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Quality of Life: What Happens When Spine, Adult Reconstructive Surgery Square Off?

by Elizabeth Hofheinz, M.P.H., M.Ed.

Citing the traditional difficulties of comparing varied disease states, a team of researchers from NYU Langone in Manhattan undertook a different approach to juxtaposing the benefits of spine versus adult reconstructive surgery. Their work, “Evaluation of Health-related Quality of Life Improvement in Patients Undergoing Spine Versus Adult Reconstructive Surgery,” appears in the September 15, 2020 edition of Spine.

The researchers examined outcomes in single-level spine (n-304) and primary hip and knee arthroplasty patients (n=347) who were treated from December 2016 until April 2019.

Aaron J. Buckland, MBBS, FRACS, FAOrthA is a Spinal and Scoliosis Surgeon, Associate Professor in Orthopaedic Surgery, and Director of Spine Research at NYU Langone Health. He told OSN, “There persists a community opinion that spine surgery is largely unsuccessful. This has many reasons, including previously mis-understood contributors to pain, less sophisticated imaging, diagnostics and instrumentation. Hip replacements (THA) and knee replacements (TKA), on the contrary, are well accepted as efficacious and cost-effective treatments.”

“Spinal surgery has seen many advances understanding, diagnostics, techniques and instrumentation over the last 10-20 years. A spine surgeon’s perspective in modern times is that well-indicated spinal surgery is just as beneficial to a patient’s pain relief and function as what we were seeing with other successful orthopedic procedures.”

You CAN compare apples and oranges

“We have been previously unable to compare these results due to limitations with how we assess patient functions, with different questionnaires for different diseases. With the advent of Patient Reported Outcomes Measurement Information System (PROMIS), a computer adaptive quality of life (QOL) metric that can allow comparison of all disease states, we aimed to assess if the results of spine surgery were comparable to the well accepted results of THA and TKA.”

“The spinal surgery procedures assessed were Cervical Disc Replacement (CDR), Anterior Cervical Discectomy & Fusion (ACDF), lumbar laminectomy, lumbar microdiscectomy (MLD) & Transforaminal Lumbar Interbody Fusion (TLIF). A minimum follow-up of 6 months was assessed after surveying hip and spine surgeons who agreed that >90% of the improvement from these procedures would be noted by 6 months postoperatively.”

Score for Spine

“When comparing spinal pathologies that required single level spinal procedures, it was evident that the spine pathology was more disabling at baseline (preoperatively), even when patients were matched for age and gender. All single spinal surgery procedures provided as much, or even greater improvement in patients pain and function than that provided by THA or TKA. Because THA and TKA patients had less disability at baseline, although they did not note as much improvement, the often-demonstrated better postoperative pain and physical function scores.”

“The results confirmed our clinical suspicions–that spinal pathologies requiring surgery are more disabling conditions than that of hip and knee arthritis. Furthermore, the improvement in pain and function as a result of well indicated spinal surgery was as good, or greater than that of THA or TKA.”

Eradicating misconceptions…

“We hope that the results of this study help to debunk the myths and stigma shared within the community regarding the results of spine surgery. With modern diagnostics, techniques, instrumentation and biologics, spinal surgery has become efficacious and cost effective in improving patients’quality of life. The authors also emphasize the importance of performing well-indicated spine surgery in achieving good outcomes. The next step in assessment of this space will be assessing durability of the treatments in the mid-term to long-term time-points.”

Elizabeth Hofheinz

Two time winner of the MORE award Ms. Hofheinz was the first writer employed by Orthopedics This Week. The MORE award is granted annually by the American Academy of Orthopaedic Surgeons to recognize excellence in journalism. Ms. Hofheinz is currently the Director of Communications for Ortho Spine Partners (OSP).

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