Impact of Sagittal Spinopelvic Alignment for Clinical Outcome after Decompression Surgery for Lumbar Spinal Canal Stenosis

Abstract

Health Survey Physical and Mental Component Summaries (SF-12 PCS and MCS), EuroQol-5D health survey (EQ-5D), NASS satisfaction METHODS: Analysis of 69 adult patients who underwent surgical correction of adult spinal deformity performed at a single institution. Patientreported outcomes (PROs) were assessed prospectively at baseline and 1 year postoperatively and included measures of back and leg pain on a numeric rating scale (BP-NRS and LP-NRS), Oswestry Disability Index (ODI), 12-Item Short Form Health Survey Physical and Mental Component Summaries (SF-12 PCS and MCS), and EuroQol-5D health survey (EQ-5D). Substantial clinical benefit (SCB) thresholds were determined by performing receiver operating curve (ROC) analysis using the NASS patient satisfaction score as an anchor. RESULTS: The mean age was 60 years (range 21-80). Fusion was performed over an average of 8 levels. Osteotomies performed included posterior column osteotomies in 53 patients (77%), pedicle subtraction osteotomies in 12 patients (17%), and vertebral column resection in 7 patients (10%). Significant improvements (p!0.01) were found in all PROs assessed except SF-12 MCS (mean improvement: BP-NRS [3], LP-NRS [2], ODI [14], SF-12 PCS [8], SF-12 MCS [1, p50.60] EQ-5D [0.2]. Surgery met patient expectations in 42 (61%) cases based on NASS Satisfaction Index. Substantial clinical benefit thresholds were 5.0 for BP-NRS, 2.0 for LP-NRS, 18 for ODI, 5.2 for SF-12 PCS, 3.5 for SF-12 MCS, and 0.09 for EQ-5D. There was a significant difference (p!0.01) seen in all PROs assessed for patients satisfied versus not satisfied. CONCLUSIONS: Thresholds of substantial clinical benefit following surgical procedures are important to understand, as they define the magnitude of improvement that patients recognize as significant postoperative improvement. This study provides these thresholds in adult patients undergoing scoliosis deformity surgery. FDA DEVICE/DRUG STATUS: This abstract does not discuss or include any applicable devices or drugs.