title: Stiffness After Pan-Lumbar Arthrodesis for Adult Spinal Deformity Does Not Significantly Impact Patient Functional Status or Satisfaction Irrespective of Proximal Endpoint.
abstract: METHODS
  Prospective, multicenter.
  
  
  OBJECTIVE
  To determine if stiffness significantly affects function or satisfaction after pan-lumbar arthrodesis.
  
  
  BACKGROUND
  The Lumbar Stiffness Disability Index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. Data suggests that patients undergoing fusion of the entire lumbar spine are at greatest risk of functional limitations from stiffness.
  
  
  METHODS
  The LSDI, Short Form 36, Scoliosis Research Society-22, and Oswestry Disability Index were administered preoperatively and at 2-year minimum follow-up to 103 spinal deformity patients from 11 centers. Patients were separated according to the proximal arthrodesis level; upper thoracic (T2-5) to pelvis (UT-Pelvis) or thoraco-lumbar (T10-T12) to pelvis (TL-Pelvis). Outcome scores were compared using Student t test or Tukey-Kramer Honest Significant Difference Analysis of Variance. Regression analysis of final LSDI scores versus Scoliosis Research Society-22 Satisfaction scores was performed.
  
  
  RESULTS
  Mean ages, baseline values, and final scores of all outcome parameters were statistically equivalent in the two groups. Final LSDI scores did not change significantly from baseline in the UT-Pelvis (P = 0.478) or TL-Pelvis (P = 0.301) groups. In contrast, highly significant improvements (P ≤ 0.0001) from baseline were seen in both groups for other health-related QoL measures. The 2-year Satisfaction scores were statistically equivalent in the two groups, and the correlation between final LSDI and Satisfaction scores in the entire cohort was not significant (R = 0.013, P = 0.146).
  
  
  CONCLUSIONS
  Patients undergoing pan-lumbar arthrodesis for adult spinal deformity did not experience substantial increases in disability due to stiffness of the low back, although they did report significant improvements in other health-related QoL measures. Further, LSDI scores did not correlate with patient satisfaction. There were no significant differences in perceived stiffness effects whether arthrodesis stopped in the thoracolumbar or upper thoracic regions. We hope these results will be useful to spine surgeons and patients during preoperative planning and discussions.
  
  
  METHODS
  2.
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Jayme
authors.initials: J
authors.lastname: Hiratzka
authors.affiliation: Oregon Health and Science University, Portland, OR.
authors.forename: Marie S
authors.initials: MS
authors.lastname: Kane
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: University of California, Davis, Davis, CA.
authors.forename: Eric
authors.initials: E
authors.lastname: Klineberg
authors.affiliation: University of California, San Francisco, San Francisco, CA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: International Spine Study Group (ISSG), Brighton, CO.
authors.forename: Breton G
authors.initials: BG
authors.lastname: Line
authors.affiliation: Hospital for Special Surgery, New York, NY.
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.affiliation: University of Illinois, Chicago, IL.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Denver International Spine Center, Denver, CO.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: University of Pittsburgh Medical Center, Pittsburgh, PA.
authors.forename: David K
authors.initials: DK
authors.lastname: Hamilton
authors.affiliation: University of Virginia Medical Center, Charlottesville, VA.
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.affiliation: Scripps Clinic, La Jolla, CA.
authors.forename: Greg
authors.initials: G
authors.lastname: Mundis
authors.affiliation: University of Virginia Medical Center, Charlottesville, VA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.affiliation: University of Kansas Medical Center, Kansas City, KS.
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Burton
authors.affiliation: Johns Hopkins Medical Institute, Baltimore, MD.
authors.forename: Daniel M
authors.initials: DM
authors.lastname: Sciubba
authors.affiliation: University of California, San Francisco, San Francisco, CA.
authors.forename: Vedat
authors.initials: V
authors.lastname: Deviren
authors.affiliation: Foundation of Orthopedics and Complex Spine (FOCOS), New York, NY.
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001174:Arthrodesis / Q000009:adverse effects / Q000639:trends; D023381:Endpoint Determination / Q000639:trends*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D016059:Range of Motion, Articular / Q000502:physiology*; D020127:Recovery of Function / Q000502:physiology; D013122:Spinal Diseases / Q000000981:diagnostic imaging / Q000601:surgery*; D013123:Spinal Fusion / Q000009:adverse effects / Q000639:trends*; D016896:Treatment Outcome