11th November 2016
A number of studies presented at the Scoliosis Research Society Annual Meeting (SRS; 21–24 September, Prague, Czech Republic) and at Eurospine (5–7 October, Berlin, Germany) have used two-year follow-up data from the Scoli-Risk-1 study to reveal a multitude of results regarding the impact of surgically treating adult spinal deformity patients across postoperative motor function, complication, revision surgery, depression and proximal junctional kyphosis.
The Scoli-Risk-1 database is a prospective, international, observational, multicentre study, run by the AO Clinical Investigation and Documentation group on behalf of AOSpine and the Scoliosis Research Society. It includes data about 272 patients undergoing surgical correction of high-risk complex adult spinal deformity (eg. Cobb angle >80 degrees). Patients in the database typically went through procedures as complex as three-column osteotomies.
Presentations on the Scoli-Risk-1 study have won a number of awards in recent years, including a 2015 IMAST Whitecloud Award for Best Clinical Paper, the Best Paper Award at the 2015 Global Spine Congress, and the Russell A Hibbs Award for the Best Clinical Research Presentation at the SRS Annual Meeting in 2013.
At SRS, five different presentations covered the Scoli-Risk-1 study. In one presentation, researchers evaluated the data to discover the rate of neurological complication in adult spinal deformity patients at six weeks, six months, and two years (n=196). The research team hypothesised that the postoperative neurological complication rate would be higher than previously reported, due to “the strict postoperative grading of the Lower Extremity Motor Score (LEMS)”, with a “gradual improvement over time.” These expectations were borne out in results, with 23% of patients experiencing such decreased motor function at hospital discharge, 17% at six weeks and ~10% at both six months and two-year follow-up. This data was also presented at Eurospine.
Subgroups of the database were used by different researchers to analyse the association of adult spinal deformity with incidence of depression (see here for a detailed report), and the link between revision surgery and complication rates. The latter presentation, hypothesising that there would be significantly fewer postoperative complications in primary (n=103) than in revision cases (n=160), in fact found no significantly higher rate of postoperative complication. Not only this, but the revision patients actually experienced similar or higher improvements than the primary patients in most self-reported outcomes.
Another SRS study used the database to test the use of a new frailty index (adult spinal deformity frailty index, ASD-FI) in a complex group of patients (see here for a detailed report).
Scoli-Risk-1 data was also used to find the rate of unplanned return to operating room for complex adult spinal deformity patients. As expected by authors, a high rate of unplanned return was found among this population, with 86 unplanned surgeries performed on 60 patients (22%) over the two-year period. The researchers noted the greatest proportion of unplanned return procedures occurred after 30 days (75), with 46% of these caused by implant failure. Wound infection was both the most common cause of return before 30 days (6/11) and the second highest cause post-30 days (22%). Authors speculated that the determination of these risk factors “may be useful for preoperative counselling of patients”, as well as “clinical decision-making.”
The Scoli-Risk-1 study was featured prominently at Eurospine, with two further presentations exploring the incidence of proximal junctional kyphosis in patients with adult spinal deformity involving pelvic fusion, and the rate of major complications in a subgroup of older (≥60) patients.
The former presentation aimed to “investigate the incidence of proximal junctional kyphosis in adult spinal deformity patients fused to the pelvis, and to compare proximal junctional kyphosis rates in patients with long…versus short fusion constructs.” The study found that the incidence in patients with fusion to the pelvis was 23.7 with 9.6% undergoing revision. No significant increase was found between the “long” and “short” fusion groups.
The final Scoli-Risk-1 presentation found that patients aged 60 or above did not experience significantly more postoperative complications (neurological or other major event) in comparison with younger patients. The older group reported similar Oswestry Disability Index and SRS-22r scores, in spite of experiencing more debility.