Effect of long spinal fusion including the pelvis on activities of daily living related to lumbar spinal function in adults with spinal deformity.

BACKGROUND: Spinal sagittal malalignment is managed by long spinal fusion including the pelvis, which reduces lumbar spine range of motion and impairs the activities of daily living. This study aimed to evaluate the changes in activities of daily living after long spinal fusion in adults with spinal deformity, and clarify the improvement or deterioration in the specific activities of daily living postoperatively. METHODS: We retrospectively reviewed 40 adults who underwent long spinal fusion in a single institution between 2014 and 2016 (female/male, 39/1; mean age, 68.5 years; range, 52-79 years). Each patient undertook three self-assessed health-related quality of life measures preoperatively and again at 2-years postoperatively: Oswestry Disability Index (ODI), Scoliosis Research Society (SRS)-22 questionnaire, and Japanese Orthopaedic Association back pain evaluation questionnaire (JOABPEQ). Radiographic outcomes were measured preoperatively and at 2 years postoperatively. RESULTS: Total ODI and all SRS-22 domains were improved at 2 years postoperatively. The JOABPEQ scores were also improved in all domains, except lumbar function. The change in pelvic incidence minus lumbar lordosis correlated with improvements in total ODI, SRS-22 function, and self-image scores. At 2 years postoperatively, satisfaction was correlated with total ODI, all SRS-22 domains, and the JOABPEQ pain domain. Subclass analysis of the JOABPEQ lumbar function domain at 2 years postoperatively revealed that 65% of patients had difficulty 'putting on socks or stockings', 42% had great difficulty 'bending forward, kneeling, or stooping', 32% reported improvement in 'sit to stand', and 32% reported deterioration in 'putting on socks or stockings' after surgery compared with before surgery. The JOABPEQ lumbar function domain was not correlated with the SRS-22 satisfaction domain. CONCLUSIONS: Despite restricting lumbar function, spinopelvic fusion improves health-related quality of life. Surgeons and patients should discuss potential changes and limitations in the activities of daily living after long spinal fusion including the pelvis.

Minimum 20 Years Long-term Clinical Outcome After Spinal Fusion and Instrumentation for Scoliosis: Comparison of the SRS-22 Patient Questionnaire With That in Nonscoliosis Group.

STUDY DESIGN: A retrospective minimum 20-year follow-up study using 4 standard self-administered questionnaires, one of which, the SRS-22 was also administered to control groups. OBJECTIVE: To evaluate long-term postoperative pain and other clinical outcomes of scoliosis correction and fusion surgery with Harrington instrumentation using Moe square-ended rods for better preservation of sagittal alignment. SUMMARY OF BACKGROUND DATA: Only a few long-term outcome studies have used standardized and validated self-administered tools, and no studies have established SRS-22 control data within their own population. There is no previous minimum 20-year follow-up evaluation after correction surgery preserving thoracic kyphosis and lumbar lordosis. METHODS: Of 86 consecutive patients who underwent instrumentation surgery for scoliosis by a single surgeon, 61 patients participated using Japanese Orthopaedic Association, Roland-Morris Disability Questionnaire, Oswestry Disability Index, and Scoliosis Research Society (SRS-22) questionnaires and 51 patients were included in this study. Results were analyzed for pain and other clinical outcomes. A total of 771 hospital employees were sent SRS-22 questionnaires. A total of 763 responded, resulting in 2 control groups composed of nonscoliosis and untreated mild scoliosis controls of the same culture and language as the long-term follow-up group. RESULTS: The prevalence of continuous low back pain was about 15%. Average Japanese Orthopaedic Association, Oswestry Disability Index, and Roland-Morris Disability Questionnaire scores at follow-up were 25 points, 7.3%, and 1.6, respectively. The average SRS-22 scores were 4.2 (function), 4.3 (pain), 3.7 (self-image), and 3.9 (mental health) for the postoperative follow-up group compared with 4.5 (function), 4.3 (pain), 3.5 (self-image), and 3.5 (mental health) for the nonscoliosis controls. CONCLUSION: Improved preservation of normal sagittal alignment resulted in a prevalence of low back pain comparable with the age-matched general population. Moreover, SRS-22 results for self-image and mental health were positive compared with the controls, possibly reflecting the surgeon's emphases on mental health and management of patient expectations. LEVEL OF EVIDENCE: 4.

Differences between pre-existing type and de novo type left convex thoracolumbar / lumbar scoliosis.

BACKGROUND: Lenke 5C type adolescent idiopathic scoliosis (AIS) with a Cobb angle of over 30 degrees has high risk of progression. The need for corrective surgeries for degenerative lumbar scoliosis has been increasing these days and some of those cases are pre-existing type scoliosis. However, it is said to be difficult to differentiate pre-existing type scoliosis from de novo type scoliosis. The purpose of this study is to analyze the relevant X ray metrics of degenerative lumbar scoliosis and to discover differences between pre-existing and de novo type scoliosis. METHODS: Of 54 consecutive patients who were diagnosed as candidates for corrective surgery for left convex thoracolumbar / lumbar scoliosis since December 2008, 19 patients over age 50 were included in this study. The average age was 60 years old (50-80 years old). All patients were female. Coronal and sagittal parameters were contrasted between two groups divided according to the existence of scoliosis in their adolescence; clear (AIS) and unclear (de novo). RESULTS: Eleven were AIS, and 8 were de novo. The average age was 54.0 years old for AIS and 67.4 for de novo (p<0.05). Cobb angles (69°, 49°) and L4 tilt (30°, 22°) were found to be significantly greater in AIS. Nash-Moe rotation assessment showed that rotational deformity was greater in AIS type than in de novo type. Lumbar lordosis (28°, 32°), thoracolumbar kyphosis (24°, 12°), sagittal vertical axis (37mm, 58mm), and pelvic incidence (51°, 60°) showed no significant difference between the groups, however, pelvic tilt (24°, 33°) showed significant difference. CONCLUSIONS: Among patients over 50 with degenerative thoracolumbar / lumbar scoliosis, those with pre-existing type scoliosis were found to have greater Cobb angle, greater L4 tilt, greater rotational deformity, less pelvic tilt, and were candidates for surgery at a younger age than those with de novo type scoliosis. In other words, those with de novo type scoliosis have less coronal deformity and worse sagittal pelvic alignment than those with pre-existing type scoliosis and are not considered candidates for surgery until a more advanced age. This study demonstrates some differences between pre-existing and de novo type scoliosis, contrasts the natural history of the two types of candidates for thoracolumbar / lumbar scoliosis surgery, and suggests the importance of performing surgery for Lenke 5C type adolescent idiopathic scoliosis at a younger age.