Low Disability Research Articles

Safety and Clinical Efficacy Outcomes From the Long-term Extension Study of Tolebrutinib in Participants With Relapsing Multiple Sclerosis: 2.5-Year Results (S16.010)

Safety and Clinical Efficacy Outcomes From the Long-term Extension Study of Tolebrutinib in Participants With Relapsing Multiple Sclerosis: 2.5-Year Results (S16.010)

Trajectories of Disability and Related Factors in Korean Adults Aged ≥75years.

This study aimed to identify distinct trajectories of activities of daily living (ADL) disability in older adults aged ≥75years over 6years. A growth mixture model and the multinomial logistic regression analysis were used to identify different disability trajectories and to investigate each trajectory. Four distinct disability trajectories were identified: low, moderate, high, and progressive. Activity restriction due to fear of falling, being underweight, impaired vision, and impaired cognition were highly associated with the progressive groups, compared with the low disability group. Activity restriction due to fear of falling, depression, impaired cognition, and poor subjective health status were associated with moderate and high disability. These findings contribute to increasing the understanding of ADL disability among older adults.

Prevalence of Low Back Ache and Functional Disability among Traffic Police in South Bangalore

Background: Around 70% to 80% of world’s population has experienced Low Back Ache (LBA) at some point in their lives. Traffic police officers are prone to number of risk factors related to LBA every day. Around 96 various tasks must be completed in a full working day by a police officer. Out of these, 46 tasks require heavy physical work. Other tasks which do not require heavy physical work can be made easier if the police officer is physically good and fit. The traffic police do not know that back pain is caused due to their poor posture. Helpless stance, long walking hours, tedious developments of the body and helpless work community configuration are principle hazard factors for these issues. Objective: The purpose of the study is to determine the prevalence of LBA and functional disability among traffic police in South Bangalore. Material and Method: Nordic musculoskeletal questionnaire is used to record sites of pain among traffic police officers. Modified ODI scale was administered to traffic police officers with Low Back Ache (LBA). Based on the ODI score, the functional disability was evaluated. VAS is used to measure pain in traffic police officers having LBA. Data was analyzed using descriptive statistics. Result: In a total of 246 traffic police personnel who took part in the study, 96 of them reported with LBA i.e, the prevalence percentage was 39.02%. The mean pain intensity according to VAS was 3.95 ± 1.59. Out of the 96 police personnel who reported LBA, 49 personnel (51%) had moderate disability. Minimal disability was observed in 35 personnel (36.5%) and severe disability was noted in 12 personnel (12.5%). Conclusion: The prevalence rate of Low Back Ache among traffic police in south Bangalore is found out to be 39.02%.

The role of co-occurring insomnia and mental distress in the association between lumbar disc degeneration and low back pain related disability

BackgroundLumbar disc degeneration (LDD) is associated with low back pain (LBP). Although both insomnia and mental distress appear to influence the pain experience, their role in the association between LDD and LBP is uncertain. Our objective was to investigate the role of co-occurring insomnia and mental distress in the association between LDD and LBP-related disability.MethodsA total of 1080 individuals who had experienced LBP during the previous year underwent 1.5-T lumbar magnetic resonance imaging, responded to questionnaires, and participated in a clinical examination at the age of 47. Full data was available for 843 individuals. The presence of LBP and LBP-related disability (numerical rating scale, range 0–10) were assessed using a questionnaire. LDD was assessed by a Pfirrmann-based sum score (range 0–15, higher values indicating higher LDD). The role of insomnia (according to the five-item Athens Insomnia Scale) and mental distress (according to the Hopkins Symptom Check List-25) in the association between the LDD sum score and LBP-related disability was analyzed using linear regression with adjustments for sex, smoking, body mass index, education, leisure-time physical activity, occupational physical exposure, Modic changes, and disc herniations.ResultsA positive association between LDD and LBP-related disability was observed among those with absence of both mental distress and insomnia (adjusted B = 0.132, 95% CI = 0.028–0.236, p = 0.013), and among those with either isolated mental distress (B = 0.345 CI = 0.039–0.650, p = 0.028) or isolated insomnia (B = 0.207, CI = 0.040–0.373, p = 0.015). However, among individuals with co-occurring insomnia and mental distress, the association was not significant (B = -0.093, CI = -0.346-0.161, p = 0.470).ConclusionsLDD does not associate with LBP-related disability when insomnia and mental distress co-occur. This finding may be useful when planning treatment and rehabilitation that aim to reduce disability among individuals with LDD and LBP. Future prospective research is warranted.

The Prevalence of Back Pain in Patients Operated on Due to Colorectal Cancer Depending on the Type of Surgical Procedure Performed

Purpose: Low back pain presents a serious challenge for numerous medical specialties. The purpose of this study was to assess disability due to low back pain in patients operated on due to colorectal cancer depending on the type of surgery performed. Methods: This prospective observational study was carried out in the period of July 2019 through March 2020. Included in the study were patients with colorectal cancer for scheduled surgeries including anterior resection of rectum (AR), laparoscopic anterior resection of rectum (LAR), Hartmann’s procedure (HART), or abdominoperineal resection of rectum (APR). The Oswestry Low Back Pain Disability Questionnaire was used as the research tool. The study patients were surveyed at three time points: before surgery, six months after surgery, and one year after surgery. Results: The analysis of study results revealed that an increase in the degree of disability and functioning impairment occurred in all groups between time points I and II, with the differences being statistically significant (p < 0.05). The inter-group comparative analysis of the total Oswestry questionnaire scores revealed statistically significant differences, with the impairment of function being most severe within the APR group and least severe within the LAR group. Conclusion: The study results showed that low back pain contributes to impaired functioning of patients operated on due to colorectal cancer regardless of the type of procedure performed. A reduction in the degree of disability due to low back pain was observed one year after the procedure in patients having undergone LAR.

Assessment of quality of life, pain level and disability outcomes after lumbar discectomy

This study aimed to assess the quality of life of 113 Caucasian patients with intervertebral disc (IVD) degeneration of the lumbosacral (L/S) spine who qualified for microdiscectomy during a 12-month period after surgery. Based on magnetic resonance imaging before the surgery, the degree of radiological advancement of the degenerative changes was determined according to the Pfirrmann grading scale from 1 to 5. To assess pain intensity, the Visual Analog Scale (VAS) was used; the Satisfaction with Life Scale (SWLS) was used to evaluate quality of life; and to assess the degree of ability, the Oswestry Low Back Pain Disability Questionnaire (ODI) was employed. The level of pain, assessed using the VAS, significantly changed in the months following the surgery, with the highest values noted before surgery and the lowest a year after. In turn, the results of the SWLS questionnaire revealed a significant increase in satisfaction with life in the subsequent stages of the study. The conducted correlation analysis revealed significant dependencies in terms of quality of life in regard to pain as well as degree of disability. The level of pain and degree of disability were closely related to the degree of radiological advancement of degenerative changes according to the Pfirrmann grading scale.

Diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low- and high-grade gliomas, taking histopathology as the gold standard

Gliomas are known to be one of the most grievous malignant central nervous system (CNS) tumors and have a high mortality rate with a low survival rate severe disability and increase risk of recurrence. Aim of his study is to determine the diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low-grade and high-grade gliomas, taking histopathology as the gold standard. It is a Cross-sectional validation study conducted at the Armed Forces Institute of Radiology and Imaging, (AFIRI) Rawalpindi, Pakistan from 28th February 2022 to 27th August 2022. Materials and methods: A total of 215 patients with focal brain lesions of age 25-65 years of either gender were included. Patients with a cardiac pacemaker, breastfeeding females, de-myelinating lesions and malignant infiltrates, and renal failure were excluded. Then diffusion-weighted magnetic resonance imaging was performed on each patient by using a 1.5 Tesla MR system. The area of greatest diffusion restriction (lowest ADC) within the solid tumor component was identified while avoiding areas of peritumoral edema. Results of ADC were interpreted by a consultant radiologist (at least 5 years of post-fellowship experience) for high or low-grade glioma. After this, each patient has undergone a biopsy in the concerned ward, and histopathology results were compared with ADC findings. Results: Overall sensitivity, specificity, positive predictive value, negative predictive value, and diagnostic accuracy of apparent diffusion coefficient (ADC) in differentiating low- and high-grade gliomas, taking histopathology as the gold standard was 93.65%, 87.64%, 91.47%, 90.70% and 91.16% respectively. Conclusion: This study concluded that apparent diffusion coefficient (ADC) is the non-invasive modality of choice with high diagnostic accuracy in differentiating low- and high-grade gliomas.

Surgical Rehabilitation of a Posttraumatic Iris Cyst, Cataract and Astigmatism Patient

Injuries cause serious disturbance of the form and function of the organ of vision due to the damage and accompanying or remote complications and therefore have a high proportion to the structure of low vision, blindness and disability. One of the complications of penetrating wounds of the eye is iris cysts. Iris cyst can increase and cause pupillary block, secondary glaucoma, uveitis, corneal dystrophy, and therefore it requires surgical intervention. The goal of surgical treatment of an iris cyst is to ensure complete removal of the cyst.Objective: to estimate the clinical and functional results of treatment in a posttraumatic iris cyst, posterior subcapsular cataract and myopic astigmatism patient.Patient and methods. Patient B., 49 years old with posttraumatic retention iris cyst, posterior subcapsular cataract, compound myopic high astigmatism was examined. To determine the tactics of surgical treatment of the patient, a complex of General ophthalmology was performed (visometry, IOP measurement, autorefractometry, biomicroscopy, ophthalmoscopy), as well as special (B-scanning, optical coherence tomography of the retina) research methods. The follow-up period was 1 year.Results and discussion. To improve visual functions and prevent the development of secondary glaucoma, the patient was offered surgery — excision of the iris cyst and cataract phacoemulsification with toric intraocular lens. Simultaneous carrying out of two stages of the operation reduced the risks of postoperative complications and shorten the rehabilitation period.Conclusion. Positive optical and therapeutic effects were achieved as a result of the surgical treatment 44 years after an open eye injury: the eye is calm, the iris cyst is not detected, visual acuity has increased. The postoperative period showed the saving the stable and high visual and functional result with no recurrence of the iris cyst.

Some magnetic resonance imaging findings may predict future low back pain and disability: a systematic review

Do magnetic resonance imaging (MRI) findings predict future low back pain (LBP), associated disability and global recovery in people with current LBP? Do MRI findings predict these outcomes in people with no current LBP? Do MRI findings predict these outcomes in a mixed sample of people with and without current LBP? This review is an update of a previous systematic review investigating the relationship between lumbar spine MRI findings and future LBP. People with or without LBP with lumbar MRI scans. MRI findings, pain and disability. Of the included studies, 28 reported on participants with current LBP, eight reported on participants with no LBP and four reported on a mixed sample. Most results were based on single studies and did not demonstrate clear relationships between MRI findings and future LBP. In populations with current LBP, pooling demonstrated that the presence of Modic type 1 changes alone or Modic type 1 and 2 changes were associated with slightly worse pain or disability outcomes in the short term, and the presence of disc degeneration was associated with worse pain and disability outcomes in the long term. In populations with current LBP, pooling demonstrated no evidence of an association between the presence of nerve root compression and disability outcomes in the short term, and no evidence of an association between the presence of disc height reduction, disc herniation, spinal stenosis, high-intensity zone and clinical outcomes in the long term. In populations with no LBP, pooling demonstrated that the presence of disc degeneration may increase the likelihood of experiencing pain in the long term. In mixed populations, no pooling was possible; however, single studies demonstrated that Modic type 1, 2 or 3 changes and disc herniation were each associated with worse pain in the long term. The results suggest that some MRI findings may have weak associations with future LBP; however, larger high-quality studies are needed to resolve uncertainty. PROSPERO CRD42021252919.

Manual Handling as Contributor of Low Back Pain for Workers: A Case Study at PT Sumber Mandiri Jaya, Kabupaten Merauke

Introduction: Manual handling activities are a main causative factor of low back pain injuries. Around 1.71 billion people worldwide live with musculoskeletal conditions, including low back pain. In the Southeast Asia region, it is estimated that around 369 million people experience low back pain. In Indonesia more than 11.9% of health workers are diagnosed with musculoskeletal disease and diagnostic specific for worker obtained 24.7%. The purpose of this study was to determine the dominant indicators of manual handling for low back pain. Method: Study design used is cross-sectional study. Sample was 62 subjects. The variables of low back pain were collected using a modified questionnaire adopted from the Oswestry Low Back Pain Disability Questionnaire. Data were analyzed with linear regression test for the main indicators contributing to low back pain. Result: Average age of workers is 26.06±7.28, education level senior high school 45%, under 4 years length of work 83.9%. Average manual handling variable is 613.45 ± 383.39, low back pain 6.48 ± 3.607. Manual handling is not significantly related to low back pain r = -0.182. Duration, frequency and load are significant in predicting low back pain. The factors of duration, frequency and lift were estimated to contribute 5.4% for low back pain. Conclusion: The main factors related to low back pain are lifting load for workers, while the factors of lifting duration and frequency are not significantly related to low back pain. The lifting load is the main factor contributing to low back pain.

Self-reported restrictions in different life domains and associated factors among people with multiple sclerosis in Sweden.

The heterogeneous symptoms of multiple sclerosis (MS) can considerably impact the lives of people with MS (PwMS). The aim of this study was to describe the extent of restrictions in different life domains that PwMS experience in relation to their symptoms and level of disability. A cross-sectional survey was conducted among working-age PwMS in Sweden. The 4052 participants who answered the questions on restrictions in work and private life domains (family, leisure activities, and contact with friends/acquaintances) were included. Predictors of restrictions in the four domains were determined through multinomial logistic regression. Approximately one-third of the PwMS reported no restrictions in the domains of work (35.7%), family (38.7%), leisure activities (31.1%) or contact with friends/acquaintances (40.3%), the remaining participants reported moderate to severe restrictions. Tiredness/fatigue was the most commonly reported most-limiting symptom (49.5%). PwMS with Expanded Disability Status Scale (EDSS) scores of zero reported restrictions in life domains ranging from 39.6% (friends/acquaintances) to 45.7% (leisure activities). Age, sex, education, type of living area, MS type, type of most-limiting symptom, and EDSS score predicted restrictions in work and private life domains. Most PwMS reported similar levels of restrictions in both their work and private lives. Restrictions in these life domains were also reported by PwMS with low disability levels (EDSS = 0) and were often associated with invisible symptoms such as fatigue. Even in a contemporary MS cohort, close to 90% of PwMS report limitations due to MS.

The prevalence of low back pain and risk factors in academic teaching staff at King Abdulaziz University Jeddah:\\ A cross-sectional study.

Low back pain (LBP) is one of the most common musculoskeletal disorder symptoms affecting adults' health in the workplace including academic settings. To estimate the prevalence of LBP among academic teaching staff at King Abdulaziz University, as well as to identify its socio-demographic and work-related risk factors. A cross-sectional study design was used to estimate the prevalence of LBP and the risk factors in 123 academic teaching staff members at King Abdulaziz University. Data on LBP history and disability using Oswestry Disability Index (ODI), work-related and socio-demographic characteristics of study participants were collected using a semi-structured questionnaire. The prevalence of low back pain data was analyzed using frequency and percentage descriptive statistics, and Chi-square was used to identify group differences. A total of 123 academic teaching staff with a mean age of 37.5 years old of whom 79 (64.2%) were females and 44 (35.8%) were males completed a self-administrative questionnaire. Using a self-rating scale, approximately a quarter of academic teaching staff had moderate disability 25.2%; 4.9% had a severe disability; only one subject 0.8% was crippled. There has been a significant relationship between the number of years of experience and the extent of low back disability (P < 0.05). The Chi-square test revealed 56.3% of takes part with 11-15 years of experience have moderate disability relative to those with 0-5 years of experience (11.1%). There was a trend towards significance among academic teaching staff for the effect of the faculty stream on low back disability (P = 0.077, Chi-square test revealed teaching staff in the medical stream had the highest percentage of participates with minimal disability (78.7%) whereas in the scientific stream had the lowest percentage of minimal disability (52%). The findings of this study have shown that there is a major problem of low back pain among academic staff at King Abdulaziz University and that the situation in other higher education institutions in Saudi Arabia is changing.

Does type 2 diabetes affect the efficacy of therapeutic exercises for degenerative lumbar spinal stenosis?

DesignPropensity-matched retrospective study.ObjectivesTo determine whether type 2 diabetes mellitus (T2D) would affect prognosis in patients with degenerative lumbar spinal stenosis (DLSS) who underwent therapeutic exercises.MethodsThis study included consecutive patients with or without T2D who underwent therapeutic exercises for symptomatic DLSS from December 2018 to January 2020. Baseline demographics and clinical and radiological data were collected. The 2 groups of patients were further matched in a 1:1 fashion based on the propensity score, balancing the groups on pre-treatment factors including age, sex, leg and back pain, and low back disability. The primary outcomes included self-reported leg pain intensity (Numerical Rating Scale, NRS) and low back disability (Oswestry Disability Index, ODI) and the secondary outcomes included low back pain intensity and walking capacity (self-paced walking test, SPWT) were compared at baseline, 6 weeks, and 12 weeks.ResultsForty-one pairs of patients were selected by propensity matching. After 6-week therapeutic exercises, patients with T2D achieved a lower improvement in leg pain at 6 weeks (NRS leg change, 1.21 ± 0.40 vs. 1.78 ± 0.52, P = 0.021) and 12 weeks (NRS leg change, 1.52 ± 0.92 vs. 2.18 ± 0.96, P = 0.007) above minimal clinically important difference (MCID), with a significant Group × Time interactions (F1,80 = 16.32, p < 0.001, ηp2 = 0.053). However, the two groups showed no difference in the improvement of ODI, although the sample had significant improvements at 6 weeks (ODI change 3.02 [95% CI, 2.08 to 2.77], P < 0.001) and 12 weeks ([ODI change 3.82 [95% CI, 4.03 to 4.90], P < 0.001), 46% of the patients achieved an MCID.ConclusionSix-week therapeutic exercises have an inferior effect on DLSS patients with T2D. Findings from this study will provide an increased understanding of exercise treatment in patients with DLSS.

Determining low back pain factors and effects on daily activities in operating room personnel in Türkiye

Introduction: Low back pain is a common problem among operating room personnel. The study was performed to determine low back pain (LBP) factors and effects on daily activities in operating room personnel. Methods: The descriptive study was conducted in January 2018 in Ankara, Türkiye. The study sample consisted of 210 operating room personnel. Data from the study were collected using the Oswestry Low Back Pain Disability Questionnaire and Socio-Demographic Characteristics and Low Back Health Question Form. Results: The majority of operating room personnel had LBP. The mean disability score of the Operating room personnel was 9.69±6.49. A total of 8.1% of operating room personnel had severe disabilities. The disability score of the operating room personnel was higher in women, nurses, and personnel who worked over 8 hours a day, those who had any level of stress, and those who lifted patients without assistance. Conclusion: LBP remains an important problem in operating room staff and negatively affects daily activities. Considering the disability caused by LBP, to prevent LBP, developing comprehensive programs with hospital management including exercise, coping with stress, smoking cessation, and regulation of the working environment and conditions is suggested.

Prevalence of Low Back Pain in Women Wearing High Heels Residing in Khanewal, Pakistan

Purpose: Low back pain is not much prevalent among women wearing high heels but in certain cases it is the cause of disability, absence from work and also affects the quality of life. The objective of the study was to determine the prevalence of low back pain among the women of Khanewal wearing high heels. Methodology: A cross sectional survey was used. Data was collected from Khanewal from 1st October to 31st December 2019. The sample size was 250 women ranging between 20 to 40 years. Inclusion criteria include age between 20 to 35 years, height of heel 2 – 10 cm, duration of wearing of high heel shoes &gt; 3 hours per day, frequency of wearing high heel shoes &gt; 3 times / week. Exclusion criteria consisted of previous history of any accident or injury to the back, fracture of the vertebrae, any spinal pathology, any systemic disease, women who left wearing heels, women wearing heels occasionally. Data was collected by convenient sampling technique, through the use of oswestry low back pain disability questionaire.Study was completed in 3 months after the approval of synopsis. Data entry and analysis were done using computer software SPSS 21. Findings: Among 250 women with the mean age of 27 years, 208(83.2%) female lie in minimum disability sore and 42(16.8%) females lie in moderate disability score. The study concluded that there is relatively low prevalence of low back pain among the women wearing high heels. Recommendations: The duration of study was short, so in future more time is required for this study. Sample was only conducted in Khanewal, therefore more cities should be selected for target population to collect sample in future.

Long-Term Outcomes and Return to Work After Isolated Coronal Shear Fractures of the Capitellum

The purpose of this study was to analyze the ability of patients to return to work after ORIF of isolated capitellar shear fractures and assess long-term functional outcomes. We retrospectively reviewed the cases of 18 patients with isolated capitellar shear fractures with or without lateral trochlear extension and investigated demographic data, occupation, worker's compensation status, injury characteristics, surgical details, motion, radiographic appearance at final in-person follow-up, complications, and return to work status via in-person and long-term telemedicine follow-ups. Final follow-up was at an average of 76.6 (7-222.6) months or 6.4 (0.58-18.6) years. Of the 14 patients working at the time of injury, 13 patients had returned to work at final clinical follow-up. The work status of the remaining patient was not documented. Mean elbow motion at final follow-up was 4° (range, 0-30) to 138° (range, 130-145) of flexion, 83° of supination, 83° of pronation. Two patients had complications that required reoperation but had no further complications. For the 13 of 18 patients with long-term telemedicine follow-up, the average Quick Disabilities of the Arm, Shoulder, and Hand score was 6.8 (0-25). In our series, rates of return to work were high after ORIF of coronal shear fractures of the capitellum with or without lateral trochlear extension. This was true across all occupational classes including manual labor, clerical, and professional. With anatomic restoration of articular congruity, stable internal fixation, and postoperative rehabilitation, these patients had excellent ROM and functional scores at an average of 7.9 years of follow-up. After ORIF of isolated capitellar shear fractures with or without lateral trochlear extension, patients can expect a high rate of return to work with excellent ROM and functionality and low long-term disability.

Low-dose celecoxib-loaded PCL fibers reverse intervertebral disc degeneration by up-regulating CHSY3 expression

Intervertebral disc degeneration (IDD) has been identified as one of the predominant factors leading to persistent low back pain and disability in middle-aged and elderly people. Dysregulation of Prostaglandin E2 (PGE2) can cause IDD, while low-dose celecoxib can maintain PGE2 at the physiological level and activate the skeletal interoception. Here, as nano fibers have been extensively used in the treatment of IDD, novel polycaprolactone (PCL) nano fibers loaded with low-dose celecoxib were fabricated for IDD treatment. In vitro studies demonstrated that the nano fibers had the ability of releasing low-dose celecoxib slowly and sustainably and maintain PGE2. Meanwhile, in a puncture-induced rabbit IDD model, the nano fibers reversed IDD. Furthermore, low-dose celecoxib released from the nano fibers was firstly proved to promote CHSY3 expression. In a lumbar spine instability-induced mouse IDD model, low-dose celecoxib inhibited IDD in CHSY3wt mice rather than CHSY3−/− mice. This model indicated that CHSY3 was indispensable for low-dose celecoxib to alleviate IDD. In conclusion, this study developed a novel low-dose celecoxib-loaded PCL nano fibers to reverse IDD by maintaining PGE2 at the physiological level and promoting CHSY3 expression.

Is central sensitization relevant in acute low back pain?

Is central sensitization relevant in acute low back pain?

Prevalence of work related musculoskeletal disorder: a potential threat to clay doll making sculptors

Background: Sculpture is one of traditional art forms of the Indian subcontinent that are made entirely by hand or with some primitive toolsfrom local and natural raw materials without using modern machines. However, these sculptors complain about work-related physicalpain, respiratory difficulties, noise-induced hearing difficulties, fatigue, and stress. They are compelled to work long hours because mostsmall enterprises fail to recruit the required workforce. Objective: The study's goal is to examine musculoskeletal pain caused by awkwardposture and long periods of labor, as well as possible solutions. Methods: This study took place in Ghurni, Krishnanagar; district Nadia,in West Bengal. Fifty sculptors and thirty non-sculptors of similar socio-economic backgrounds participated in this study. The ModifiedNordic Musculoskeletal Disorder and the Oswestry Low Back Pain Disability Questionnaire were used to collect the data. Student t-testwas employed for statistical processing. Results: Analysis revealed that sculptors suffered mostly from musculoskeletal disorders. Thesculptors raised maximum complaints about the pain from the shoulder and lower back. Conclusion: Based on the investigation andcomplaints, work posture and workstation modification is required. The design of a newly developed ergonomic workstation and itsusability is proposed for review.

Can unsupervised cluster analysis identify patterns of complex adult spinal deformity with distinct perioperative outcomes?

The objective of this study was to use an unsupervised cluster approach to identify patterns of operative adult spinal deformity (ASD) and compare the perioperative outcomes of these groups. A multicenter data set included patients with complex surgical ASD, including those with severe deformities, significant surgical complexity, or advanced age who underwent a multilevel fusion. An unsupervised cluster analysis allowing for 10% outliers was used to identify different deformity patterns. The perioperative outcomes of these clusters were then compared using ANOVA, Kruskal-Wallis, and chi-square tests, with p values < 0.05 considered significant. Two hundred eighty-six patients were classified into four clusters of deformity patterns: hyper-thoracic kyphosis (hyper-TK), severe coronal, severe sagittal, and moderate sagittal. Hyper-TK patients had the lowest disability (mean Oswestry Disability Index [ODI] 32.9 ± 17.1) and pain scores (median numeric rating scale [NRS] back score 6, leg score 1). The severe coronal cluster had moderate functional impairment (mean physical component score 34.4 ± 12.3) and pain (median NRS back score 7, leg score 4) scores. The severe sagittal cluster had the highest levels of disability (mean ODI 49.3 ± 15.6) and low appearance scores (mean 2.3 ± 0.7). The moderate cluster (mean 68.8 ± 7.8 years) had the highest pain interference subscores on the Patient-Reported Outcomes Measurement Information System (mean 65.2 ± 5.8). Overall 30-day adverse events were equivalent among the four groups. Fusion to the pelvis was most common in the moderate sagittal (89.4%) and severe sagittal (97.5%) clusters. The severe coronal cluster had more osteotomies per case (median 11, IQR 6.5-14) and a higher rate of 30-day implant-related complications (5.5%). The severe sagittal and hyper-TK clusters had more three-column osteotomies (43% and 32.3%, respectively). Hyper-TK patients had shorter hospital stays. This cohort of patients with complex ASD surgeries contained four natural clusters of deformity, each with distinct perioperative outcomes.