Health Outcome Assessment Before and After Adult Deformity Surgery: A Prospective Study

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Abstract

Study Design

Fifty-five patients undergoing surgery for adult spinal deformity assessed their health status using a generic health outcome instrument before surgery and at an average of 2 years after surgery.

Objectives

To assess whether adult spinal deformity surgery is a useful intervention when patients evaluate their own perception of health. The Medical Out-comes Survey Short Form-36, a validated generic health outcome assessment form, was used to measure patient's health status.

Summary of Background Data

Surgery for adult scoliosis is technically demanding. No study that we are aware of uses a generic health outcome instrument in a prospective manner to compare patients' perception of their health after adult scoliosis surgery. The Medical Outcomes Survery Short Form-36 has been validated in multiple studies assessing other medical conditions and was found to be reliable, comprehensive, brief, and generic.

Methods

Sixty-eight adult patients undergoing surgery for adult spinal deformity were prospectively enrolled. Fifty-five patients were available to complete the Medical Outcomes Surgery Short Form −36 after surgery.The scores of the health profile were compared before and after surgery. The results of patients younger than 40 years were compared with those of patients older than 40 years. The results of patients fused to more caudal end vertebral levels (L4, L5) were compared with those who were fused to more cranial and vertebral levels. The results of patients without complication after surgery were compared with those of patients with complication after surgery.

Results

Average follow-up period was 22.5 months (minimum 12 months) in 82% of 68 patients. Statistically significant improvements were seen in postoperative scores for physical function, social function, bodily pain, and perceived health change. We found no significant differences in self-reported health function parameters related to age (>40 vs. <40), and vertebral level of fusion or presence of complications after surgery.

Conclusions

Applying a generic health outcome instrument to adult spinal deformity surgery shows that adult scoliosis surgery significantly improves patients self-reported health assessment and function. Beneficial results do not appear to deteriorate with age or more caudal and vertebral levels of fusion. Future studies combining disease-specific outcomes analysis and generic health surveys to assess and results of adult spinal deformity surgery will be useful.

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