Spine · 2025
Self-Image in Adult Spinal Deformity: The Critical Link Between Baseline Disability, Treatment Choice, and Surgical Satisfaction.
СтатьяМногоцентровое исследованиеНазвание и аннотация: Перевод в очереди
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Bess Shay, Line Breton G, Passias Peter G, Lafage Virginie, Lafage Renaud, Kelly Michael P, Eastlack Robert K, Gupta Munish C, Mundis Gregory M, Gum Jeffrey L, Hamilton Kojo D, Okonkwo David, Hostin Richard, Klineberg Eric O, Diebo Bassel G, Lenke Lawrence G, Ames Christopher P, Burton Douglas C, Lewis Stephen M, Daniels Alan H, Protopsaltis Themistocles S, Kebaish Khaled M, Kim Han Jo, Schwab Frank J, Shaffrey Christopher I, Smith Justin S, International Spine Study Group (ISSG)
Аннотация
STUDY DESIGN: Prospective, multicenter analysis.
OBJECTIVE: Evaluate the impact that self-image has upon operative versus nonoperative treatment choice for adult spine deformity (ASD) patients, and evaluate the association of post-treatment self-image with treatment satisfaction.
SUMMARY OF BACKGROUND DATA: ASD outcomes traditionally focus upon pain and physical function. Self-image is an important outcome measure for pediatric spine deformity. Little data exists regarding the impact self-image has upon ASD treatment choice and outcomes.
METHODS: Factor analysis and decision tree modeling were performed upon ASD patients prospectively enrolled into a multi-center study from 2009 to 2020. Data elements from physical examination, demographics, spinal alignment, and individual questions from administered PROMs, including SRS-22r, ODI, SF36, and NRS back and leg pain were evaluated for variables that correlated most with (1) patients electing for operative versus nonoperative treatment and (2) treatment satisfaction at minimum 2-year follow-up.
RESULTS: Evaluation of 735 ASD patients demonstrated operatively treated patients (OP; n=548) were older (58.0±15.3 vs . 52.4±16.0 yr; P <0.0001), had similar scoliosis (44.9±20.1° vs . 45.5±16.1°; P =0.5555) but worse sagittal malalignment than nonoperatively treated patients (NON; n=187; P <0.0001, respectively). Baseline PROMs were worse for OP versus NON ( P <0.0001). Gradient-boosted decision trees, factor analysis, and logistic regression of demographic, physical examination, radiographic, and PROM variables associated with treatment choice demonstrated self-image (odds ratio=4.5; 95% CI=3.4-6.0; P <0.0001) had the greatest correlation for patients choosing operative treatment. At minimum 2-year follow-up self-image demonstrated the greatest health domain improvement for OP and self-image improvement correlated most with post-treatment satisfaction, while NON demonstrated deterioration of self-image and reported poor treatment satisfaction.
CONCLUSION: Multivariable evaluation of 735 operative and nonoperative treated ASD patients demonstrated baseline self-image strongly correlated with ASD patients pursuing surgical treatment and postoperative treatment satisfaction. Patient self-image is a critical measure that must be assessed in ASD.
OBJECTIVE: Evaluate the impact that self-image has upon operative versus nonoperative treatment choice for adult spine deformity (ASD) patients, and evaluate the association of post-treatment self-image with treatment satisfaction.
SUMMARY OF BACKGROUND DATA: ASD outcomes traditionally focus upon pain and physical function. Self-image is an important outcome measure for pediatric spine deformity. Little data exists regarding the impact self-image has upon ASD treatment choice and outcomes.
METHODS: Factor analysis and decision tree modeling were performed upon ASD patients prospectively enrolled into a multi-center study from 2009 to 2020. Data elements from physical examination, demographics, spinal alignment, and individual questions from administered PROMs, including SRS-22r, ODI, SF36, and NRS back and leg pain were evaluated for variables that correlated most with (1) patients electing for operative versus nonoperative treatment and (2) treatment satisfaction at minimum 2-year follow-up.
RESULTS: Evaluation of 735 ASD patients demonstrated operatively treated patients (OP; n=548) were older (58.0±15.3 vs . 52.4±16.0 yr; P <0.0001), had similar scoliosis (44.9±20.1° vs . 45.5±16.1°; P =0.5555) but worse sagittal malalignment than nonoperatively treated patients (NON; n=187; P <0.0001, respectively). Baseline PROMs were worse for OP versus NON ( P <0.0001). Gradient-boosted decision trees, factor analysis, and logistic regression of demographic, physical examination, radiographic, and PROM variables associated with treatment choice demonstrated self-image (odds ratio=4.5; 95% CI=3.4-6.0; P <0.0001) had the greatest correlation for patients choosing operative treatment. At minimum 2-year follow-up self-image demonstrated the greatest health domain improvement for OP and self-image improvement correlated most with post-treatment satisfaction, while NON demonstrated deterioration of self-image and reported poor treatment satisfaction.
CONCLUSION: Multivariable evaluation of 735 operative and nonoperative treated ASD patients demonstrated baseline self-image strongly correlated with ASD patients pursuing surgical treatment and postoperative treatment satisfaction. Patient self-image is a critical measure that must be assessed in ASD.