What functional benefits can older patients expect after adult spinal deformity surgeries? Subanalysis from the Prospective Evaluation of Elderly Deformity Surgery (PEEDS) study with 5 Year Follow Up

BACKGROUND CONTEXT: Increasing number of patients are undergoing surgical treatment for Adult Spinal Deformity (ASD). The main indications are pain, disability and loss of function. Multiple patient- reported Health Related Quality of Life (HRQOL) measures are utilized to assess functional status and disability before and after the surgery. Some components of these questionnaires may be more pertinent in the elderly population.

PURPOSE: Primary aim was to assess key functional outcomes were most relevant to elderly patients undergoing multilevel fusion surgery for ASD. Secondary aim was to assess if these functional improvements were maintained over the follow up period.

STUDY DESIGN/SETTING: Post hoc analysis of prospectively collected data from multicenter observational study, where primary outcome was the absolute changes in the SRS-22r total and subtotal scores between baseline and 2-years FU.

PATIENT SAMPLE: 219 patients.

OUTCOME MEASURES: Self reported and functional measures were included. Function was assessed using the Scoliosis Research Society 22r (SRS-22r) function domain, and the personal care, walking, sitting and standing sections from the Oswestry Disability Index (ODI) and EuroQol- 5 Dimension (EQ-5D-3L scores).

METHODS: Patients ≥ 60 years of age from 12 international centres undergoing spinal fusion of at least 5 levels were included. Follow up visits were performed at 10 weeks, 12 months, 24 months and 60 months.

RESULTS: A total of 219 patients (80.4% females) were included with a mean age of 67.5 years. The mean SRS-22r function scores preoperative were 2.70 (CI: 2.60-2.80), which improved to 3.46 (CI: 3.36-3.56) by 2 years post-surgery and were maintained at 5 years (3.39, CI: 3.27-3.51). 44.9% patients were either bedbound or had primarily no activity before the surgery which reduced to 18.3 % at 2 years and 17.4% at 5 years follow up. Similarly, the percentage of patients that could stand >30 minutes improved from 24.5% to 68.6% at 2 years and 59.4% at 5 years. 26% of the patients could walk for a mile or more before surgery which improved to 63.1 % at 2 years and maintained in 58.7% patients at 5 years. 43.1 % had unlimited sitting pre-operatively, that improved to 65.3% at 2 years and 64.7% at 5 years. Normal social life was seen in 19.2% of patients at baseline compared to 57.5% at 2 years and 52.7% at 5 years.

CONCLUSIONS: Elderly patients undergoing multilevel spinal fusions for ASD experienced significant functional improvements, which were maintained at 5 years postoperatively. This practical information can be utilised during patient counselling pre-operatively when considering functional outcomes after major ASD surgery in patients over 60 years of age.