Return to Activities of Daily Living After Fusion to the Pelvis for Adult Spinal Deformity

Abstract

Study Design: Cross-sectional survey and retrospective review of prospectively-collected data. Objective: To investigate return to activities among adult spinal deformity (ASD) patients following long-segment fusion to the pelvis. Summary of Background Data: No prior studies have assessed the extent and timing of return to employment, driving, and walking among a single cohort of ASD patients. Methods: Patients who underwent thoracolumbar ASD surgery between 2016-2021 with ≥1 year follow-up were included (posterior-only, ≥3 levels of fusion to pelvis). A cross-sectional survey was implemented to evaluate preoperative and postoperative activity tolerance. Patients were categorized into (1)Better/Unchanged or (2)Worse groups based on their postoperative activity tolerance to allow for comparison of demographics and perioperative variables. Results: Ninety-five patients were included (mean age:64.3±10.1 years; body mass index (BMI):27.3±6.1 kg/m2; levels fused:8 [range 3-16]; follow-up:43.5 months). Most patients endorsed improved capacity to walk (improved:64.2%, unchanged:17.9%, worse:17.9%) and navigate stairs (improved:52.6%, unchanged:33.7%, worse:13.7%) postoperatively. Seventy-five (97.4%) patients returned to driving (4.1±10.8 months) and 44 (88.0%) patients returned to work (5.4±8.0 months). Patients with decreased walking tolerance were more likely to have greater lumbar lordosis correction (37.2±10.5° vs. 18.6±16.7°, P=0.02) and worse Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) at long-term follow-up (40.2±11.0 vs. 48.0±9.6, P=0.03). Patients with decreased ability to navigate stairs were more likely to have undergone revision fusion (69.2% vs. 28.0%, P=0.003) and have greater BMI (30.7±5.8 vs. 26.7±6.0 kg/m2, P=0.04). Patients requiring the use of a postoperative assistive walking device were more likely to have undergone revision fusion (66.7% vs. 27.5%, P=0.003), exhibit greater BMI (31.4±7.2 vs. 26.5±5.6 kg/m2, P=0.004), longer operative times (285.1±79.9 vs. 244.5±63.4 minutes, P=0.03), and worse PROMIS-PF at long-term follow-up (39.9±5.1 vs. 47.7±10.5, P=0.04). Conclusion: Despite the reduced range of motion caused by spinopelvic fusion, a majority of patients are able to successfully return to ADLs after deformity surgery.