgical correction of adult spinal deformity (ASD) are adversely impacted.
Patient-reported outcomes vary after correction of adult spinal deformity, even when patients are optimally realigned. There is a paucity of literature examining the impact of baseline disability on patient-reported outcomes in ASD.
Patients with baseline (BL) and two-year data were included. Disability was ranked according to BL Oswestry Disability Index (ODI) into quintiles: Q1 (lowest ODI score) to Q5 (highest ODI score). Adjusted logistic regression analyses evaluated the likelihood of reaching ≥1 MCID in Scoliosis Research Society Outcomes Questionnaire (SRS-22) Pain, SRS-22 Activity, and Short Form-36 physical component summary at two years across disability groups Q1-Q4 with respect to Q5. Sensitivity tests were performed, excluding patients with any "0" Schwab modifiers at BL.
Compared with patients in Q5, the odds of reaching MCID in SRS-22 Pain at 2Y were significantly higher for those in Q1 (OR: 3.771), Q2 (OR: 3.006), and Q3 (OR: 2.897), all P <0.021. Similarly, compared with patients in Q5, the odds of reaching MCID in SRS-22 Activity at two years were significantly higher for those in Q2 (OR: 3.454) and Q3 (OR: 2.801), both P <0.02. Lastly, compared with patients in Q5, odds of reaching MCID in Short Form-36 physical component summary at two years were significantly higher for patients in Q1 (OR: 5.350), Q2 (OR: 4.795), and Q3 (OR: 6.229), all P <0.004.
This study found that patients presenting with moderate disability at BL (ODI<40) consistently surpassed health-related quality of life outcomes as compared with those presenting with greater levels of disability. We propose that a baseline ODI of 40 represents a disability threshold within which operative inte rvention maximizes patient-reported outcomes. Furthermore, delaying the intervention until patients progress to severe disability may limit the benefits of surgical correction in ASD patients.
回顾性队列研究。
评估基线残疾程度是否存在一个阈值，超过这个阈值，成人脊柱畸形（ASD）手术后患者报告的结果就会受到不利影响。
即使患者得到了最佳的矫正，成人脊柱畸形矫正后的患者报告结果也会有所不同。目前文献中关于基线残疾对 ASD 患者报告结果的影响的研究很少。
纳入基线（BL）和两年数据的患者。根据 BL Oswestry 残疾指数（ODI）将残疾程度分为五组：Q1（最低 ODI 评分）至 Q5（最高 ODI 评分）。使用调整后的逻辑回归分析，评估在 Q1-Q4 残疾组中，与 Q5 相比，达到 Scoliosis Research Society 结果问卷（SRS-22）疼痛、SRS-22 活动和简明健康调查问卷 36 项物理成分综合量表（SF-36）≥1 个 MCID 的可能性。进行了敏感性测试，排除了 BL 时任何“0”Schwab 修饰符的患者。
与 Q5 患者相比，在 2 年时达到 SRS-22 疼痛 MCID 的几率在 Q1（OR：3.771）、Q2（OR：3.006）和 Q3（OR：2.897）患者中显著更高，所有 P<0.021。同样，与 Q5 患者相比，在 2 年时达到 SRS-22 活动 MCID 的几率在 Q2（OR：3.454）和 Q3（OR：2.801）患者中显著更高，两者 P<0.02。最后，与 Q5 患者相比，在 2 年时达到 SF-36 物理成分综合量表 MCID 的几率在 Q1（OR：5.350）、Q2（OR：4.795）和 Q3（OR：6.229）患者中显著更高，所有 P<0.004。
本研究发现，与基线残疾程度更高的患者相比，基线残疾程度为中度（ODI<40）的患者在身体相关生活质量结果方面表现出持续改善。我们提出，ODI 基线值为 40 代表了一个残疾阈值，在此阈值内，手术干预可以最大限度地提高患者报告的结果。此外，延迟手术干预直至患者发展为严重残疾可能会限制 ASD 患者手术矫正的获益。
3。
