Research Fellow NYU Langone Medical Center Paterson, NJ, US
Disclosure(s):
Peter G. Passias, MD: Cerapedics: Consultant (Ongoing); Globus Medical: Consultant (Ongoing); Journal of Neurosurgery: Spine: Board Member/Officer/Trustee (Ongoing); Medtronic: Consultant (Ongoing); Nuvasive: Consultant (Ongoing); Royal Biologics: Consultant (Ongoing); Spine: Board Member/Officer/Trustee (Ongoing); Terumo: Consultant (Ongoing)
Introduction: Adult spinal deformity (ASD) patients have become increasingly complex due to older patients with advanced medical comorbidities and more severe deformities undergoing surgical correction more frequently. The effect of the additional complexity on alignment correction and patient-reported outcomes has not been characterized.
Methods: Operative ASD patients (scoliosis >20º, SVA>5cm, PT>25º, or TK>60º) with available baseline (BL) and 2-year (2Y) radiographic and HRQL data were included. Miller frailty index was used to classify patients as Not Frail(NF) < 3, Frail(F) 3-5, and Severely Frail(SF)>5. Means comparison, one way ANOVA, and multivariable regressions analyzed impact of frailty on development of proximal junctional failure(PJF). PJF was defined according to Lafage criteria. “Matched” and “unmatched” refers to ideal and non-ideal age-adjusted alignment in PI-LL.
Results: 381 ASD patients were included. PJF rates increased with increasing frailty degree: NF: 5%, F: 15%, SF: 18%, p < .001, and PJK trended higher: NF: 46%, F: 57%, SF: 58%, p=.09. Controlling for invasiveness, and deformity, frailty score independently showed direct association with development of PJF (OR:1.5, 95% CI: 1.2-1.8,p < .001). F patients, compared to NF, had a 3x higher likelihood (OR:3, 95% CI: 1.3-5.8, p=.011), and SF patients a 4.4x higher likelihood of PJF (OR:4.4, 95% CI: 1.6-12.5, p=.005). In patients with ideal alignment, adjusted analysis shows frailty had no significant effect on rates of PJF. In patients who remained unmatched post-operatively, F and SF patients had higher rates of PJF. Specifically, controlling for invasiveness, and deformity, adjusted analysis shows overcorrection in PI-LL resulted in higher rates of PJF in F and SF patients PJF (OR: 6, 1.1-32, p=.041), while NF patients showed no significant relationship.
Conclusion : Frailty is independently associated with higher rates of proximal junctional failure. Restoration of ideal age based alignment mitigates this effect, however, frail patients are particularly susceptible to surgical correction resulting in substantially higher rates of PJF.
