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  • Impact of New Motor Deficit on HRQOL After Adult Spinal Deformity Surgery

    Final Number:

    R. Saigal MD PhD; S. Berven MD; V. Lafage PhD; M. P. Kelly MD; B. Kopjar MD; J. S. Smith MD, PhD; B. Dahl MD, PhD, DMSci; K. MC Cheung MBBS, MD; L. Y. Carreon MD, MSc; F. Schwab MD, PhD; K. Rebmann; C. I. Shaffrey MD, FACS; M. G. Fehlings MD, PhD, FRCS(C), FACS; L. Lenke MD; C. P. Ames MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2015 Annual Meeting

    Introduction: The Scoli Risk 1 study found a 30.9% risk of lower extremity motor score (LEMS) worsening within the first 6 months after correction of severe spinal deformities. The purpose of this analysis was to define the impact of new LEMS deficit on health-related quality of life (HRQOL) metrics and recovery of those measures after surgery in the first 6 months.

    Methods: Adult spinal deformity patients were eligible for enrollment at 15 sites worldwide. Other inclusion criteria included major Cobb >80 degrees, C7-L2 curve apex, and any patient undergoing 3 column osteotomy. ASIA scores and standard HRQOL scores were recorded pre-op, 6 weeks and 6 months.

    Results: 273 complex adult spinal deformity (ASD) patients enrolled, with 184 female (67%) and 89 male (33%) patients. Mean age was 56.9 years (SD 15.3, range 18-81). 30.9% of patients suffered LEMS worsening within the first 6 months post-surgery. HRQOL scores worsened as LEMS worsened. The 6 week HRQOL changes for LEMS <=2 patients vs LEMS -1 to 0 vs improved LEMS patients were: ODI (11.6 vs 0.7 vs -0.6), SF-36 physical (-3.9 vs -1.6 vs 1.0), SF-36 mental (-1.5 vs 1.4 vs 0.6), and SRS total change (0 vs 0.4 vs 0.5), respectively. The 6 month data similarly showed worsening HRQOL changes for patients with worsening LEMS. Table 1 shows these data. While the database is not yet locked, these data are subject to minor changes.

    Conclusions: In the subgroup of patients who developed a new lower extremity motor deficit after adult spinal deformity surgery, total HRQOLs and HRQOL changes were negatively impacted. Patients with 2 or more points of LEMS worsening had the worst HRQOL changes. However, even these patients showed overall improvement in ODI, SF-36 physical and SRS total scores at 6 months compared to pre-op baseline.

    Patient Care: Improved knowledge of surgical risk and how motor deficits impact quality of life will help guide physician and patients to make better informed decisions about adult deformity surgery.

    Learning Objectives: 1. Understand that this was an ambispective, multi-center observational study, completed to determine the impact of neural injury on Health-related Quality of Life scores (HRQOLs). 2. Understand that 30.9% of patients suffered any ASIA lower extremity motor score (LEMS) worsening during the first 6 months after surgery. 3. Know that within 3 subcategories of LEMS change (=2 points worsening, 1 pt worsening to no change, or LEMS improvement), ODI, SRS, SF-36 mental, and SF-36 physical scores worsened with LEMS worsening at 6 weeks and 6 months.


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