Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery

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  • 1 Norton Leatherman Spine Center, Louisville, Kentucky;
  • 2 Department of Orthopedics, University of Calgary, Alberta, Canada;
  • 3 Department of Orthopedic Surgery, Brown University, Providence, Rhode Island;
  • 4 Denver International Spine Center, Presbyterian St. Luke’s Medical Center, Denver, Colorado;
  • 5 Department of Orthopaedics, NYU Hospital for Joint Diseases, New York, New York;
  • 6 Department of Orthopaedic Surgery, Baylor Scoliosis Center, Plano, Texas;
  • 7 Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, Kansas;
  • 8 Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia;
  • 9 Department of Neurosurgery, Duke University School of Medicine, Durham, North Carolina;
  • 10 Department of Orthopaedic Surgery, Hospital for Special Surgery, New York, New York;
  • 11 Department of Orthopaedic Surgery, University of California, Davis, California;
  • 12 Department of Orthopaedic Surgery, The Johns Hopkins Medical Institutions, Baltimore, Maryland; and
  • 13 Department of Neurological Surgery, University of California, San Francisco, California
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OBJECTIVE

The shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery.

METHODS

From a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval.

RESULTS

Of 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows:

1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%.

2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level.

3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance.

4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively.

5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication.

6. Will I need another surgery? 25.0% will have a reoperation within 2 years.

7. Will I regret having surgery? 6.5% would not choose the same treatment.

8. Will I get a blood transfusion? 73.7% require a blood transfusion.

9. How long will I stay in the hospital? You need to stay 8.1 days on average.

10. Will I have to go to the ICU? 76.0% will have to go to the ICU.

11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively.

12. Will I be taller after surgery? You will be 1.1 cm taller on average.

CONCLUSIONS

The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.

ABBREVIATIONS AP = anteroposterior; ASD = adult spinal deformity; FAQs = frequently asked questions; HRQOL = health-related quality of life; LOS = length of hospital stay; MCID = minimal clinically important difference; NRS = numeric rating scale; ODI = Oswestry Disability Index; PCS = physical component summary; SDM = shared decision-making; SF-36 = 36-Item Short Form Health Survey; SRS-22r = 22-Item Scoliosis Research Society questionnaire; 3CO = 3-column osteotomy.

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Contributor Notes

Correspondence Yoji Ogura: Norton Leatherman Spine Center, Louisville, KY. yojitotti1223@gmail.com.

INCLUDE WHEN CITING Published online October 16, 2020; DOI: 10.3171/2020.6.SPINE20363.

Disclosures Dr. Ames is an employee of UCSF; receives royalties from Stryker, Biomet Zimmer Spine, DePuy Synthes, NuVasive, Next Orthosurgical, K2M, and Medicrea; is a consultant for DePuy Synthes, Medtronic, Medicrea, and K2M; conducts research for Titan Spine, DePuy Synthes, and the International Spine Study Group (ISSG); is on the Editorial Board of Operative Neurosurgery; receives grant funding from SRS; is on the Executive Committee of ISSG; and is a Director at Global Spinal Analytics. Dr. Bess is a consultant for Stryker and Mirus; has direct stock ownership in Progenitive Medicine and Carlsmed; is a patent holder with K2M; receives clinical or research support for the study described (includes equipment or material) from DePuy Synthes, Stryker, and NuVasive; receives support of non–study-related clinical or research effort that he oversees from DePuy Spine, Medtronic, Globus, SI Bone, Orthofix, and ISSG Foundation; and receives royalties from Stryker Spine and NuVasive. Dr. Burton has an ownership interest in Progenerative Medical; is a consultant for DePuy; and receives clinical or research support for the study described (includes equipment or material) from DePuy and Pfizer. Dr. Carreon is an employee of Norton Healthcare and the University of Southern Denmark; is a consultant for National Spine Health Foundation; and receives support of non–study-related clinical or research effort that she oversees from OREF, NIH, ISSG, SRS, TSRH, Pfizer, Lifesciences Corp., IntelliRod, Cerapedics, Medtronic, Empirical Spine, and the NeuroPoint Alliance. She is also a member of the Editorial Advisory Board for Spine Deformity, The Spine Journal, and Spine; and is a member of the University of Louisville’s IRB. Dr. Daniels is a consultant for Spineart, Stryker, Orthofix, Medtronic, EOS, Southern Spine, Springer, and Medicrea. Dr. Gum is an employee of Norton Healthcare; is a consultant for Medtronic, DePuy, K2M/Stryker, Acuity, PacMed, and NuVasive; receives clinical or research support for the study described (includes equipment or materials) from Intellirod, Integra, Pfizer, and ISSG; has direct stock ownership in Cingulate Therapeutics; is a patent holder with Medtronic; and receives royalties from Acuity. Dr. Kim receives royalties from Zimmer Biomet and K2M-Stryker; and is a consultant for Alphatec. Dr. Klineberg is a consultant for DePuy Synthes, Stryker, and Medicrea; and receives honoraria and a fellowship grant from AO Spine. Mr. R. Lafage has direct stock ownership in Nemaris. Dr. V. Lafage is a consultant for Globus Medical; receives royalties from NuVasive; and receives honoraria from DePuy Synthes Spine, The Permanente Medical Group, and Implanet. Mr. Line is a consultant for ISSG. Dr. Passias is a paid presenter or speaker for Allosource, Globus Medical, and Zimmer; receives support of non–study-related clinical or research effort that he oversees from the Cervical Scoliosis Research Society; and is a consultant for Medicrea and SpineWave. Dr. Protopsaltis is a consultant for Globus, Stryker K2M, Medicrea, NuVasive, and Innovasis; and receives royalties from Altus. Dr. Schwab is a consultant for Globus Medical, K2M, and Zimmer Biomet; receives royalties from Medicrea, Medtronic, and Zimmer Biomet; receives honoraria from Zimmer Biomet; and is on the Executive Committee of the ISSG. Dr. Shaffrey is a consultant for Medtronic, NuVasive, and SI Bone; has direct stock ownership in NuVasive; is a patent holder with Medtronic, NuVasive, and Zimmer Biomet; and receives royalties from Medtronic and NuVasive. Dr. Smith is a consultant for Zimmer Biomet, NuVasive, Stryker, DePuy Synthes, Cerapedics, and Carlsmed; receives royalties from Zimmer Biomet and NuVasive; has direct stock ownership in Alphatec; receives support of non–study-related clinical or research effort that he oversees from DePuy Synthes, ISSG, and AO Spine; receives fellowship funding from NREF and AO Spine; and receives clinical or research support for the study described (includes equipment or materials) from DePuy Synthes/ISSG.

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