New Motor Deficit after Adult Spinal Deformity Surgery Leads to Worsened Early HRQOL: Subanalysis of 273 Patients from Scoli Risk 1 Prospective Study

Introduction An International, ambispective, multi-center observational cohort study (Scoli-Risk-1) was completed to determine the impact of neural injury on Health-related Quality of Life scores (HRQOLs). 30.9% of patients suffered any ASIA lower extremity motor score (LEMS) worsening during the first 6 months after surgery. The purpose of this analysis is to define the impact of new LEMS deficit on HRQOL metrics and recovery of those measures after surgery in the first 6 months. We hypothesized that new motor deficits (defined by LEMS worsening) will lead to worsened HRQOL scores, after correction of adult spinal deformity. Material and Methods Patients aged 18–80 years with a diagnosis of adult spinal deformity were eligible for enrollment at 15 sites worldwide. Other inclusion criteria included major Cobb > 80 degrees, C7-L2 curve apex, and any patient undergoing 3 column osteotomy. ASIA scores and standard HRQOL scores (ODI, SRS, SF-36 mental, and SF-36 physical) were recorded pre-op, 6 weeks and 6 months. Patients were subdivided into three subcategories of LEMS change (≥2 points worsening, 1 pt worsening to no change, or LEMS improvement). Results 273 complex adult spinal deformity (ASD) patients enrolled, with 184 female (67%) and 89 male (33%) patients. Mean age was 56.9 years (SD 15.3, range 18–81). 30.9% of patients suffered a worsening of LEMS within the first 6 months post-surgery. HRQOL scores worsened as LEMS worsened. The 6 week HRQOL changes for LEMS ≤2 patients vs LEMS −1 to 0 vs improved LEMS patients were: ODI (11.6 vs 0.7 vs −0.6), SF-36 physical (−3.9 vs −1.6 vs 1.0), SF-36 mental (−1.5 vs 1.4 vs 0.6), and SRS total change (0 vs 0.4 vs 0.5), respectively. The 6 month HRQOL changes for LEMS < =2 patients vs LEMS −1 to 0 vs improved LEMS were: ODI (−6.8 vs −9.5 vs −14), SF-36 physical (0.6 vs 2.6 vs 6.2), SF-36 mental (−1.1 vs 3.8 vs 5.9), and SRS total change (0.3 vs 0.7 vs 0.8), respectively. Table 1 shows these data. While the database is not yet locked, these data are subject to minor changes. Conclusion In the subgroup of patients who developed a new lower extremity motor deficit after adult spinal deformity surgery, total HRQOLs and HRQOL changes were negatively impacted. Patients with 2 or more points of LEMS worsening had the worst HRQOL changes. However, even these patients showed overall improvement in ODI, SF-36 physical and SRS total scores at 6 months compared with pre-op baseline.

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