216. Contrary to popular belief, self-image in adult spinal deformity (ASD) is most correlated with physical and social function and mental health and minimally correlated with magnitude of spine deformity

Abstract

BACKGROUND CONTEXT Self-image (SI) is the most negatively impacted health domain for ASD. SI also strongly correlates with ASD postoperative satisfaction. Surgeons often assume that negative SI is due to scoliosis and/or sagittal malalignment, however data from cancer patients indicates physical and social function is strongly associated with of self-image. Little data exists investigating SI in ASD. PURPOSE Evaluate the radiographic, demographic, and health related quality of life (HRQOL) variables most correlated with SI in operatively treated ASD patients. STUDY DESIGN/SETTING Regression analysis of radiographic, demographic and HRQOL domains most associated with baseline and postoperative improvements in SI for operatively treated ASD patients from a prospective multicenter database. PATIENT SAMPLE Surgically treated ASD patients enrolled into a prospective multicenter study of operative vs nonoperative treatment for ASD, minimum 2-year postoperative follow-up. OUTCOME MEASURES Numeric rating scale (NRS) for back and leg pain, Scoliosis Research Society-22r questionnaire (SRS-22r), Short Form-36v2 questionnaire (SF-36), Oswestry Disability Index (ODI), self-image domain of SRS-22r. METHODS Baseline SI was assessed for operatively treated patients enrolled into a prospective multicenter study of operative vs nonoperative treatment for ASD (inclusion criteria age >18 years, scoliosis > 20°, thoracic kyphosis >60°, and/or SVA>5cm). Patients were organized according to SRS-Schwab ASD deformity types, and SI was reevaluated at minimum 2-year follow up. Regression analysis was performed on patient demographic, radiographic, and HRQOL domains and correlated with SI and treatment satisfaction. RESULTS A total of 591 of 789 patients eligible for study were evaluated (mean follow-up 3.2 years). Regression analysis demonstrated baseline SI (mean=2.4, range 1-4.6) correlated significantly (p 0.05). SI correlated most with SRS-22r activity (R=0.57), SF-36 social function (R=0.56), ODI (R=-0.52), SRS-22r mental health (R=0.51), and SF-36 vitality (R=0.50) but weakly with back (R=-0.265) and leg pain (R=-0.170; p 0.05). At last follow up SI improved from preop (3.6, range 1.6-5), and correlated most with improvements in SRS-22r activity (R=0.53), ODI (R=-0.45), and SRS-22r mental health (R=0.45; p CONCLUSIONS Baseline SI and postoperative SI improvement for ASD correlated most with physical and social function and mental health. ASD treatment satisfaction at 2 years postoperative strongly correlated with SI. The correlations between SI and physical and social function were independent of pain and spine deformity magnitude as correlations between SI, pain scales, scoliosis and sagittal malalignment ranged from weak to nonsignificant. These findings are consistent with research surrounding SI and cancer patients. More research is needed regarding the psychology and physiology of SI for ASD to improve patient outcomes and treatment satisfaction. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.