Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)

Christopher J. Nielsen; Stephen J. Lewis; Colby Oitment; Allan R. Martin; Lawrence G. Lenke; Yong Qiu; Kenneth MC Cheung; Marinus de Kleuver; David W. Polly; Christopher I. Shaffrey; Justin S. Smith; Maarten Spruit; Ahmet Alanay; Yukihiro Matsuyama; Thorsten Jentzsch; Anna Rienmuller; Hananel Shear-Yashuv; Ferran Pellisé; Michael P. Kelly; Jonathan N. Sembrano; Benny T. Dahl; Sigurd H. Berven; AO Spine Knowledge Forum Deformity

doi:10.1016/j.spinee.2021.07.007

Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)

Christopher J. Nielsen, Stephen J. Lewis, Colby Oitment, Allan R. Martin, Lawrence G. Lenke, Yong Qiu, Kenneth MC Cheung, Marinus de Kleuver, David W. Polly, Christopher I. Shaffrey, Justin S. Smith, Maarten Spruit, Ahmet Alanay, Yukihiro Matsuyama, Thorsten Jentzsch, Anna Rienmuller, Hananel Shear-Yashuv, Ferran Pellisé, Michael P. Kelly, Jonathan N. SembranoBenny T. Dahl, Sigurd H. Berven, AO Spine Knowledge Forum Deformity

Orthopaedic Surgery

Research output: Contribution to journal › Article › peer-review

9 Scopus citations

Abstract

BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements.

PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery.

STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity.

OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-<20%) or no change (within 10%).

RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling.

CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.

Original language	English (US)
Pages (from-to)	1775-1783
Number of pages	9
Journal	Spine Journal
Volume	21
Issue number	11
Early online date	Jul 15 2021
DOIs	https://doi.org/10.1016/j.spinee.2021.07.007
State	Published - Nov 2021

Bibliographical note

Funding Information:
Yabin Wu, Christian Knoll, Niccole Germscheid, Daniela Voegtli. This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Deformity, a focused group of international spine deformity experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department and the AO Innovation Translation Center, Clinical Evidence.

Funding Information:
Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Materials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical (B); Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine (B), Medtronic (B); Grants: Depuy Synthes Spine (B), Medtronic (B). YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B).

Funding Information:
Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Mterials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical; Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine, Medtronic; Grants: Depuy Synthes Spine, Medtronic. YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B).

Publisher Copyright:
© 2021

Keywords

Adult spinal deformity
Elderly
Fusion
Oswestry disability index (ODI)
Outcomes
Quality of life
Sagittal malalignment
Scoliosis
Surgery
Symptomatic

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10.1016/j.spinee.2021.07.007

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Nielsen, C. J., Lewis, S. J., Oitment, C., Martin, A. R., Lenke, L. G., Qiu, Y., Cheung, K. MC., de Kleuver, M., Polly, D. W., Shaffrey, C. I., Smith, J. S., Spruit, M., Alanay, A., Matsuyama, Y., Jentzsch, T., Rienmuller, A., Shear-Yashuv, H., Pellisé, F., Kelly, M. P., ... Forum Deformity, AO. S. K. (2021). Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS). Spine Journal, 21(11), 1775-1783. https://doi.org/10.1016/j.spinee.2021.07.007

Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS). / Nielsen, Christopher J.; Lewis, Stephen J.; Oitment, Colby et al.
In: Spine Journal, Vol. 21, No. 11, 11.2021, p. 1775-1783.

Research output: Contribution to journal › Article › peer-review

Nielsen, CJ, Lewis, SJ, Oitment, C, Martin, AR, Lenke, LG, Qiu, Y, Cheung, KMC, de Kleuver, M, Polly, DW, Shaffrey, CI, Smith, JS, Spruit, M, Alanay, A, Matsuyama, Y, Jentzsch, T, Rienmuller, A, Shear-Yashuv, H, Pellisé, F, Kelly, MP, Sembrano, JN, Dahl, BT, Berven, SH & Forum Deformity, AOSK 2021, 'Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)', Spine Journal, vol. 21, no. 11, pp. 1775-1783. https://doi.org/10.1016/j.spinee.2021.07.007

Nielsen CJ, Lewis SJ, Oitment C, Martin AR, Lenke LG, Qiu Y et al. Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS). Spine Journal. 2021 Nov;21(11):1775-1783. Epub 2021 Jul 15. doi: 10.1016/j.spinee.2021.07.007

Nielsen, Christopher J. ; Lewis, Stephen J. ; Oitment, Colby et al. / Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older : a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS). In: Spine Journal. 2021 ; Vol. 21, No. 11. pp. 1775-1783.

@article{256cd6cd7b5b471e9a19f4f7bc01d501,

title = "Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)",

abstract = "BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements.PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery.STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity.OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-<20%) or no change (within 10%).RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling.CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.",

keywords = "Adult spinal deformity, Elderly, Fusion, Oswestry disability index (ODI), Outcomes, Quality of life, Sagittal malalignment, Scoliosis, Surgery, Symptomatic",

author = "Nielsen, {Christopher J.} and Lewis, {Stephen J.} and Colby Oitment and Martin, {Allan R.} and Lenke, {Lawrence G.} and Yong Qiu and Cheung, {Kenneth MC} and {de Kleuver}, Marinus and Polly, {David W.} and Shaffrey, {Christopher I.} and Smith, {Justin S.} and Maarten Spruit and Ahmet Alanay and Yukihiro Matsuyama and Thorsten Jentzsch and Anna Rienmuller and Hananel Shear-Yashuv and Ferran Pellis{\'e} and Kelly, {Michael P.} and Sembrano, {Jonathan N.} and Dahl, {Benny T.} and Berven, {Sigurd H.} and {Forum Deformity}, {AO Spine Knowledge}",

note = "Funding Information: Yabin Wu, Christian Knoll, Niccole Germscheid, Daniela Voegtli. This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Deformity, a focused group of international spine deformity experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department and the AO Innovation Translation Center, Clinical Evidence. Funding Information: Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Materials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical (B); Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine (B), Medtronic (B); Grants: Depuy Synthes Spine (B), Medtronic (B). YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B). Funding Information: Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Mterials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical; Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine, Medtronic; Grants: Depuy Synthes Spine, Medtronic. YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B). Publisher Copyright: {\textcopyright} 2021",

year = "2021",

month = nov,

doi = "10.1016/j.spinee.2021.07.007",

language = "English (US)",

volume = "21",

pages = "1775--1783",

journal = "Spine Journal",

issn = "1529-9430",

publisher = "Elsevier Inc.",

number = "11",

}

TY - JOUR

T1 - Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older

T2 - a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)

AU - Nielsen, Christopher J.

AU - Lewis, Stephen J.

AU - Oitment, Colby

AU - Martin, Allan R.

AU - Lenke, Lawrence G.

AU - Qiu, Yong

AU - Cheung, Kenneth MC

AU - de Kleuver, Marinus

AU - Polly, David W.

AU - Shaffrey, Christopher I.

AU - Smith, Justin S.

AU - Spruit, Maarten

AU - Alanay, Ahmet

AU - Matsuyama, Yukihiro

AU - Jentzsch, Thorsten

AU - Rienmuller, Anna

AU - Shear-Yashuv, Hananel

AU - Pellisé, Ferran

AU - Kelly, Michael P.

AU - Sembrano, Jonathan N.

AU - Dahl, Benny T.

AU - Berven, Sigurd H.

AU - Forum Deformity, AO Spine Knowledge

N1 - Funding Information: Yabin Wu, Christian Knoll, Niccole Germscheid, Daniela Voegtli. This study was organized and funded by AO Spine through the AO Spine Knowledge Forum Deformity, a focused group of international spine deformity experts. AO Spine is a clinical division of the AO Foundation, which is an independent medically-guided not-for-profit organization. Study support was provided directly through the AO Spine Research Department and the AO Innovation Translation Center, Clinical Evidence. Funding Information: Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Materials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical (B); Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine (B), Medtronic (B); Grants: Depuy Synthes Spine (B), Medtronic (B). YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B). Funding Information: Author disclosures: CJN: Nothing to disclose. SJL: Support for travel to meetings for the study or ither purposes: AO Spine (B); Consulting: Stryker (C), L&K Biomed (D); Speaking and/or Teaching Arrangements: Medtronics (B), L&K Biomed (C), Trips/Travels: AO Spine (D); Scientific Advisory Board/Other Office: SRS Research Task Force; Fellowship Support: Medtronic (F, Paid directly to institution/employer), Depuy Synthes (F, Paid directly to institution/employer); Stryker (D, Paid directly to institution/employer). CO: Nothing to disclose. AM: Nothing to disclose. LGL: Grant: Scoliosis Research Society (D, Paid directly to institution/employer); Provision of writing assistance, medicines, equipment or administrative support: Harms Study Group (Paid directly to institution/employer); Royalties: Medtronic (I), Quality Medical Publishing (A); Consulting: Medtronic (monies donated to a charitable foundation) (F), ABRYX, EOS TECHNOLOGY, ACUITY SURGICAL (B); Trips/Travel: Broadwater (reimbursement for airfare/hotel), Seattle Science Foundation (reimbursement for airfare/hotel), Scoliosis Research Society (reimbursement for airfare/hotel), Stryker Spine (reimbursement for airfare/hotel), The Spinal Research Foundation (reimbursement for airfare/hotel), AOSpine (reimbursement for airfare/hotel); Research Support (Investigator Salary, Staff/Mterials): Scoli-RSK-1 (B, Paid directly to institution/employer), Fox Pediatric Spinal Deformity Study (A, Paid directly to institution/employer), Tropical Application of Tranexamic Acid to Reduce Blood Loss in Spine Surgery (G, Paid directly to institution/employer), Adult Symptomatic Lumbar Scoliosis (B, Paid directly to institution/employer), COMPLEX CADS ISSG (E, Paid directly to institution/employer), Confirming S2AI Screw Placement by Routine Fluoroscopy (B, Paid directly to institution/employer), Scoliosis Outcomes Database Registry (A, Paid directly to institution/employer); Grants: Scoliosis Research Society (Paid directly to institution/employer), EOS (Paid directly to institution/employer), Setting Scoliosis Straight Foundation (Paid directly to institution/employer). YQ: Nothing to disclose. KMCC: Speaking and/or Teaching Arrangements: Nuvasive, Medtronic and Globus Medical Inc (Paid directly to institution/employer); Trips/Travel: AOSpine; Grants: Nuvasive (Paid directly to institution/employer). MdeK: Consulting: Medtronic (B); Speakind and/or Teaching Arrangements: Medtronic (B); Grants: Dutch National Institute for Health Care Innovation (ZoneMw) (E), Scoliosis Research Society (D). DWP: Royalties: Springer (A), Globus Medical: (No compensation, Paid directly to institution/employer), Consulting: Globus Medical (A), SI-Bone (E), Research Support (Investigator Salary, Staff/Materials): AO Spine (Paid directly to institution/employer), Mizuho OSI (Paid directly to institution/employer); Grants: Medtronic (Paid directly to institution/employer). CIS: Grant: AO Foundation (F, Paid directly to institution/employer), NuVasive (D, Paid directly to institution/employer); Support for travel to meetings for the study or other purposes: AO Foundation (F); Royalties: NuVasive (F); Stock Ownership: NuVasive (H); Consulting: Medtronic (C); Fellowship Support: NuVasive (E), Globus (E). JSS: Royalties: Zimmer Biomet (F, Paid directly to institution/employer), Nuvasive (A, Paid directly to institution/employer), Thieme (A); Private Investments: Alphatec (G), Nuvasive (B); Consulting: Zimmer Biomet (B), Nuvasive (B), Depuy synthes (B), Cerpaedics (B), Stryker (B), Carlsmed; Grants: Nuvasive (D, Paid directly to institution/employer), Depuy Synthes/ISSG (B, Paid directly to institution/employer); Fellowship Support: AOSpine (E, Paid directly to institution/employer). MS: Nothing to disclose. AA: Consulting: Globus Medical; Scientific Board Advisory Board/Other Office: JBJS Reviews, NASS Journal; Research Support (Investigator Salary, Staff/Materials): Depuy Synthes Spine, Medtronic; Grants: Depuy Synthes Spine, Medtronic. YM: Nothing to disclose. TJ: Nothing to disclose. AR: Nothing to disclose. HSY: Nothing to disclose. FP: Grant: AOSpine (A); Consulting: Medtronic (B), Stryker (B); Grsants: DepuySpine (F), Medtronic (F). MPK: Consulting: The Journal of Bone and Joint Surgery (A), Scientific Advisory Board/Other office: The Journal of Bone and Joint Surgery (F, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Mterials): SSSF (B, Paid directly to institution/employer); Fellowship Support: AO Spine (F, Paid directly to institution/employer). JNS: Grant: AO Spine Foundation (B, Paid directly to institution/employer); Research Support (Investigator Salary, Staff/Materials): NuVasive (B, Paid directly to institution/employer), Orthofix (B, Paid directly to institution/employer). BTD: Nothing to disclose. SHB: Grants: AOSpine (C, Paid directly to institution/employer); Royalties: Stryker (F, Paid directly to institution/employer); Consulting: Medtronic (E), Integrity (C), Stryker (B). Publisher Copyright: © 2021

PY - 2021/11

Y1 - 2021/11

N2 - BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements.PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery.STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity.OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-<20%) or no change (within 10%).RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling.CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.

AB - BACKGROUND CONTEXT: Patients with adult spinal deformity suffer from disease related disability as measured by the Oswestry Disability Index (ODI) for which surgery can result in significant improvements.PURPOSE: The purpose of this study was to show the change in overall and individual components of the ODI in patients aged 60 years or older following multi-level spinal deformity surgery.STUDY DESIGN: Prospective, multicenter, multi-continental, observational longitudinal cohort study PATIENT SAMPLE: Patients ≥60 years undergoing primary spinal fusion surgery of ≥5 levels for coronal, sagittal or combined deformity.OUTCOME MEASURES: Oswestry Disability Index (ODI) METHODS: : Patients completed the ODI pre-operatively for baseline, then at 10 weeks, 12 months and 24 months post-operatively. ODI scores were grouped into deciles, and change was calculated with numerical score and improvement or worsening was further categorized from baseline as substantial (≥20%), marginal (≥10-<20%) or no change (within 10%).RESULTS: Two-hundred nineteen patients met inclusion criteria for the study. The median number of spinal levels fused was 9 [Q1=5.0, Q3=12.0]. Two-year mean (95% CI) ODI improvement was 19.3% (16.7%; 21.9%; p<.001) for all age groups, with mean scores improved from a baseline of 46.3% (44.1%; 48.4%) to 41.1% (38.5%; 43.6%) at 10 weeks (p<.001), 28.1% (25.6%; 30.6%) at 12 months (p<.001), and 27.0% (24.4%; 29.5%) at 24 months (p<.001). At 2 years, 45.5% of patients showed 20% or greater improvement in ODI, 23.7% improved between 10% and 20%, 26.3% reported no change (defined as±10% from baseline), 4.5% of patients reported a worsening between 10% to 20%, and none reported worsening greater than 20%. 59.0% of patients were severely disabled (ODI >40%) pre-operatively, which decreased to 20.2% at 2 years. Significant improvement was observed across all 10 ODI items at 12 and 24 months. The largest improvements were seen in pain, walking, standing, sex life, social life and traveling.CONCLUSIONS: In this prospective, multicenter, multi-continental study of patients 60 years or older undergoing multi-level spinal deformity surgery, almost 70% of patients reported significant improvements in ODI without taking into account surgical indications, techniques or complications. Clear data is presented demonstrating the particular change from baseline for each decile of pre-operative ODI score, for each sub-score, and for each age group.

KW - Adult spinal deformity

KW - Elderly

KW - Fusion

KW - Oswestry disability index (ODI)

KW - Outcomes

KW - Quality of life

KW - Sagittal malalignment

KW - Scoliosis

KW - Surgery

KW - Symptomatic

UR - http://www.scopus.com/inward/record.url?scp=85113339570&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85113339570&partnerID=8YFLogxK

U2 - 10.1016/j.spinee.2021.07.007

DO - 10.1016/j.spinee.2021.07.007

M3 - Article

C2 - 34273569

AN - SCOPUS:85113339570

SN - 1529-9430

VL - 21

SP - 1775

EP - 1783

JO - Spine Journal

JF - Spine Journal

IS - 11

ER -

Stratifying outcome based on the Oswestry Disability Index for operative treatment of adult spinal deformity on patients 60 years of age or older: a multicenter, multi-continental study on Prospective Evaluation of Elderly Deformity Surgery (PEEDS)

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