title: Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score-Matched Comparison Between African and US Populations.
abstract: Retrospective analysis of propensity score-matched (PSM) observational cohorts.
  
  
  
  To evaluate and compare preoperative health-related quality of life (HRQoL) scores and radiographic measurements of young African and US adults with spinal deformity (ASD).
  
  
  
  Young ASD patients in the United States are motivated more to correct coronal and sagittal plane deformities than to alleviate pain. Motivations for surgical correction in young ASD patients in Africa have not been previously investigated.
  
  
  
  Retrospective review of two large databases of African and US patients with ASD. African patients who underwent ASD surgery were PSM by age, gender, and pelvic tilt with US patients. Preoperative radiographic parameters and HRQoL scores (ODI, SRS-22r, back/leg pain) were compared between cohorts. Pearson correlations used to evaluate relationships between radiographic parameters and HRQoL scores.
  
  
  
  Fifty-four US patients (average age 22.9 ± 4.9 years; 0% African American) and 54 African patients (24.6 ± 7.2 years) met inclusion criteria. Compared to the United States, African patients had significantly lower body mass index (21.1 ± 3.3 vs. 24.6 ± 7.2) and more severe scoliosis, coronal malalignment, and sagittal malalignment (p < .05). Africans also had significantly better Oswestry Disability Index (12.8 vs. 17.7), worse Scoliosis Research Society questionnaire (SRS-22r)-Appearance (2.5 vs. 3.2), SRS-Function (3.3 vs. 3.9), and SRS-Total (3.2 vs. 3.5) scores than US patients (p < .05). SRS-Appearance scores correlated with Cobb angles of the upper thoracic (r = -0.321), thoracic (r = -0.277), and thoracolumbar (r = -0.300) curves for US patients. For African patients, global sagittal alignment and C7 inclination correlated with SRS-Appearance (r = -0.347, -0.346, respectively).
  
  
  
  Young African ASD patients have significantly more severe deformity, less disability, and worse SRS-22r scores preoperatively than a matched cohort of US patients. Spinal deformity and associated poor self-image appear to be the major drivers of surgical intervention in this cohort. Global malalignment in African patients is most closely correlated with appearance scores and should be surgically addressed accordingly.
  
  
  
  Level III.
authors.affiliation: Department of Orthopaedic Surgery, NYU Langone Medical Center, New York, NY, USA.
authors.forename: Bradley Y
authors.initials: BY
authors.lastname: Harris
authors.affiliation: School of Medicine, Wayne State University, 540 E Canfield St, Detroit, MI 48201, USA.
authors.forename: Matthew F
authors.initials: MF
authors.lastname: Roth
authors.affiliation: Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Bassel G
authors.initials: BG
authors.lastname: Diebo
authors.affiliation: Orthopaedic Surgery, Rocky Mountain Scoliosis and Spine, 2055 High St, Denver, CO 80205, USA.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.affiliation: Orthopaedic Surgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Alexander A
authors.initials: AA
authors.lastname: Theologis
authors.affiliation: Neurosurgery, University of California San Diego School of Medicine, 9500 Gilman Dr, La Jolla, CA 92093, USA.
authors.forename: Justin K
authors.initials: JK
authors.lastname: Scheer
authors.affiliation: Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA.
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.affiliation: Spine Service, Hospital for Special Surgery, 535 E 70th St, New York, NY 10021, USA. Electronic address: virginie.lafage@gmail.com.
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.affiliation: Neurosurgery, University of California San Francisco, San Francisco, CA, USA.
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.affiliation: American Jewish Joint Distribution Committee, New York, NY, USA.
authors.forename: Richard
authors.initials: R
authors.lastname: Hodes
authors.affiliation: Research, FOCOS Orthopedic Hospital, Teshie St, Pantang, Accra, Ghana.
authors.forename: Jennifer
authors.initials: J
authors.lastname: Ayamga
authors.affiliation: Orthopedics, FOCOS Orthopedic Hospital, Teshie St, Pantang, Accra, Ghana.
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.affiliation: International Spine Study Group Foundation, 15480 Iola St, Brighton, CO 80602, USA.
mesh_terms: D000293:Adolescent; D000328:Adult; D000349:Africa; D005260:Female; D006304:Health Status; D006801:Humans; D008297:Male; D057216:Propensity Score; D011788:Quality of Life; D012189:Retrospective Studies; D013131:Spine / Q000002:abnormalities*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Adult spinal deformity; African spinal deformity; HRQoL