Introduction: Contradictory information exists for disability associated with ASD, creating confusion among medical providers and third-party payers. Purpose: compare SF-36v2 Health Survey (SF-36) scores of ASD patients by type of spinal deformity to United States (US) general population and disease-specific values and correlate ASD deformity types with specific disease states.
Methods: Multi-center, prospective analysis of consecutive ASD patients (scoliosis=20°, sagittal vertical axis (SVA)=5cm, pelvic tilt (PT)=25°, or thoracic kyphosis>60°), no prior spine surgery. ASD grouped by type/severity of scoliosis and sagittal spinopelvic malalignment (SSM). Baseline ASD SF-36 physical component (PCS) and mental component (MCS) scores compared to US normative and disease-specific values. SF-36 reported as norm-based values (NBS) and compared to reported means using minimally important clinical difference (MCID) values for PCS and MCS (3 NBS points).
Results: 497 ASD patients (mean age=50.4yrs) met criteria. Mean PCS (41) was 3 MCID values (9 NBS points) below the US general population (50). Mean PCS for ASD with isolated thoracic scoliosis (45.5) was 1 MCID lower than US mean, and similar to PCS for anemia (45.3) and sciatica (45.7). PCS worsened as scoliosis apex moved distally to the thoracolumbar (43.4; n=149) and lumbar spine (36.7; n=16). PCS for ASD with SVA=5cm, scoliosis<20° (32.4; n=14) was >5 MCID worse than US mean. PCS for SVA>10cm (28.5; n=40), was >7 MCID lower than US mean, and was worse than PCS for patients in the 25th percentile for diabetes (31.1), heart disease (30.5), and limited use of arms/legs (29.1). Multivariate analysis demonstrated pelvic incidence-lumbar lordosis mismatch (R=-.44), SVA (R=-.40) and PT (R=-.38) correlated most strongly with worsening PCS (p<0.05).
Conclusions: Analysis of ASD patients demonstrated varied disability. ASD with SSM had greater disability than any disease reported in the SF-36 manual. Healthcare providers must be educated regarding the types of ASD correlating with disability.
Patient Care: Improve our understanding of the health impact of adult spinal deformity.
Learning Objectives: By the conclusion of this session, participants should be able to: (1) Appreciate the substantial but varied impact of adult spinal deformity on patient health status (SF-36 scores); (2) Patients with isolated thoracic scoliosis reported mild disability, while patients with severe sagittal spinopelvic malalignment had greater disability than any disease state reported in the SF-36 manual; (3) Appreciate the need for healthcare providers and third-party payers to be educated regarding the types of ASD correlating with disability.