188. Prospective analysis of adult spinal deformity patients demonstrates radically different preop demographic, radiographic and quality of life parameters for primary vs revision patients

Abstract

<h3>BACKGROUND CONTEXT</h3> ASD is a vague and heterogeneous label applied to adults afflicted with varying types, severities, and etiologies of spine deformities. We hypothesized that ASD patients with a history of spine fusion and associated spine deformity (revision=R) have distinct pathognomonic differences from ASD patients with no history of spine fusion (primary=P). <h3>PURPOSE</h3> Evaluate baseline differences for revision vs primary ASD patients including demographics, radiographic spine deformity, functional measures, opiate consumption and patient-reported outcome measures (PROMs), prior to receiving reconstructive ASD surgery. <h3>STUDY DESIGN/SETTING</h3> Preoperative analysis of ASD patients prospectively enrolled into a multicenter study. <h3>PATIENT SAMPLE</h3> ASD patients prospectively enrolled into multicenter study. <h3>OUTCOME MEASURES</h3> Numeric rating scale (NRS) back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Edmonton Frailty Index (EFI score), grip strength, Veterans Rand Health Questionnaire (VR-12), Oswestry Disability Index (ODI), daily morphine milligram equivalent consumption (MME), PROMIS-Pain Interference (PROMIS-PI), PROMIS-Physical Function (PROMIS-PF), PROMIS-Depression (DEP), PROMIS-Anxiety (ANX), PROMIS-Satisfaction with Social Roles (SR) and PROMIS-Satisfaction with Discretionary Social Activities (SSA) computer adaptive tests (CATs). <h3>METHODS</h3> From 2018-2020, patients age >18 years were enrolled in a multicenter prospective study evaluating surgical treatment for ASD. Patients were dichotomized according to R vs P, and preop demographics, grip strength, frailty, daily MME consumption, physical examination, radiographic measures, and PROMs data were compared. <h3>RESULTS</h3> A total of 204/204 enrolled patients were evaluated; R (n=99), P (n= 105). R and P had similar age, Charleson Comorbidity Index (CCI) and gender distribution (p>0.05). R had greater daily MME consumption (35mg vs 15mg), were more frail (EFI score 4 vs 2), and had greater incidence of motor deficits (54% vs 37%) than P, respectively (p<0.05). R differed radiographically from P in 11/15 measurements, as nearly all sagittal parameters were worse for R (SVA=139mm vs 57mm; PI-LL=26° vs 12°; PT=28.2° vs 20.7°), while P had greater scoliosis (50.6° vs 20.3°), respectively (p<0.05). Nearly all PROM measures were worse for R vs P, including disability (ODI=48 vs 38), pain measures (PROMIS PI=66.9 vs 61.9; NRS-Back=7.0 vs 6.0), physical function (PROMIS-PF=32.8 vs 36.8, SRS-Activity=2.6 vs 3.2), social function (PROMIS-SSA= 40.4 vs 45.4), depression (PROMIS-DEP=51.1 vs 48.8), and self-image (SRS-Appearance=2.2 vs 2.6). <h3>CONCLUSIONS</h3> Revision ASD patients are distinctly different from primary ASD patients. Despite having similar preop age, gender and CCI, R were more frail, consumed more opiates, and reported greater pain, disability, function, and worse mental health than P. R had greater sagittal deformities while P had worse coronal deformities. Future analysis of ASD patients should distinguish between revision and primary patients to avoid confounding analyses. <h3>FDA DEVICE/DRUG STATUS</h3> This abstract does not discuss or include any applicable devices or drugs.