title: Changes in radiographic and clinical outcomes with primary treatment adult spinal deformity surgeries from two years to three- to five-years follow-up.
abstract: METHODS
  Retrospective analysis of data entered prospectively into a multicenter database-clinical and radiographic outcomes assessment.
  
  
  OBJECTIVE
  Our hypothesis is that between the 2-year and the 3- to 5-year points surgically treated adult spinal deformity patients will show significant reduction in outcomes by Scoliosis Research Society (SRS), Oswestry Disability Index (ODI), and numerical rating scale back and leg pain scores and will show increasing thoracic kyphosis, loss of lumbar lordosis, and loss of coronal and sagittal balance.
  
  
  BACKGROUND
  Most analyses of primary presentation adult spinal deformity surgery assess 2-year follow-up. However, it is established that in some patients unfavorable events occur between the 2-year and 5-year points.
  
  
  METHODS
  The cohort of 113 patients entered into a multicenter database with complete preoperative, 2-year, and 3- to 5-year data. All patients who had adult spinal deformity and surgical treatment represented their first reconstruction. Diagnoses were scoliosis (82.5%), kyphosis (10%), and scoliosis and kyphosis combined (7.5%). Outcome measures and basic radiographic parameters (curve size, thoracic and lumbar sagittal plane, coronal and sagittal balance) were assessed at those 3 time intervals. Complications (pseudarthrosis/implant failure, infection, and junctional deformities) were assessed at the 2-year and the 3- to 5-year (mean, 3.76 years) points. RESULTS.: The mean major curve Cobb angle (preoperative, 57°; 2-year, 29°; 3-5 year, 26°); thoracic kyphosis T5 to T12 (30°, 31°, 32°) and lumbar lordosis T12 to sacrum (48°, 49°, 51°) did not change from the 2-year to ultimate follow-up. Likewise, coronal and sagittal balance parameters were the same at 2-year and ultimate follow-up. SRS total scores and modified ODI were similar at the 2 year and final follow-up (SRS: 3.89-3.88; ODI: 19-18). Preoperative SRS total score was 3.17. Six patients demonstrated complications at the 2-year point and additional 9 patients demonstrated complications at the 3- to 5-year point. Those 9 patients with complications at ultimate follow-up demonstrated significant deterioration in their ODI and SRS scores when compared with the patients who did not have complications at ultimate follow-up.
  
  
  CONCLUSIONS
  Contrary to our hypothesis, we could not establish deterioration in mean radiographic or clinical outcomes between the 2-year and 3- to 5-year follow-up points when analyzing the group as a whole. However, for the 9 patients who experienced complications between 3- and 5-year follow-up, their outcomes were significantly worse than for the other 104 patients.One should not anticipate an overall radiographic and clinical deterioration of the outcomes of surgically treated primary presentation adult spinal deformity patients in this studied time interval. However, close to 10% of patients will experience a new complication at the 3- to 5-year point, most commonly implant failure/nonunion and/or junctional kyphosis, which will negatively effect the patient-reported outcome.
authors.affiliation: Washington University School of Medicine, St. Louis, MO, USA. bridwellk@wudosis.wustl.edu
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Christine
authors.initials: C
authors.lastname: Baldus
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Charles
authors.initials: C
authors.lastname: Edwards
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: Christopher
authors.initials: C
authors.lastname: Hamill
authors.forename: William
authors.initials: W
authors.lastname: Horton
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Stephen
authors.initials: S
authors.lastname: Ondra
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Christopher
authors.initials: C
authors.lastname: Shaffrey
authors.forename: David
authors.initials: D
authors.lastname: Wootten
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004185:Disability Evaluation; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007738:Kyphosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D008137:Longitudinal Studies; D008875:Middle Aged; D010146:Pain / Q000453:epidemiology; D011542:Pseudarthrosis / Q000453:epidemiology; D011859:Radiography; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging* / Q000601:surgery*; D013997:Time Factors; D016896:Treatment Outcome; D055815:Young Adult