Predictors of Health-Related Quality-of-Life After Complex Adult Spinal Deformity Surgery: A Scoli-RISK-1 Secondary Analysis

Leah Y. Carreon, Steven D. Glassman, Christopher I. Shaffrey, Michael G. Fehlings, Benny Dahl, Christopher P. Ames, Yukihiro Matsuyama, Yong Qiu, Hossein Mehdian, Kenneth M.C. Cheung, Frank J. Schwab, Ferran Pellisé, Khaled M. Kebaish, Lawrence G. Lenke

Research output: Contribution to journalArticlepeer-review

15 Scopus citations


Study Design Longitudinal cohort. Objectives To identify variables that predict 2-year Short Form-36 Physical Composite Summary Score (SF-36PCS) and the Scoliosis Research Society-22R (SRS22-R) Total score after surgery for complex adult spinal deformity. Summary of Background Data Increasingly, treatment effectiveness is assessed by the extent to which the procedure improves a patient's health-related quality of life (HRQOL). This is especially true in patients with complex adult spinal deformity. Methods The data set from the Scoli-Risk-1 study was queried for patients with complete 2-year SF-36 and SRS-22R. Regression analysis was performed to determine predictors of 2-year SF-36PCS and SRS-22R Total scores. Factors included were sex, age, smoking status, body mass index, American Society of Anesthesiologists (ASA) grade, Lower Extremity Motor Score improvement, indication for surgery, preoperative and 2-year maximum coronal Cobb angles, number of prior spine surgeries, number of three-column osteotomies, number of surgical levels, number of surgical stages, lowest instrumented level, presence and type of neurologic complication, and number of reported serious adverse events. Results Of 272 cases enrolled, 206 (76%) cases were included in this analysis, 143 (69%) females, and mean age of 57.69 years. Factors that were significantly associated with of 2-year SF-36PCS were age (p < .001), ASA grade (p < .001), maximum preoperative Cobb angle (p = .007), number of three-column osteotomies (p = .049) and type of neurologic complication (p = .068). Factors predictive of 2-year SRS-22R Total scores were maximum preoperative Cobb angle (p = .001) and the number of serious adverse events (p = .071). Conclusions Factors predictive of lower 2-year HRQOLs after surgery for complex adult spinal deformity were older age, higher ASA grade, larger preoperative Cobb angle, larger numbers of three-column osteotomies, and the occurrence of both neurologic and nonneurologic complications. Most of these factors are beyond the control of surgeons. Still, surgeons should medically optimize a patient prior to surgery to minimize the risk of complications and offer the best chance of improving a patient's quality of life. Level of Evidence Level II. Prospective cohort.

Original languageEnglish (US)
Pages (from-to)139-144
Number of pages6
JournalSpine deformity
Issue number2
StatePublished - Mar 1 2017


  • Adult spinal deformity
  • Clinical outcomes
  • Complication
  • Health-related quality of life
  • Osteotomies
  • Predictor
  • Scoli-Risk-1
  • Scoliosis Research-22R
  • Short Form 36

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine


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