Changes in health-related quality of life measures associated with degree of proximal junctional kyphosis.

PURPOSE: To explore the changes in health-related quality of life parameters observed in patients experiencing varying degrees of proximal junctional kyphosis following corrective adult spinal deformity fusions. METHODS: Inclusion: adult spinal deformity patients > 18 y/o, undergoing spinal fusion. PJK: ≥ 10° measure of the sagittal Cobb angle between the inferior endplate of the UIV and the superior endplate of the UIV + 2. Severe PJK: > 28° PJK. Mild PJK: ≥ 10oand ≤ 28°. ANOVA, followed by ANCOVA, compared the change in HRQoLs between time points (BL, 1Y, 2Y) among PJK groups. Correlation-related change in PJK and change in HRQoL for mild and severe groups. RESULTS: 969 patients (age: 64.5 y/o,75% F, posterior levels fused:12.3) were studied. 59% no PJK, 32% mild PJK, 9% severe PJK. No differences in HRQoLs were seen between no PJK and PJK groups at baseline, one year, and 2 years. Adjusted analysis revealed Severe PJK patients improved less in SRS-22 Satisfaction (NoPJK: 1.6, MildPJK: 1.6, SeverePJK: 1.0; p = 0.022) scores at 2 years. Linear regression analysis only found clinical improvement in SRS-22 Satisfaction to correlate with the change of the PJK angle by 2 years (R = 0.176, P = 0.008). No other HRQoL metric correlated with either the incidence of PJK or the change in the PJK angle by one or 2 years. CONCLUSIONS: These results maintain that patients presenting with and without proximal junctional kyphosis report similar health-related qualities of life following corrective adult spinal deformity surgery, and SRS-22 Satisfaction may be a clinical correlate to the degree of PJK. Rather than proving proximal junctional kyphosis to have a minimal clinical impact overall on HRQoL metrics, these data suggest that future analysis of this phenomenon requires different assessments. LEVEL OF EVIDENCE: Level of evidence: III.

Is frailty responsive to surgical correction of adult spinal deformity? An investigation of sagittal re-alignment and frailty component drivers of postoperative frailty status.

PURPOSE: Frailty has been associated with adverse postoperative outcomes. Recently, a novel frailty index for preoperative risk stratification in patients with adult spinal deformity was developed. Components of the ASD-FI utilize patient comorbidity, clinical symptoms, and patient-reported-outcome-measures (PROMS). Our purpose was to investigate components of the Adult Spinal Deformity Frailty Index (ASD-FI) responsive to surgery and drivers of overall frailty. METHODS: Operative ASD patients ≥ 18 years, undergoing multilevel fusions, with complete baseline, 6 W, 1Y and 2Y ASD-FI scores. Descriptive analysis assessed demographics, radiographic parameters, and surgical details. Pearson bivariate correlations, independent and paired t tests assessed postoperative changes to ASD-FI components, total score, and radiographic parameters. Linear regression models determined the effect of successful surgery (achieving lowest level SRS-Schwab classification modifiers) on change in ASD-FI total scores. RESULTS: 409 6-week, 696 1-year, and 253 2-year operative ASD patients were included. 6-week and 1-year baseline frailty scores were 0.34, 2 years was 0.38. Following surgery, 6-week frailty was 0.36 (p = 0.033), 1 year was 0.25 (p < 0.001), and 2 years was 0.28 (p < 0.001). Of the ASD-FI variables, 17/40 improved at 6 weeks, 21/40 at 1 year, and 18/40 at 2 years. Successful surgery significantly predicted decreases in 1-year frailty scores (R = 0.27, p < 0.001), SRS-Schwab SVA modifier was the greatest predictor (Adjusted Beta: - 0.29, p < 0.001). CONCLUSIONS: Improvement in sagittal realignment and functional status correlated with improved postoperative frailty. Additional research and deformity sub-group analyses are needed to describe associations between specific functional activities that correlated with frailty improvement as well as evaluation of modifiable and non-modifiable indices.

Rapidly Progressive Myelopathy Caused by Aggressive Vertebral Hemangioma.

INTRODUCTION: Vertebral hemangiomas are the most common benign tumors of the spine, having an incidence of 10-12% in the general population. They are asymptomatic, incidental findings in the vast majority of patients; however, in rare cases, they can expand to cause neural compression. Aggressive lesions of this sort are most commonly found in the thoracic spine, and expansion leads to the subacute development of myelopathy. CASE REPORT: The authors report a rare case of aggressive vertebral hemangioma at the T1 vertebral body which caused rapidly progressive myelopathy over the course of 7 days. Clinical and radiological findings are shown as well as surgical management of the lesion. The patient regained the ability to ambulate, and there was no evidence of disease recurrence at 2-year follow-up. CONCLUSIONS: Although aggressive vertebral hemangiomas are a rare cause of myelopathy, they must be kept in mind in the differential diagnosis of cord compressive lesions. In this case, contrary to most, the expansion of the hemangioma led to rapid development of neurological decline necessitating urgent surgical intervention.