Surgical treatment of ASD associated with significant long-term improvements in health-related quality of life

Elias Elias

Surgical treatment of spinal deformity (ASD) in adults provides a significant improvement in health-related quality of life with a minimum follow-up of three years (mean 4.1 years), suggesting that the benefits of surgery for ASD persist over the long term. This is the gist of a study recently published in the Journal of Neurosurgery: Spine by Elias Elias (University of Virginia, Charlottesville, USA) et al.

Researchers note that the results of this prospective, multi-centre analysis “should prove useful for guidance, cost-benefit assessments, and efforts to improve security of supply.”

They state that longer durability is important given the invasiveness, complications, and cost of these procedures, and therefore the aim of the study was to evaluate the outcomes and complications of ASD surgery over at least three years.

Surgically treated ASD patients were assessed at baseline, at follow-up, and through mailings. Patient-reported outcome measures (PROMs) included results from the Oswestry Disability Index (ODI), Scoliosis Research Society–22r (SRS-22r) Questionnaire, Mental Component Summary (MCS), and Physical Component Summary (PCS) of the SF-36 , and Numerical Rating Scale (NRS) for back and leg pain.

Complications were classified as perioperative (≤ 90 days), delayed (90 days to two years), and long-term (≥ two years). The analyzes focused on patients with a follow-up period of at least three years.

Of a total of 569 patients, 427 (75%) received at least three years of follow-up (mean ± standard deviation [range] 4.1±1.1 [3–9.6] years) had a mean age of 60.8 years and 75% were women. Operative treatment included a posterior approach in 426 patients (99%) with a mean ± standard deviation (SD) of 12 ± 4 levels of fusion. Anterior lumbar interbody fusion was performed in 35 (8%) patients and a three column osteotomy was performed in 89 (21%) patients.

The study found that all PROMs improved significantly (p

Deteriorations in some outcome measurements were observed between the two-year and most recent follow-up visits, but the magnitude of these deteriorations were modest and may not be clinically significant, the researchers note.

A total of 277 (65%) patients had at least one complication, of which 185 (43%) were perioperative, 118 (27%) delayed, and 56 (13%) long-term. Notably, the 142 patients who did not achieve three-year follow-up were similar to the study patients in terms of demographics, malformations, and baseline PROMs, and had similar rates and types of complications.

Speaking to Spinal News International, Elias said, “Adult patients with spinal deformities experience significant pain and disability that impacts their quality of life, resulting in significant functional impairment and neurological deficits.

“We already know that deformity surgery has short-term benefits, at least for the first year or two, but what about the long-term durability of the outcome? As spine surgeons, we should consider the high cost, invasiveness, and early and delayed complications of this procedure and justify to the patient why we are offering the surgical option.

“Our work is one of the largest prospective studies conducted at 11 different sites across the United States to evaluate the outcomes and rates and types of complications associated with spinal deformity surgery in adults. We were able to show that the durability of the good result was maintained despite the associated complication rates with a mean follow-up time of four years.

“We should remember that adult spinal deformity surgery is a journey for both the patient and the surgeon. The ride is bumpy but the result is satisfying.”