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STUDY DESIGN: Retrospective cohort study. OBJECTIVE: To assess the utility of preoperative vertebral bone quality (VBQ) scores in predicting the 5-year clinical outcomes following lumbar spine surgery. SUMMARY OF BACKGROUND DATA: Osteoporosis poses a significant concern in older adults undergoing spinal surgery. The VBQ score, assessed through preoperative magnetic resonance imaging (MRI), is associated with subsequent osteoporotic fractures and postoperative complications. However, previous report on the impact of VBQ score on mid-term clinical outcomes after lumbar spine surgery remains lacking. METHODS: A total of 189 patients who underwent lumbar surgery (≤3-disc levels) for lumbar spinal stenosis between 2010 and 2016 were enrolled. Patients were classified into high (>3.35), middle (2.75 to 3.35), and low (<2.73) VBQ score groups based on tertiles. Clinical scores, including Japanese Orthopedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and Short Form-36 (SF-36), were recorded preoperatively and 1, 2, and 5 years postoperatively. RESULTS: Comparative analysis showed significant differences among the VBQ groups throughout the study period in low back pain (P=0.013), walking ability (P=0.005), social life function (P=0.010) of JOABPEQ, and physical component summary of the SF-36 (P=0.018) following lumbar spine surgery. A higher VBQ score was significantly correlated with worse 5-year postoperative outcomes for all domains except for lumbar function of the JOABPEQ using multiple linear regression analysis, adjusting for age, sex, BMI, hyperlipidemia, surgical procedures, and each preoperative score. CONCLUSION: A high preoperative VBQ score is a risk factor for poor 5-year clinical outcomes after lumbar spine surgery. Evaluation of the VBQ score through routine preoperative MRI facilitates osteoporotic screening in lumbar patients without radiation exposure and healthcare costs, while also demonstrating its potential as a prognostic indicator of postoperative clinical outcomes. LEVEL OF EVIDENCE: 3.
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STUDY DESIGN: Retrospective single-center study. PURPOSE: This study aimed to examine the factors associated with the self-image domain of the Scoliosis Research Society-22 revised (SRS-22r) in patients who underwent corrective surgery for adult idiopathic scoliosis (AdIS). OVERVIEW OF LITERATURE: Adult spinal deformity (ASD) can be classified into AdIS and de novo scoliosis. However, no studies have investigated the effect of different ASD pathologies on self-image. METHODS: This study enrolled 60 patients who underwent corrective surgery and were followed up for >2 years postoperatively. AdIS was defined as adolescent idiopathic scoliosis in patients who had no history of corrective surgery, had a primary thoracolumbar/lumbar (TL/L) curve, and were ≥30 years old at the time of surgery. RESULTS: The AdIS (n=23; mean age, 53.1 years) and de novo (n=37; mean age, 70.0 years) groups were significantly different in terms of the main thoracic and TL/L curves, sagittal vertical axis, thoracic kyphosis, and thoracolumbar kyphosis preoperatively. The scores in the self-image domain of the SRS-22r (before surgery/2 years after surgery [PO2Y]) were 2.2/4.4 and 2.3/3.7 in the AdIS and de novo groups, respectively, and PO2Y was significantly different between the two groups (p<0.001). Multivariate regression analysis revealed that AdIS was an independent factor associated with self-image at PO2Y (p=0.039). CONCLUSIONS: AdIS, a spinal deformity pathology, was identified as a significant factor associated with the self-image domain of SRS-22r in patients who underwent corrective surgery. AdIS is not solely classified based on pathology but also differs in terms of the clinical aspect of self-image improvement following corrective surgery.
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Introduction: Osteoporotic vertebral fractures (OVFs) are a significant problem among older patients who are undergoing spine surgery. This study examined the influence of incident OVFs on clinical outcomes and spinal alignment 5 years following short-segment fusion (SSF) for lumbar spinal stenosis. Methods: We studied 88 patients who underwent SSF (≤2-disc level) for lumbar spinal stenosis with instability and were followed up for more than 5 years postoperatively. Those with prior OVFs were excluded. We evaluated incident OVFs with plain whole-spine lateral radiography preoperatively (before) and at 5 years postoperatively (after). Using preoperative lumbar computed tomography, Hounsfield unit (HU) values were evaluated. The patients were classified into two groups according to the presence of incident OVFs. Repeated-measures analysis of variance was utilized to compare the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) and the 36-item Short-Form Health Survey (SF-36), and spinal parameters were recorded before and after. Multiple linear regression analyses were employed to investigate the association between the incident OVFs and the clinical scores and spinal alignment recorded after. Results: In the fracture group, the clinical course of low back pain score on the JOABPEQ, physical component summary SF-36 score, and spinal alignment including C7 sagittal vertical axis (SVA), thoracic kyphosis (TK), and pelvic tilt were significantly worse. Multiple linear regression revealed a significant correlation between incident OVFs and worse 5-year postoperative spinal alignment, which includes SVA and TK. The optimal threshold for the HU values for predicting the incidence of OVFs within 5 years postoperatively was 83.0 (area under the curve 0.701). Conclusions: Incident OVFs in patients following SSF were significantly correlated with the 5-year clinical outcomes and spinal alignment. Patients at risk of OVFs, especially those with HU values below 83, must take preventive measures against OVFs, as this could prevent deteriorating midterm postoperative clinical outcomes and spinal alignment. Level of Evidence: 3.
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Introduction: The Scoliosis Research Society-30 (SRS-30) is a questionnaire originally developed from the SRS-22r questionnaire and is used to evaluate adolescent idiopathic scoliosis (AIS). It comprised questions on five domains: function, pain, self-image, mental health, and satisfaction, with seven additional questions related to postoperative aspects. In addition to the original English version, translations in multiple languages have been effectively applied. Herein, we evaluated the internal consistency and external validity of the Japanese version of the SRS-30 for AIS patients. Methods: Among the 30 questions in SRS-30, the eight additional questions from SRS-22r were translated and back-translated to create a Japanese version of the SRS-30. This translated questionnaire was then used to survey patients with AIS who underwent corrective fusion surgery one year postoperatively. The internal consistency of the responses was evaluated using the Cronbach α coefficient. Additionally, the Spearman correlation analyses were conducted to assess the correlation between the scores obtained from the SRS-30 Japanese version and SRS-22r and the Oswestry Disability Index (ODI) for the overall scale and the five domains. Results: A total of 81 cases (eight males and 73 females; mean age at surgery 14.4 years) were enrolled. The mean preoperative Cobb angle was 51.0°. The Cronbach α coefficient for the overall SRS-30 was 0.861, indicating high internal consistency, while the coefficients for each domain were as follows: function/activity, 0.697; pain, 0.405; self-image/appearance, 0.776; mental health, 0.845; and satisfaction, 0.559. The SRS-30 total score significantly correlated with the SRS-22r total (r=0.945, P<0.001) and the ODI (r=-0.511, P<0.001). The SRS-30 domains highly correlated with the corresponding SRS-22r domains, with correlations ranging from r=0.826 to 0.901 (all P<0.001). Conclusions: The Japanese version of the SRS-30 demonstrated good internal and external validity. The SRS-30 can be used as an assessment tool for health-related quality of life in AIS patients.