title: Impact of Age on Change in Self-Image 5 Years After Complex Spinal Fusion (≥5 Levels).
abstract: BACKGROUND
  Spinal deformities that require ≥5 fusion levels are difficult and challenging for both the surgeon and patient. Corrections of moderate to severe deformities have been shown to improve patient-reported outcomes (PROs), and provide patients with a better quality of life. Self-image is an important PRO because it sheds insight into the patient's perception of health, as well as serving as a proxy of satisfaction for patients with spine deformity undergoing corrective surgery. However, with an aging population, the impact of age on long-term change in self-image is unknown. The aim of this study is to determine the effects of age on self-image 5 years after undergoing an elective complex spinal fusion (≥5 levels).
  
  
  METHODS
  This was a retrospective analysis of prospectively collected data of 55 adult patients (≥18 years old) undergoing ≥5 levels of spinal fusion to the sacrum with iliac fixation from January 2002 to December 2008. Patients were grouped by age: young (<60 years old) and older (≥60 years old). Patient demographics, comorbidities, preoperative variables (sagittal and Cobb angles) and postoperative complication rates were collected. All patients had prospectively collected outcome measures and a minimum of 5 years follow-up. PRO instrument SRS-22r (function, self-image, mental health, and pain) was completed before surgery then at follow-up (at least 5 years after surgery). The primary outcome investigated in this study was the change in self-image after surgery.
  
  
  RESULTS
  Baseline characteristics and preoperative variables were similar in both cohorts. There were no significant differences in intraoperative variables, including the mean ± standard deviation number of fusion levels between the cohorts (young, 11.2 ±4.3 vs. older, 12.1 ± 4.0; P = 0.42). Complication rates were similar between the cohorts, with no significant differences in the types of complications (young, 29.63% vs. older, 25.0%; P = 0.77). There were no significant differences in preoperative and follow-up PROs between the cohorts. The mean ± standard deviation preoperative and follow-up self-image scores were (young, 2.35±0.58 vs. older, 2.68 ± 0.64; P = 0.51) and (young, 3.82 ± 0.63 vs. older, 3.51 ± 0.94), respectively. There were no significant differences in the change of function, mental health, or pain between the cohorts. However, the younger cohort experienced a significantly greater overall change in self-image than did the older cohort (young, 1.49 ± 0.87 vs. older, 0.70±1.14; P = 0.01).
  
  
  CONCLUSIONS
  Our study suggests that age significantly affects the perception of self-image after deformity correction surgery; with younger patients reporting a greater change from baseline in self-image after surgery. Further studies are necessary to corroborate our observed findings.
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Aladine A
authors.initials: AA
authors.lastname: Elsamadicy
authors.affiliation: Department of Neurosurgery, Rush University Medical Center, Chicago, Illinois, USA.
authors.forename: Owoicho
authors.initials: O
authors.lastname: Adogwa
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Amanda
authors.initials: A
authors.lastname: Sergesketter
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Shay
authors.initials: S
authors.lastname: Behrens
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Cassie
authors.initials: C
authors.lastname: Hobbs
authors.affiliation: Department of Orthopedic Surgery, Washington University in St. Louis, St. Louis, Missouri, USA.
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.affiliation: Department of Neurosurgery, Duke University Medical Center, Durham, North Carolina, USA. Electronic address: Isaac.karikari@duke.edu.
authors.forename: Isaac O
authors.initials: IO
authors.lastname: Karikari
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000375:Aging; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017063:Outcome Assessment, Health Care; D011183:Postoperative Complications / Q000209:etiology; D011788:Quality of Life; D012447:Sacrum / Q000601:surgery; D012649:Self Concept; D013118:Spinal Cord Diseases / Q000523:psychology* / Q000601:surgery*; D013123:Spinal Fusion / Q000379:methods*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Age; Patient-reported outcomes; Self-image; Spine surgery