67. The value of overall assessment in adult degenerative scoliosis patients: short- and long-term effect of surgical intervention on static and dynamic balance, gait and pain level

• Published in: The spine journal 2021-09, Vol.21 (9), p.S33-S33
• Main Authors: Haddas, Ram, Sikora-Klak, Jakub, Mar, Damon E., Kisinde, Stanley, Block, Andrew R., Lieberman, Isador H.
• Format: Article
• Language: English
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2021.05.092

In the diagnosis and treatment of adult spinal deformities, static radiographic measurements in the sagittal and coronal anatomical planes and patient-reported outcome measures (PROMs) serve as the gold standard for assessment of spinal alignment and deformity. However, there is a lack of published literature on their relation to objective functional outcome measures (FOMs) among patients afflicted with adult spinal deformity. Adult spinal deformity (ASD) is due to degeneration, functional decline is partly due to loss of postural stability and neuromuscular capacity and coordination. Objective functional measures (eg, static standing and walking alignment) cover more information than just radiographic alignment in the ASD population. Gait and dynamic balance analysis can reveal functional compensatory alignment changes where static imaging is limited. Previous studies have shown improvement in postoperative gait, approximating non-ASD control cohorts but still symptomatic. Many studies have shown surgical reconstruction in ASD patients has improved patient outcomes, but not overall assessment of objective function along with psychological factors. Therefore, a more comprehensive standard outcome measurement is needed. To determine the one-year effects of spinal alignment on function in ASD patients following surgical treatment using radiographic parameters, 3D gait and balance analysis, PROMs, and psychological tests and compared to healthy control. Nonrandomized, prospective study. Forty-three symptomatic ASD patients, 24 age-matched control. Gait spatiotemporal parameters, dynamic balance as measurement by balance effort and Cone of Economy (CoE) dimensions, radiograph alignment measurements, PROMs, and psychological factors. Patients performed dynamic balance and gait evaluations prior to surgery (Pre), 3 months (Post3), and 12 months (Post12) postoperatively. Patients also completed full-length, head-to-toe, micro-dose X-rays along with PROMs, and psychological questionnaires. Balance effort and CoE dimensions were measured by total sway and range of sway, respectively. Repeated measurement analysis of variance (ANOVA) and one-way ANOVA were used to determine differences in radiographic, dynamic balance, gait, and PROMs parameters at Post3 and Post12 and to the match control group. Significant improvements in radiographic alignment were found in Cobb angle (