Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery

Bassel G Diebo; Daniel Alsoof; Renaud Lafage; Mohammad Daher; Mariah Balmaceno-Criss; Peter G Passias; Christopher P Ames; Christopher I Shaffrey; Douglas C Burton; Vedat Deviren; Breton G Line; Alex Soroceanu; David Kojo Hamilton; Eric O Klineberg; Gregory M Mundis; Han Jo Kim; Jeffrey L Gum; Justin S Smith; Juan S Uribe; Khaled M Kebaish; Munish C Gupta; Pierce D Nunley; Robert K Eastlack; Richard Hostin; Themistocles S Protopsaltis; Lawrence G Lenke; Robert A Hart; Frank J Schwab; Shay Bess; Virginie Lafage; Alan H Daniels; ISSG

doi:10.3390/jcm13082202

Impact of Self-Reported Loss of Balance and Gait Disturbance on Outcomes following Adult Spinal Deformity Surgery

J Clin Med. 2024 Apr 11;13(8):2202. doi: 10.3390/jcm13082202.

Authors

Bassel G Diebo¹, Daniel Alsoof¹, Renaud Lafage², Mohammad Daher¹, Mariah Balmaceno-Criss¹, Peter G Passias³, Christopher P Ames⁴, Christopher I Shaffrey⁵, Douglas C Burton⁶, Vedat Deviren⁴, Breton G Line⁷, Alex Soroceanu⁸, David Kojo Hamilton⁹, Eric O Klineberg¹⁰, Gregory M Mundis¹¹, Han Jo Kim¹², Jeffrey L Gum¹³, Justin S Smith¹⁴, Juan S Uribe¹⁵, Khaled M Kebaish¹⁶, Munish C Gupta¹⁷, Pierce D Nunley¹⁸, Robert K Eastlack¹¹, Richard Hostin¹⁹, Themistocles S Protopsaltis³, Lawrence G Lenke²⁰, Robert A Hart²¹, Frank J Schwab², Shay Bess⁷, Virginie Lafage², Alan H Daniels¹; ISSG

Affiliations

¹ Department of Orthopedics, Warren Alpert Medical School of Brown University, East Providence, RI 02914, USA.
² Department of Orthopedic Surgery, Lenox Hill Northwell, New York, NY 10075, USA.
³ Department of Orthopedics, NYU Langone Orthopedic Hospital, New York, NY 10016, USA.
⁴ Department of Neurosurgery, University of California, San Francisco, CA 94115, USA.
⁵ Department of Neurosurgery, Duke Spine Division, Durham, NC 27708, USA.
⁶ Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd., Kansas City, KS 66160, USA.
⁷ Denver International Spine Center, Denver, CO 80218, USA.
⁸ Department of Orthopedic Surgery, University of Calgary, Calgary, AB T2N 1N4, Canada.
⁹ Department of Neurological Surgery, University of Pittsburgh, Pittsburgh, PA 15260, USA.
¹⁰ Department of Orthopaedic Surgery, University of California, 1 Shields Ave., Davis, CA 95616, USA.
¹¹ San Diego Spine, La Jolla, CA 92037, USA.
¹² Hospital for Special Surgery, New York, NY 10021, USA.
¹³ Leatherman Spine Center, Louisville, KY 40202, USA.
¹⁴ Department of Neurosurgery, University of Virginia, Charlottesville, VA 22903, USA.
¹⁵ Department of Neurosurgery, Barrow Neurological Institute, St. Joseph's Hospital and Medical Center, Phoenix, AZ 85013, USA.
¹⁶ Johns Hopkins University School of Medicine, Baltimore, MD 21218, USA.
¹⁷ Department of Orthopedics, Washington University in St Louis, St. Louis, MO 63110, USA.
¹⁸ Spine Institute of Louisiana, Shreveport, LA 71101, USA.
¹⁹ Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Blvd #800, Plano, TX 75093, USA.
²⁰ Department of Orthopedic Surgery, Columbia University Medical Center, The Spine Hospital at New York Presbyterian, New York, NY 10032, USA.
²¹ Swedish Neuroscience Institute, Seattle, WA 98027, USA.

Abstract

Background: The objective of this study was to evaluate if imbalance influences complication rates, radiological outcomes, and patient-reported outcomes (PROMs) following adult spinal deformity (ASD) surgery. Methods: ASD patients with baseline and 2-year radiographic and PROMs were included. Patients were grouped according to whether they answered yes or no to a recent history of pre-operative loss of balance. The groups were propensity-matched by age, pelvic incidence-lumbar lordosis (PI-LL), and surgical invasiveness score. Results: In total, 212 patients were examined (106 in each group). Patients with gait imbalance had worse baseline PROM measures, including Oswestry disability index (45.2 vs. 36.6), SF-36 mental component score (44 vs. 51.8), and SF-36 physical component score (p < 0.001 for all). After 2 years, patients with gait imbalance had less pelvic tilt correction (-1.2 vs. -3.6°, p = 0.039) for a comparable PI-LL correction (-11.9 vs. -15.1°, p = 0.144). Gait imbalance patients had higher rates of radiographic proximal junctional kyphosis (PJK) (26.4% vs. 14.2%) and implant-related complications (47.2% vs. 34.0%). After controlling for age, baseline sagittal parameters, PI-LL correction, and comorbidities, patients with imbalance had 2.2-times-increased odds of PJK after 2 years. Conclusions: Patients with a self-reported loss of balance/unsteady gait have significantly worse PROMs and higher risk of PJK.

Keywords: adult spinal deformity; balance; radiological outcomes.

Grants and funding

The International Spine Study Group reports the following: grants to the foundation from Medtronic, Globus, Stryker, SI Bone, Carlsmed. Source of Funding: DePuy Syntheses Spine, NuVasive, K2/Stryker.