Impact of Preoperative Clinical State on 2‐year Clinical Outcomes Following Degenerative Lumbar Scoliosis Surgery
Lei Yuan, Yinhao Liu, Yan Zeng, Zhongqiang Chen, Weishi Li- Orthopedics and Sports Medicine
Abstract
Purpose
To assess the preoperative clinical state's impact on clinical outcomes after surgery for degenerative lumbar scoliosis (DLS) based on the minimal clinically important difference (MCID).
Methods
Preoperative and follow‐up (FU) scores in each SRS‐22 domain were compared with age‐ and sex‐matched normative references. At baseline, patients were classified by differences from normative values in four groups: Worst, Severe, Poor, and Moderate. At 2‐years postoperative follow‐up, patients were divided into four groups (Worst Severe Poor Asymptomatic) based on the difference in MCID between postoperative and normal values. The changes in MCID were considered as the criterion for surgical efficacy. In addition, we calculated the classification of preoperative and follow‐up clinical symptom severity in each domain in same patient. The distinction among curve types was also performed based on the SRS‐Schwab classification.
Results
A total of 123 patients were included. During follow‐up, patients with more severe preoperative clinical symptoms were more likely to achieve clinical changes (>1 MCID, P<0.05), but the rate of reaching “asymptomatic” was lower (P<0.05). Kendall's tau‐b correlation analysis found that preoperative clinical severity was correlated with clinical changes category in Activity (Tau‐b=0.252; P =0.002), Pain (Tau‐b=0.230; P =0.005), Appearance (Tau‐b=0.307; P <0.001), and Mental (Tau‐b=0.199; P =0.016), and it also was correlated with follow‐up clinical severity in Activity (Tau‐b=0.173; P =0.023), Pain(Tau‐b=0.280; P <0.001), and Mental(Tau‐b= 0.349; P <0.001).
Conclusions
There was a correlation between preoperative clinical severity and follow‐up SRS‐22 score outcomes. Patients with severe preoperative clinical symptoms can experience better treatment outcomes during follow‐up, but it is also more difficult to recover to the normal reference.
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