Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)
Research output: Contribution to journal › Journal article › Research › peer-review
BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements. PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery. STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity. OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10–<20%) or no change (within 10%). RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling. CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.
| Original language | English |
|---|---|
| Journal | Spine Journal |
| Volume | 21 |
| Issue number | 11 |
| Pages (from-to) | 1775-1783 |
| Number of pages | 9 |
| ISSN | 1529-9430 |
| DOIs | |
| Publication status | Published - Nov 2021 |
Bibliographical note
Funding Information:
Yabin Wu, Christian Knoll, Niccole Germscheid, Daniela Voegtli. This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Deformity, a focused group of international spine deformity experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department and the AO Innovation Translation Center, Clinical Evidence.
Funding Information:
Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Materials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical (B); Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine (B), Medtronic (B); Grants: Depuy Synthes Spine (B), Medtronic (B). YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B).
Funding Information:
Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Mterials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical; Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine, Medtronic; Grants: Depuy Synthes Spine, Medtronic. YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B).
Publisher Copyright:
© 2021
- Adult spinal deformity, Elderly, Fusion, Oswestry disability index (ODI), Outcomes, Quality of life, Sagittal malalignment, Scoliosis, Surgery, Symptomatic
Research areas
ID: 302550358