Global burden of adult spinal deformity is large compared with other chronic conditions

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Ferran Pellisé (Spine Surgery Unit, Hospital Vall D’Hebron, Barcelona, Spain) and others write in The European Spine Journal that the impact of adult spinal deformity on health related quality of life warrants the same research and health policy attention as other important chronic diseases as they found that the global burden of the condition is large compared with these other conditions (eg, heart failure).

Pellisé et al comment that there is concern that the impact of adult spinal deformity on health related quality of life “may not be appreciated by medical and health policy providers”. Therefore, they compared the relative burden of adult spinal deformity with that of chronic conditions using the SF-36 health survey and data from the International Quality of Life Assessment (IQOLA) project, which assessed the impact of chronic conditions on health related quality of life at the level of the general population in representative samples of eight countries worldwide. The IQOLA project found, according to the authors, that arthritis, chronic heart failure, chronic lung disease, and diabetes had the greatest impact on SF-36 physical component summary (PCS).


Using data from the European Spine Study Group (ESSG), Pellisé et al identified 766 patients with adult spinal deformity. Of these, 284 were non-surgical patients without previous surgery, 178 were non-surgical patients with previous surgery, and 304 were surgical candidates (either operated on prior to enrolment in the ESSG database or placed on a surgical waiting list). Within this group, surgical candidates had the lowest (worse) SF-36 PCS and SF-36 mental component scores (MCS) whereas non-surgical patients previously operated on had the highest (best) scores. However, all groups of patients with adult spinal deformity had lower SF-36 scores than patients with chronic conditions. Pellisé et al comment: “SF-36 scores were significantly lower in adult spinal deformity patients than in any of the four self-reported chronic conditions assessed in the IQOLA [arthritis, chronic heart failure, chronic lung disease, and diabetes]. SF-36 PCS from the general population ranged from -3.5 to -4.5. Patients with adult spinal deformity presented PCS mean differences ranging from -10.4 to -14.5. MCS showed smaller differences between the reference and the self-reported chronic conditions or adult spinal deformity patient groups.”


They add that while the comorbid conditions that are frequently associated with adult spinal deformity “might be suspected” as being indirectly responsible for the effect of the condition on health related quality of life, they found that “low health related quality scores associated with adult spinal deformity were not just the result of additional comorbidity”. “Patients with American Society of Anesthesiologists (ASA) score I (without comorbidities) had better SF-36 scores than patients with ASA≥II (with comorbidities), but the former still had worse scores than those of any other self-reported chronic condition in the IQOLA project,” Pellisé et al write.


The authors conclude: “The global burden of adult spinal deformity is large compared with other self-reported chronic conditions in the general population. The impact of adult spinal deformity on health related quality of life warrants the same research and health policy attention as other important chronic diseases.”


Pellisé told Spinal News International: “Our results show that patients with adult spinal deformity are unhealthy; they deserve the same attention as other well-known conditions with similar or less burden in patients’ health related quality of life.


The study has won the 2014 EuroSpine Full Paper Award and will be presented during the “Presidential address, medal and award lectures” during the conference (Thursday).

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