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Characterization of Patients with Poor Risk for Clinical Outcomes in Adult Symptomatic Lumbar Deformity Surgery
Mitsuru Yagi1,2, Takehiro Michikawa3, Satoshi Suzuki1
1Department of Orthopedic Surgery, Keio University School of Medicine, Shinjuku City, Tokyo, Japan.
Spine
|January 5, 2021
Summary
Adult symptomatic lumbar deformity (ASLD) surgery generally yields favorable outcomes. However, poor-risk patients, identified by frailty, mental health, function, GAP score, and severe adverse events, experience inferior results, necessitating alternative strategies.
Area of Science:
- Spine surgery
- Orthopedics
- Deformity correction
Background:
- Adult symptomatic lumbar deformity (ASLD) poses challenges, particularly for high-risk patients who are poorly characterized.
- Understanding risk factors for poor outcomes in ASLD surgery is crucial for patient management.
Purpose of the Study:
- To comprehensively analyze the independent risk factors associated with poor clinical outcomes following surgical correction of ASLD.
- To identify specific patient characteristics and surgical factors that predict inferior results in ASLD surgery.
Main Methods:
- Retrospective review of 159 adult symptomatic lumbar deformity patients undergoing surgical treatment from a multicenter database.
- Poisson regression analysis was used to identify independent predictors of poor clinical outcomes, defined by specific Scoliosis Research Society 22 (SRS22) scores at 2 years post-surgery.
Main Results:
- While overall ASLD surgery improved SRS22 scores, 21% reported low satisfaction and 29% reported significant pain or function deficits.
- Independent risk factors for poor outcomes included frailty, baseline mental health and function, Global Alignment and Proportion (GAP) score, and severe adverse events (SAEs).
- Only 17% of patients classified as high-risk achieved a favorable SRS22 total score at 2 years.
Conclusions:
- ASLD surgery demonstrates favorable overall clinical outcomes, but high-risk patients consistently experience poorer results.
- Optimizing modifiable factors like physical function and mental health, alongside reducing SAEs, may improve outcomes for high-risk ASLD patients.
- Alternative treatment strategies should be considered for patients identified as high-risk for poor outcomes in ASLD surgery.
