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What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients

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Abstract

Introduction

Previous studies suggest that a meaningful and easily understood measure of treatment outcome may be the proportion of patients who are in a “patient acceptable symptom state” (PASS). We sought to quantify the score equivalent to PASS for different outcome instruments, in patients with adult spinal deformity (ASD).

Methods

We analysed the following 12-month questionnaire data from the European Spine Study Group (ESSG): Oswestry Disability Index (ODI; 0–100); Numeric Rating Scales (NRS; 0–10) for back/leg pain; Scoliosis Research Society (SRS) questionnaire; and an item “if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?” (5-point scale, dichotomised with top 2 responses “somewhat satisfied/very satisfied” being considered PASS+, everything else PASS−). Receiver operating characteristics (ROC) analyses indicated the cut-off scores equivalent to PASS+.

Results

Out of 1043 patients (599 operative, 444 non-operative; 51 ± 19 years; 84% women), 42% reported being PASS+ at 12 months’ follow-up. The ROC areas under the curve were 0.71–0.84 (highest for SRS subscore), suggesting the questionnaire scores discriminated well between PASS+ and PASS−. The scores corresponding to PASS+ were > 3.5 for the SRS subscore (> 3.3–3.8 for SRS subdomains); ≤ 18 for ODI; and ≤ 3 for NRS pain. There were slight differences in cut-offs for subgroups of age, treatment type, aetiology, baseline symptoms, and sex.

Conclusion

Most interventions for ASD improve patients’ complaints but do not totally eliminate them. Reporting the percentage achieving a score equivalent to an “acceptable state” may represent a more stringent and discerning target for denoting treatment success in ASD.

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Notes

  1. The same data are not presented in detail for the non-operative patients, since many who were included in the database were not actively seeking treatment but were simply under observation or were presenting for routine follow-up from a previous surgery, more than 2 years prior to recruitment in ESSG. Overall, 12% (54/442) reported being in PASS for all of the three main outcome measures as well as the SRS subdomains at baseline.

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Authors and Affiliations

  1. Department of Teaching, Research and Development, Spine Center Division, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    A. F. Mannion & S. Richner-Wunderlin

  2. Spine Center, Schulthess Klinik, Lengghalde 2, 8008, Zurich, Switzerland

    M. Loibl, T. F. Fekete, D. Haschtmann, D. Jeszenszky & F. S. Kleinstück

  3. Spine Unit, Hospital Universitari Vall Hebron, Passeig Vall Hebron 119-129, 08035, Barcelona, Spain

    J. Bago & F. Pellisé

  4. Spine Research Unit, Spine Research Unit, Vall d’Hebron Institute of Research (VHIR), Passeig Vall Hebron 119-129, 08035, Barcelona, Spain

    A. Vila-Casademunt

  5. Department of Orthopaedics and Traumatology, Acibadem University School of Medicine, Büyükdere cad, 40 Maslak, 344457, Istanbul, Turkey

    A. Alanay

  6. Pellegrin Bordeaux University Hospital, Place Amélie Raba Léon, 33000, Bordeaux, France

    I. Obeid

  7. Hospital Universitario, La Paz Paseo de la Castellana 261, 28046, Madrid, Spain

    F. S. Pérez-Grueso

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  1. A. F. Mannion
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European Spine Study Group (ESSG)

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Correspondence to A. F. Mannion.

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None of the authors have any conflict of interest in relation to the current work. The ESSG is partially funded by research grants from Depuy Synthes Spine and Medtronic.

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Mannion, A.F., Loibl, M., Bago, J. et al. What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients. Eur Spine J 29, 1340–1352 (2020). https://doi.org/10.1007/s00586-020-06365-z

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