Lumbar Stiffness After Pan-Lumbar Arthrodesis Adversely Affects Patient-Reported Outcomes But Does Not Compromise Patient Satisfaction in Adult Spinal Deformity.

STUDY

DESIGN

A retrospective study.

OBJECTIVES

To investigate the effect of lumbar stiffness on patient-reported outcomes (PROs) and satisfaction in patients undergoing adult spinal deformity (ASD) surgery.

SUMMARY OF BACKGROUND DATA: Lumbar stiffness following pan-lumbar arthrodesis may impair the activities of daily living. However, the effect of lumbar stiffness on the PROs and patient satisfaction in Asian populations remains unclear.

MATERIALS AND

METHODS

Patients who underwent ≥5-level fusion, including the sacrum, were selected for the study. Radiographic and clinical outcomes were evaluated at postoperative 2 years. Lumbar stiffness was evaluated using the modified lumbar stiffness disability index (M-LSDI), which comprises 10 questionnaires with higher scores indicating greater disability. The PRO measures included the visual analog scale (VAS), Oswestry Disability Index (ODI), Scoliosis Research Socitey-22 (SRS-22), Short Form-36 (SF-36) physical component score (PCS), and SF-36 mental component score (MCS). Patients were divided into two groups based on their 2-year SRS-22 satisfaction scores: high satisfaction (≥4.0) and low satisfaction (<4.0).

RESULTS

A total of 194 patients were included in the study (female, 87.6%; mean age, 69.1 yr; and mean fusion length, 8.0). All PROs significantly improved after surgery with regard to VAS, ODI, SRS-22, and SF-36. The M-LSDI score worsened significantly from 22.3 preoperatively to 26.6 postoperatively. Correlation analysis showed that the 2-year M-LSDI scores were negatively associated with PRO measures, including VAS, ODI, SRS-22, SF-36 PCS, and SF-36 MCS. Multivariate regression analysis revealed that the 2-year M-LSDI score did not affect patient satisfaction status; the 2-year SRS-22 score was an independent factor for high satisfaction.

CONCLUSIONS

After surgery, significant improvements were observed in all RROs. Although the postoperative increase in M-LSDI scores was significant, the changes were small. The degree of lumbar stiffness negatively influenced all PRO measures but did not affect patient satisfaction at 2 years postoperatively.