Advantages and Disadvantages of Adult Spinal Deformity Surgery and its Impact on Health-related Quality of Life.

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Every year, the Scoliosis Study Group selects the best published papers on conservative spine treatment from the global scientific literature.
Here is the abstract from one of these papers.

Advantages and Disadvantages of Adult Spinal Deformity Surgery and its Impact on Health-related Quality of Life.

Oshida G, Boissiere L, Larrieu D, Bourghli A, Vital JM, Gille O, Pointillart V, Challier V, Mariey R, Pellise F, Vila-Casademunt A, Perez-Grueso FJ, Alanay A, Acaroglu E, Kleinstuck F, Obeid I
Spine (Phila Pa 1976). 2016 Jul 7.

STUDY DESIGN: Prospective multicenter study of adult spinal deformity (ASD) surgery.

OBJECTIVE: To clarify the impact of ASD surgery on each health-related quality of life (HRQOL) subclass/domain.

SUMMARY OF BACKGROUND DATA: For ASD patients, surgery offers superior radiological and HRQOL outcomes compared to non-operative care. However, HRQOL may be affected by surgical advantages related to corrective effects, yielding adequate spinopelvic alignment and stability or disadvantages because of long segment fusion. METHODS: The study included 170 consecutive ASD patients from a multicenter database with >2-year follow-up period. We analyzed each HRQOL domain/subclass [short form-36 items (SF-36), Oswestry Disability Index (ODI), Scoliosis Research Society-22 questionnaire (SRS-22)], and radiographic parameters preoperatively and at 1 and 2 years postoperatively. We divided the patients into two groups each based on lowest instrumented vertebra (LIV; above L5 or S1 to ilium) or surgeon-determined preoperative pathology (idiopathic or degenerative). Improvement rate (%) was calculated as follows: 100 x |pre.-post.|/preoperative points (%) (+, advantages; -, disadvantages).

RESULTS: The scores of all SF-36 and SRS-22 subclasses improved at 1 and 2 years after surgery, regardless of LIV location and preoperative pathology. However, personal care and lifting in ODI were not improved after 1 year. These disadvantages were correlated to sagittal modifiers of SRS-Schwab classification similar to other HRQOL. The degree of personal care disadvantage mainly depended on LIV location and preoperative pathology. Although personal care improved after 2 years postoperatively, no noticeable improvements in lifting were recorded.

CONCLUSION: HRQOL subclass analysis indicated two disadvantages of ASD surgery, which were correlated to sagittal radiographic measures. Fusion to the sacrum or ilium greatly restricted the ability to stretch or bend, leading to limited daily activities for at least 1 year postoperatively, although this effect may subside after another year. Consequently, spinal surgeons should note the impact of surgical treatment on each HRQOL domain and counsel patients on the implications of surgery.

Eurospine: a participant’s comment

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In September Isico attended the International Eurospine Congress in Barcelona. Dr. Francesca Di Felice presented a poster titled Adolescent idiopathic bracing success rates influenced by time in brace: Comparative effectiveness analysis of the BrAIST and ISICO cohorts, while Dr. Fabio Zaina delivered an oral presentation about the study, ISYQOL discriminates adolescents with spinal deformities subgroups better than the SRS-22 questionnaire.

The aim of Eurospine is to optimize patient care and prevention of spinal disorders, stimulating the exchange of knowledge and ideas in the field of research, prevention, and treatment of spine diseases. In recent years, the society, mostly represented by surgeons, has offered different surgical courses, but a novel development has occurred in Barcelona with the birth of Non-Surgical Interprofessional Courses: the EUROSPINE Diploma in Interprofessional Spine Care (EDISC). The non-surgical task force includes Dr. Fabio Zaina as responsible of the module on spinal deformities.

“We want to underline the great value in the field of research of Prof. Martin E. Schwab ‘s Medal Lecture at the conference: New therapies to repair the neuronal hardware and improve functional recovery after spinal cord injury,” says Dr. Di Felice. “Prof Schwab presented a clinical trial for anti-Nogo-A in acute spinal cord injury, promising in the rehabilitation of spinal cord injury (SCI). Nogo A is a suppressor of nerve fiber growth in the adult central nervous system (CNS); neutralization of Nogo-A by antibodies after CNS injury allows the enhancement of long-distance regeneration of injured fibers, the stimulation of compensatory fiber growth by speared systems, and a functional recovery.

An interesting topic has been the surgical symposium on Adolescent Spinal Deformities and Treatment Options in which the anterior surgery was debated. Anterior scoliosis correction and vertebral body tethering are examples of that: these techniques can be considered less invasive approaches compared to posterior surgery. The first one can also be used in curves over 65 degrees, stiff curves in mature adolescents and adults; the second one can be used in flexible curves less than 65 degrees in the growing spine”.