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Improvement in Back and Leg Pain and Disability Following Adult Spinal Deformity Surgery

Study of 324 Patients With 2-year Follow-up and the Impact of Surgery on Patient-reported Outcomes

Verma, Ravi, MD, MBA; Lafage, Renaud, MS; Scheer, Justin, MD; Smith, Justin, MD, PhD§; Passias, Peter, MD; Hostin, Richard, MD||; Ames, Christopher, MD∗∗; Mundis, Gregory, MD††; Burton, Douglas, MD‡‡; Kim, Han Jo, MD; Bess, Shay, MD; Klineberg, Eric, MD§§; Schwab, Frank, MD; Lafage, Virginie, PhD; the International Spine Study Group

doi: 10.1097/BRS.0000000000002815

Study Design. A retrospective review of a prospective, multicenter adult spinal deformity (ASD) database.

Objective. Our objective was to quantify the change in disability reported for patients with radiculopathy as compared with patients with back pain only following ASD realignment surgery.

Summary of Background Data. Studies utilizing patient-reported outcomes (PROs) have shown that ASD patients suffer from significant pain and disability. Although surgical correction has been effective at improving back and leg pain, no studies have investigated the impact of radiculopathy on pain and disability in ASD patients.

Methods. Inclusion criteria were age ≥ 18 years and presence of spinal deformity as defined by coronal Cobb angle ≥ 20°, sagittal vertical axis (SVA) ≥ 5 cm, pelvic tilt (PT) angle ≥ 25°, or thoracic kyphosis (TK) angle ≥ 60°. Demographics and PRO were collected. Patients with radiculopathy were propensity matched with patients with back pain. Preoperative, postoperative, and 2-year follow-up radiographic parameters and PRO were analyzed.

Results. Three hundred twenty-four patients met inclusion criteria, and following propensity matching, 90 patients were placed into the radiculopathy and back pain groups. These groups showed no difference in demographic or radiographic parameters. The groups were similar in PRO, with a difference in leg pain as per design. At baseline, leg pain patients had higher disability [Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS)]. Surgical strategies between the two groups showed no differences. Postoperative radiographic parameters showed no difference. Despite a significantly greater decrease in numerical rating scale (NRS) Leg for the leg pain group, postoperatively, these patients remained more disabled than the nonleg group in terms of NRS (back and leg), ODI, and most of the SRS domains.

Conclusion. ASD patients with radiculopathy exhibit increased pain and disability when compared with patients without leg pain. This increased pain and disability persists after surgical correction in these patients.

Level of Evidence: 3

Adult spinal deformity patients exhibit pain and disability, however the impact of radiculopathy has not been studied. This study examines propensity matched groups of ASD patients with and without radiculopathy at baseline, postoperative, and 2 year follow up. Patients with radiculopathy have greater pain and disability and this persists postoperatively.

New York Medical College, Department of Orthopaedic Surgery, Valhalla, NY

Hospital for Special Surgery, Department of Orthopaedic Surgery, New York, NY

University of Illinois College of Medicine at Chicago, Department of Neurosurgery, Chicago, IL

§University of Virginia, Department of Neurosurgery, Charlottesville, VA

New York University, Hospital for Joint Diseases Department of Orthopaedic Surgery, New York, NY

||Baylor Scoliosis Center, Department of Orthopaedic Surgery, Plano, TX

∗∗University of California, San Francisco, Department of Neurological Surgery, San Francisco, CA

††Scripps Clinic, San Diego, CA

‡‡University of Kansas Medical Center, Department of Orthopaedic Surgery, Kansas City, KS

§§University of California, Davis, Department of Orthopaedic Surgery, Sacramento, CA.

Address correspondence and reprint requests to Virginie Lafage, PhD, Hospital for Special Surgery, 535 East 74th Street, New York, NY 10021; E-mail:

Received 12 May, 2018

Revised 19 June, 2018

Accepted 12 July, 2018

The manuscript submitted does not contain information about medical device(s)/drug(s).

DePuy Synthes Spine, K2M, NuVasive, Biomet, Orthofix, Medtronic, Innovasis, Stryker funds to the International Spine Study Group (ISSG) were received in support of this work.

Relevant financial activities outside the submitted work: board membership, consultancy, stocks, grants, payment for lecture, royalties.

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