Improvement in SRS-22R Self-Image Correlate Most with Patient Satisfaction after 3-Column Osteotomy

Spine (Phila Pa 1976). 2021 Jun 15;46(12):822-827. doi: 10.1097/BRS.0000000000003897.

Abstract

Study design: Longitudinal cohort.

Objectives: The aim of this study was to examine the relationship between patient satisfaction, patient-reported outcome measures (PROMs) and radiographic parameters in adult spine deformity (ASD) patients undergoing three-column osteotomies (3CO).

Summary of background data: Identifying factors that influence patient satisfaction in ASD is important. Evidence suggests Scoliosis Research Society-22R (SRS-22R) Self-Image domain correlates with patient satisfaction in patients with ASD.

Methods: This is a retrospective review of ASD patients enrolled in a prospective, multicenter database undergoing a 3CO with complete SRS-22R pre-op and minimum 2-years postop. Spearman correlations were used to evaluate associations between the 2-year SRS Satisfaction score and changes in SRS-22R domain scores, Oswestry Disability Index (ODI), and radiographic parameters.

Results: Of 135 patients eligible for 2-year follow-up, 98 patients (73%) had complete pre- and 2-year postop data. The cohort was mostly female (69%) with mean BMI of 29.7 kg/m2 and age of 61.0 years. Mean levels fused was 12.9 with estimated blood loss of 2695 cc and OR time of 407 minutes; 27% were revision surgeries. There was a statistically significant improvement between pre- and 2-year post-op PROMs and all radiographic parameters except Coronal Vertical Axis. The majority of patients had an SRS Satisfaction score of ≥3.0 (90%) or ≥4.0 (68%), consistent with a moderate ceiling effect. Correlations of patient satisfaction was significant for Pain (0.43, P < 0.001), Activity (0.39, P < 0.001), Mental (0.38, P = 0.001) Self-Image (0.52, P < 0.001). ODI and Short-Form-36 Physical component summary had a moderate correlation as well, with mental component summary being weak. There was no statistically significant correlation between any radiographic or operative parameters and patient satisfaction.

Conclusion: There was statistically significant improvement in all PROMs and radiographic parameters, except coronal vertical axis at 2 years in ASD patients undergoing 3CO. Improvement in SRS Self-Image domain has the strongest correlation with patient satisfaction.Level of Evidence: 3.

MeSH terms

  • Female
  • Humans
  • Male
  • Middle Aged
  • Osteotomy*
  • Patient Reported Outcome Measures*
  • Patient Satisfaction / statistics & numerical data*
  • Radiography
  • Reoperation
  • Retrospective Studies
  • Scoliosis* / diagnostic imaging
  • Scoliosis* / psychology
  • Scoliosis* / surgery
  • Self Concept