Research presented at the 2021 Eurospine annual meeting (6–8 October, Vienna, Austria) shows that there is strong evidence to suggest that surgery for adult spinal deformity (ASD) is associated with durable outcomes that do not deteriorate over time and that the extent of gain in health-related quality of life (HRQL) at five-year follow-up depends on baseline HRQL and sagittal alignment, as well as the occurrence of major complications and unplanned reinterventions.
The aim of the prospective multicentre observational cohort study, the findings of which were presented by Ferran Pellisé (Spine Surgery Unit, Vall d’Hebron University Hospital, Barcelona, Spain) during the meeting’s Best of Show session, was to investigate the durability of ASD surgical outcomes and identify predictors of HRQL gain at five years’ follow-up.
According to Pellisé et al, despite an increasing number of surgeries undertaken for ASD, there is still a lack of data beyond five years. They note that this study represents the largest prospective multicentre surgical cohort of ASD patients, with five-year follow-up, reported in the literature to date.
The study included surgical patients enrolled in an international ASD database, operated on prior to March 2015 and assessed at two- and five-year follow-up for outcomes including any adverse events (major complications or unplanned reoperations), HRQL and standing radiographic (coronal and sagittal) parameters.
Values at two- and five-year follow-up were compared for spinal alignment, HRQL gain, percentage of patients reaching published minimal clinically important difference (MCID) and patient acceptable symptom state (PASS), and adverse events.
A total of 361 patients (77.8% women; mean age 52.1) met the inclusion criteria. 316 (87.5%) completed two-year follow-up and 258 (71.5%), five-year follow-up.
There was no change (p>0.05) in coronal alignment, lumbar lordosis, lordosis gap (LGap) or sagittal vertical axis (SVA) from six weeks following the procedure out to five years. There was a significant increase in T2-T12 kyphosis (43.4º vs 50.6º, p=0.02), pelvic tilt (18.1º vs 21.7º, p=0.02) and global tilt (18.6º vs 24.4º, p=0.03) was observed between six weeks and five years.
The incidence of major complications (24.9% vs 10.5%, p<0.001) and unplanned reoperations (18.8% vs 12.2%, p<0.0018) was greater during the first two year follow-up than between two and five year follow-up. Mean HRQL scores, proportion of patients reaching MCID and PASS, and satisfaction with treatment were similar at both two- and five-year follow-up.
Speaking to Spinal News International, Pellisé said: “The relevance of our study resides above all in the longevity / durability of ASD surgical outcomes. HRQL gain is maintained at five-year follow-up and does not decrease. The durability of the effect of the surgery undoubtedly improves the cost-effectiveness of the intervention.
“However, our study also shows that we have to focus very much on prevention of major complications (MC) and reinterventions (RI): The impact of MC and RI is still evident at five-year follow-up. There’s no dilution of the negative impact during follow-up. Furthermore 10.5% of patients may still need an unplanned RI between two- and five-year follow-up. This study confirms that ASD treatment is not totally resolved at the two-year follow-up benchmark.
“Prevention of MC and RI will increase even more cost-effectiveness by eliminating the associated negative impact on HRQL and costs of RI and MC. I believe that prehab and an optimised patient selection, with the use of machine learning accurate risk calculators, will be key to improve ASD surgical care.”