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  • Elevated Fall Rate and Fall Risk in Patients with Adult Spinal Deformity

    Final Number:

    Jakub Godzik MD; Rohit Mauria BS; Randall Hlubek MD; Jay D. Turner MD, PhD

    Study Design:

    Subject Category:

    Meeting: Section on Disorders of the Spine and Peripheral Nerves Spine Summit- 2017

    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 from outpatient records at a single institution. Inclusion criteria: coronal Cobb angle >20°, sagittal vertical axis >5 cm, pelvic tilt >25°, or thoracic kyphosis >60°. Exclusion criteria: inability to walk/stand, neurodegenerative disease, spinal cord injury, or stroke. Fall risk and fall rate were determined based on the Morse Fall Scale (MFS). Demographic, radiographic, surgical, and HRQOL measures such as Short Form-36 (SF-36), Oswestry Disability Index (ODI), and Scoliosis Research Society (SRS-22) were collected. The relationship between fall risk, degree of spinal deformity and HRQOL was evaluated utilizing Pearson correlation and t-tests.

    Results: A total of 71 patients with ASD were identified. Mean age was 59(+16), and 45 (63%) were female. Mean spinopelvic parameters were pelvic incidence 52+12, lumbar lordosis of 39+22, pelvic tilt (PT) of 24+11, sagittal vertical axis of 5.1+6.3cm, and thoracic kyphosis of 33+18.3. Self-reported fall incidence was 31% over 3 months, mean MFS fall risk was 33+22. Thoracic kyphosis was higher in patients with fall history (40.4+17.5 vs 29.5+17.8, p=0.021). MFS was positively correlated with PT (0.27, p=0.026). MFS was significantly associated with ODI (p=0.003), SF-36 PF (p=0.021), and SRS subdomains (p<0.047).

    Conclusions: Based on our findings, incidence rate of falls in patients with ASD is elevated compared to published fall incidence rates among similar age groups. Patients with higher preoperative thoracic kyphosis and pelvic tilt appear to be at elevated risk of falls, and their MFS-based fall risk is strongly associated with multiple 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: Fall incidence and risk are important elements to consider in evaluating patients with spinal deformity, as they may be at elevated risk compared to the normal population. Fall risk in Adult spinal deformity appears to be strongly associated with thoracic kyphosis and pelvic tilt, and is strongly associated with subjective health outcomes.

    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. 5. Pellise, F., et al., Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J, 2015. 24(1): p. 3-11. 6. Turner, J.D., et al., Health Burden of Adult Spinal Deformity Compared with Other Chronic Diseases. World Neurosurg, 2015. 84(4): p. 876-7. 7. Imagama, S., et al., Influence of spinal sagittal alignment, body balance, muscle strength, and physical ability on falling of middle- aged and elderly males. Eur Spine J, 2013. 22(6): p. 1346-53. 8. Lee, B.H., et al., Spinal sagittal balance status affects postoperative actual falls and quality of life after decompression and fusion in-situ surgery in patients with lumbar spinal stenosis. Clin Neurol Neurosurg, 2016. 148: p. 52-9.

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