Predicting Good Outcomes After Adult Spinal Deformity Surgery: Analysis of Presenting Symptoms and Radiographic Presentations Associated with Positive Outcomes

Introduction: ASD corrective surgery is associated with high rates of complications postoperatively. This study aims to identify presenting symptoms with radiographic presentations as predictors of good outcomes.

Methods: Operative ASD patients (scoliosis >20, SVA>5cm, PT>25, or TK>60) with available baseline (BL) and 2-year (2Y) HRQL data were included from a prospective, multi-center database. Descriptive analysis identified cohort demographics, radiographic parameters, and surgical details. Optimal radiographic outcome was defined by improvement in all three age-aligned SRS-Schwab modifiers, proportioned (P) in GAP, and an ODI score of less than 25 at 2 years. Presenting symptoms were defined by SRS-22 Pain, Activity, and Total Scores, along with ODI. Logistic regression was used to determine association between presenting symptoms scores and optimal alignment. Further multivariate analysis was used to determine significance for complications and good outcomes.

Results: 469 ASD patients (59.9±14.7yrs, 27.3±5.3kg/m2, CCI: 1.63±1.6, FI: 3.12±1.65) were included and underwent surgery (11.5±4 levels fused, EBL: 1565±1406 mL, op time: 371±136 min, LOS: 8.5±4.6 days). 63% of patients underwent a posterior approach, 37% underwent a combined approach, 52% underwent a decompression, and 66% underwent an osteotomy. Patients had the following mean baseline Schwab modifier measurements: SVA: 63.3±70.7 mm, PI-LL: 14.4±21.2, PT: 23.49±11.1. 112 patients met optimal realignment goals. Significant differences were found in 2 year SRS-22 Pain (mean 4.17±.70), Activity (mean 4.11±.62), and Total Scores (mean 4.15±.55, all p < .001) as compared to non-optimized group. Baseline and 6 week SRS-22 and ODI scores were not significant between non-optimized and optimized groups.

Conclusion : Optimization in radiographics is associated with improvement in symptomology based on patient reports. This study found that good outcomes are associated with optimal realignment surgically and lower patient-reported presenting symptoms.