Adult Spinal Deformity Over 70 Years of Age: A 2-Year Follow-Up Study
Adult Spinal Deformity Over 70 Years of Age: A 2-Year Follow-Up Study
Tarih
2019-01-01
Yazarlar
Karabulut, Cem
Ayhan, Selim
Yuksel, Selcen
Nabiyev, Vugar
Vila-Casademunt, Alba
Pellise, Ferran
Alanay, Ahmet
Sanchez Perez-Grueso, Francisco Javier
Kleinstuck, Frank
Obeid, Ibrahim
Süreli Yayın başlığı
Süreli Yayın ISSN
Cilt Başlığı
Yayınevi
INT SOC ADVANCEMENT SPINE SURGERY-ISASS
Dergi Adı
INTERNATIONAL JOURNAL OF SPINE SURGERY
Özet
Background: Treatment of adult spinal deformity (ASD) in elderly patients remains controversial. The aim of this study was to identify the factors leading to the surgical treatment by comparing the baseline characteristics of operative versus nonoperative patients, to evaluate the safety and efficacy of surgery, and to compare operative and nonoperative management of elderly ASD patients at the end of the 2-year follow-up period. Methods: Retrospective review of a multicenter, prospective ASD database was performed. Patients over 70 years of age with ASD who were scheduled to undergo surgical treatment and who were treated and/or followed without surgical intervention participated in the study. Demographic, clinical, surgical, and radiological characteristics and health-related quality-of-life (HRQOL) (Core Outcome Measures Index {[}COMI], Oswestry Disability Index {[}ODI], Short-Form-36 Mental Component Summary {[}SF-36 MCS], Short-Form-36 Physical Component Summary {[}SF36-PCS], and Scoliosis Research Society-22 {[}SRS-22]) parameters of such group of patients were evaluated pre-and posttreatment. Results: A total 90 patients (females: 71, males: 29
operative: 61, nonoperative: 29) made up the study group. The comparison between the operative and the nonoperative groups at baseline showed statistical significance for all the HRQOL parameters and the major coronal Cobb angle (P < .05). The calculated optimal cutoff values to diverge operative and nonoperative groups for COMI, ODI, SF-36 PCS, and SRS-22 were 5.7, 37.0, 37.5, and 3.2, respectively (P < .05). All operative patients were treated with posterior surgery. Overall, 135 complications (71 major, 64 minor) and 1 death were observed. Surgically treated patients were found to be improved both clinically and in HRQOL parameters 2 years after surgery for all HRQOL parameters except SF-36 MCS, even in the presence of complications (P < .05), while nonoperative patients have not changed or deteriorated at the end of 2 years. Conclusions: Despite a relatively high incidence of complications, the likelihood of achieving a clinically significant and relevant HRQOL improvement was superior for patients who were treated surgically in the present population.
operative: 61, nonoperative: 29) made up the study group. The comparison between the operative and the nonoperative groups at baseline showed statistical significance for all the HRQOL parameters and the major coronal Cobb angle (P < .05). The calculated optimal cutoff values to diverge operative and nonoperative groups for COMI, ODI, SF-36 PCS, and SRS-22 were 5.7, 37.0, 37.5, and 3.2, respectively (P < .05). All operative patients were treated with posterior surgery. Overall, 135 complications (71 major, 64 minor) and 1 death were observed. Surgically treated patients were found to be improved both clinically and in HRQOL parameters 2 years after surgery for all HRQOL parameters except SF-36 MCS, even in the presence of complications (P < .05), while nonoperative patients have not changed or deteriorated at the end of 2 years. Conclusions: Despite a relatively high incidence of complications, the likelihood of achieving a clinically significant and relevant HRQOL improvement was superior for patients who were treated surgically in the present population.
Açıklama
Anahtar kelimeler
adult spinal deformity, complications, elderly, nonoperative, outcomes, surgery, treatment