Shay Bess, Rocky Mountain Scoliosis and Spine, Denver, USA, told delegates at the annual meeting of the North American Spine Society (NASS; 24–27th October, Dallas, USA) that contrary to the common misconception that adult spinal deformity was “not really” painful, its actual impact was similar to the impact of cancer and diabetes.
Bess said: “There remains a misconception among the medical community as well as third party payers that adult spinal deformity causes little physical impairment other than back pain and cosmetic concerns.” He explained that, historically, the standardised quality of life questionnaires that are available today were not available when previous research of the effect of adult spinal deformity on quality of life was conducted. Therefore, Bess told Spinal News International, this led investigators to not perform thorough analyses of spinal deformity as a predictor of pain and make “grand sweeping statements about patients with adult spinal deformity not having more pain than the general population.” He added: “I think this has radically affected the care that patients with adult spinal deformity receive. They are seen as malingerers or patients who are ‘not really’ in pain and who should move on with their lives [rather than continue to seek treatment]. The problem with adult spinal deformity is that it is such as heterogeneous disease that patients get lumped together as having low back pain without anyone digging deeper to actually find what is causing their pain.”
According to Bess, there is very little data comparing the disease impact of adult spinal deformity vs. the impact of other disease states. He told the NASS audience that the purpose of his study was to use “the SF36 to evaluate a consecutive cohort of adult spinal deformity patients and compare these values to US general population norms, US generational norms as well as US disease specific norms.”
Bess et al performed a prospective analysis of 497 patients (from different centres) who were treated operatively or non-operatively for adult spinal deformity—scoliosis ≥20 degrees, sagittal vertical axis ≥5cm, pelvic tilt ≥25 degrees, or thoracic kyphosis >60 degrees—and who did not have a prior history of spinal surgery. The average age of patients in the cohort was 50.4 years, the average body mass index (BMI) was 25.6, and the maximum degree of scoliosis observed was 45.3 degrees. The investigators compared the SF36 physical component scores and SF36 mental component scores of the deformity cohort with total population norms, generational norms, and disease specific norms.
According to Bess, the average SF36 physical component score of the deformity group was three minimally important clinical difference (MICD) values below the general population norms and two MICD values below the generational norms for all generations except the 18–24 age group. Additionally for all generations, there was greater worsening in the SF36 physical component scores in the deformity group. No differences were observed between patients with adult spinal deformity and other groups in terms of mental component scores.
Comparing deformity patients with no comorbidities with healthy norms and disease-specific norms, Bess et al found that deformity patients had SF36 physical component scores that were four MCID values below healthy norms, one MCID value below back pain/sciatica norms and one MCID value below hypertension norms. Bess reported that these scores also showed that deformity had a similar impact on physical function as “cancer, diabetes, and heart and lung disease.”
Bess told Spinal News International that the main implication of his research was that “Patients with adult spinal deformity have been incompletely evaluated and seen as not having a true reason for disability, which is clearly not the case with patients with cancer or diabetes. We hope this research will help advocate for effective evaluation and treatment for adult spinal deformity.”
