Introduction: Falls pose a major medical risk to our aging population. Annual fall rate for adults over the age of 65 is 13-20%, and 20% of those falls result in serious injury. Identification of modifiable risk factors is essential for developing fall prevention strategies. We currently know very little about the influence of adult spinal deformity (ASD) on fall risk.

Methods: Patients were retrospectively identified at our institution. Inclusion criteria: coronal Cobb >20°, sagittal vertical axis(SVA) >5 cm, pelvic tilt(PT) >25°, or thoracic kyphosis(TK) >60°, and completion of a prospectively collected fall risk questionnaire. Exclusion criteria: inability to walk, neurodegenerative disease, spinal cord injury, or stroke. Falling and fall risk were determined using the validated Morse Fall Scale (MFS). Demographic, radiographic, and health-related quality of life (HRQOL) measures such as the Oswestry Disability Index (ODI) and Scoliosis Research Society (SRS-22) were collected. Univariate and logistic regression analysis were used to evaluate independent predictors of falling.

Results: We identified 143 patients. Mean age was 60+16, 90 (63%) were female. Mean pelvic incidence (PI) was 52+13, lumbar lordosis (LL) 38+21, PT 24+13, SVA 6.0+6.4cm, and TK 34+17. Fall incidence was 31% over 6 months; mean MFS fall risk was 36+24. Patients who fell had higher TK (p<0.001), PI (p=0.046), and PT (p=0.025). On multivariate analysis, PT (OR 1.05, p=0.013) and TK (1.05, p<0.001) were independent predictors of falls when adjusted for relevant covariates. MFS was significantly associated with PT (p=0.001), PI (p=0.01), ODI (p<0.001), SRS Function (p<0.001), SRS Pain (p<0.001), SRS Self (p=0.021), SRS average (p<0.001).

Conclusions: We found that ASD patients fell more often than reported rates in similar age groups. Also, patients with greater thoracic kyphosis and pelvic tilt were at high risk of falling, and their MFS fall risk was associated with HRQOL measures.

Patient Care: By improving our understanding of the underlying risk of falls, and its association with degree of deformity in patients with adult spinal deformity (ASD) surgeons will be better equipped to provide counseling to patients regarding ASD and the indications for surgical interventions.

Learning Objectives: By the conclusion of this session, participants should be able to: 1) describe the rate of falling in the general population and identify key risk factors, 2) identify the risk factors associated with falling in patients with spinal deformity.

References: 1. Schwab, F.J., et al., Radiographical spinopelvic parameters and disability in the setting of adult spinal deformity: a prospective multicenter analysis. Spine (Phila Pa 1976), 2013. 38(13): p. E803-12. 2. Fehlings, M.G., et al., The Aging of the Global Population: The Changing Epidemiology of Disease and Spinal Disorders. Neurosurgery, 2015. 77 Suppl 4: p. S1-5. 3. Muramoto, A., et al., Spinal sagittal balance substantially influences locomotive syndrome and physical performance in community-living middle-aged and elderly women. J Orthop Sci, 2016. 21(2): p. 216-21. 4. Bess, S., et al., The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases. Spine (Phila Pa 1976), 2016. 41(3): p. 224-33.