Improvements in physical functionality in elderly patients with spinal deformity after corrective fusion surgery: a gait analysis

Hideyuki Arima MD, PhD1, Yu Yamato MD, PhD1,2, Tomohiko Hasegawa MD, PhD1, Daisuke Togawa MD, PhD3, Go Yoshida MD, PhD1, Tatsuya Yasuda MD, PhD1, Tomohiro Banno MD, PhD1, Shin Oe MD, PhD1,2, Hiroki Ushirozako MD, PhD1, Tomohiro Yamada MD1, Yuh Watanabe MD1, Koichiro Ide MD1, and Yukihiro Matsuyama MD, PhD1
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  • 1 Department of Orthopaedic Surgery and
  • | 2 Division of Geriatric Musculoskeletal Health, Hamamatsu University School of Medicine, Hamamatsu; and
  • | 3 Department of Orthopaedic Surgery, Kinki University Nara Hospital, Ikoma, Japan
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OBJECTIVE

Extensive corrective fusion surgery was performed on elderly patients with adult spinal deformity (ASD) to improve abnormal posture. Varying improvements in postoperative walking function were expected owing to differences in muscular strength and bone quality between patients in their 40s and those over 75 years of age. The purpose of this study was to compare preoperative and postoperative gait posture and physical functionality in elderly patients with ASD who underwent extensive corrective fusion to the thoracic spine.

METHODS

A prospectively maintained surgical database was reviewed for patients with ASD who underwent corrective fusion surgery (thoracic spine to pelvis) between 2011 and 2016. The cohort was divided into three age groups: nonelderly (40–64 years), young-old (65–74 years), and old-old (> 75 years). Patients underwent a 4-m walk test preoperatively and 2 years postoperatively to measure gait-trunk tilt angle and walking speed (meters per minute).

RESULTS

Among 291 patients with ASD who underwent corrective fusion surgery, 56 patients (14 men and 42 women; mean age 68.8 years) were included. Mean preoperative gait-trunk tilt angle (12.9° vs 5.2°, p < 0.01) and walking speed (41.2 m/min vs 45.7 m/min, p < 0.01) significantly improved postoperatively. Intergroup analysis revealed that the mean preoperative gait-trunk tilt angles in the nonelderly (n = 13), young-old (n = 28), and old-old (n = 15) groups were 11.9°, 10.0°, and 19.3°, respectively; postoperatively, these improved to 4.5°, 4.5°, and 7.2°, respectively. Mean preoperative walking speeds of 47.9, 40.0, and 37.7 m/min improved to 52.4, 44.8, and 41.5 m/min postoperatively in the nonelderly, young-old, and old-old groups, respectively. There were no statistically significant differences in degree of improvement in gait-trunk tilt angle and walking speed among groups.

CONCLUSIONS

Extensive corrective fusion surgery improved the postoperative walking posture of patients with ASD. Statistical analysis of gait measurements demonstrated intergroup equivalence, indicating comparable improvement in physical functionality in elderly and middle-aged patients after corrective fusion surgery.

ABBREVIATIONS

ASD = adult spinal deformity; GTA = gait-trunk tilt angle; LL = lumbar lordosis; LLIF = lateral lumbar interbody fusion; ODI = Oswestry Disability Index; QOL = quality of life; SRS-22r = Scoliosis Research Society-22r; SVA = sagittal vertical axis; UIV = upper instrumented vertebra.

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Contributor Notes

Correspondence Hideyuki Arima: Hamamatsu University School of Medicine, Hamamatsu, Shizuoka, Japan. arihidee@gmail.com.

INCLUDE WHEN CITING Published online June 4, 2021; DOI: 10.3171/2020.10.SPINE201323.

Disclosures Drs. Yamato and Oe received laboratory fund donations from Medtronic Sofamor Danek, Inc., Japan Medical Dynamic Marketing, Inc., and Meitoku Medical Institute Jyuzen Memorial Hospital. Dr. Togawa serves as Deputy Editor of The Journal of Bone and Joint Surgery.

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