208. Patients undergoing adult spinal deformity surgery report more improvement with standing than sitting

BACKGROUND CONTEXT Sparse literature exists regarding which Oswestry Disability Index (ODI) subdomains improve after adult spinal deformity (ASD) surgery and what influences improvement in each subdomain. PURPOSE In a cohort of patients undergoing ASD surgery, we sought to: 1) evaluate postoperative changes in the five functional subdomains of the ODI (pain, lifting, walking, sitting, and standing), and 2) determine which demographic and operative factors influenced improvement in each subdomain. STUDY DESIGN/SETTING Retrospective cohort study. PATIENT SAMPLE A total of 132 patients undergoing ASD surgery from 2011-17 with 2-year follow-up. OUTCOME MEASURES The five functional subdomains of the ODI (pain intensity, lifting, walking, sitting, and standing). METHODS A single-institution, retrospective, cohort study was conducted of patients undergoing ASD surgery from 2011-17 with 2-year follow-up. Preoperative and 2-year follow-up ODI were reported. Preoperative, operative, and radiographic parameters were analyzed with each of the five functional subdomains of the ODI (pain intensity, lifting, walking, sitting, and standing). All factors with p<0.020 after univariable analysis were included in the multivariable regression model. RESULTS Among 132 patients undergoing ASD surgery, mean age was 64.0±11.6years and 108 (81.8%) were female. The upper instrumented vertebra (UIV) was thoracolumbar in 108 (82.8%) patients, and mean total instrumented levels was 10.0±2.5. Comparing preoperative to 2-years postoperative, a significant improvement was seen in the mean scores of all ODI subdomains (p<0.05), with most improvement in standing (3.5 vs 2.4, p<0.001) and pain intensity (2.7 vs 1.7, p<0.001), with less improvement was in lifting (3.2 vs 2.8, p=0.008), walking (2.9 vs 2.3, p<0.001), sitting (1.8 vs 1.3, p<0.001). Multivariable logistic regression revealed the following predictors of improvement. Pain intensity: diabetics were less likely improve (OR=0.44, 95%CI=0.19-0.99, p=0.048). Lifting: no predictors. Walking: sacral lower instrumented vertebra (LIV) was associated with significant improvement (OR=4.3, 95%CI=1.4-12.7, p=0.010). Sitting: more instrumented levels was associated with less improvement (OR=0.88, 95%CI=0.77-0.99, p=0.047). Standing: No predictors. CONCLUSIONS After ASD surgery, patients reported more improvement with standing than sitting. Diabetics were less likely to improve their pain and more instrumented levels led to less improvement sitting, whereas fusing to the sacrum was more likely to improve walking. FDA Device/Drug Status This abstract does not discuss or include any applicable devices or drugs. Sparse literature exists regarding which Oswestry Disability Index (ODI) subdomains improve after adult spinal deformity (ASD) surgery and what influences improvement in each subdomain. In a cohort of patients undergoing ASD surgery, we sought to: 1) evaluate postoperative changes in the five functional subdomains of the ODI (pain, lifting, walking, sitting, and standing), and 2) determine which demographic and operative factors influenced improvement in each subdomain. Retrospective cohort study. A total of 132 patients undergoing ASD surgery from 2011-17 with 2-year follow-up. The five functional subdomains of the ODI (pain intensity, lifting, walking, sitting, and standing). A single-institution, retrospective, cohort study was conducted of patients undergoing ASD surgery from 2011-17 with 2-year follow-up. Preoperative and 2-year follow-up ODI were reported. Preoperative, operative, and radiographic parameters were analyzed with each of the five functional subdomains of the ODI (pain intensity, lifting, walking, sitting, and standing). All factors with p<0.020 after univariable analysis were included in the multivariable regression model. Among 132 patients undergoing ASD surgery, mean age was 64.0±11.6years and 108 (81.8%) were female. The upper instrumented vertebra (UIV) was thoracolumbar in 108 (82.8%) patients, and mean total instrumented levels was 10.0±2.5. Comparing preoperative to 2-years postoperative, a significant improvement was seen in the mean scores of all ODI subdomains (p<0.05), with most improvement in standing (3.5 vs 2.4, p<0.001) and pain intensity (2.7 vs 1.7, p<0.001), with less improvement was in lifting (3.2 vs 2.8, p=0.008), walking (2.9 vs 2.3, p<0.001), sitting (1.8 vs 1.3, p<0.001). Multivariable logistic regression revealed the following predictors of improvement. Pain intensity: diabetics were less likely improve (OR=0.44, 95%CI=0.19-0.99, p=0.048). Lifting: no predictors. Walking: sacral lower instrumented vertebra (LIV) was associated with significant improvement (OR=4.3, 95%CI=1.4-12.7, p=0.010). Sitting: more instrumented levels was associated with less improvement (OR=0.88, 95%CI=0.77-0.99, p=0.047). Standing: No predictors. After ASD surgery, patients reported more improvement with standing than sitting. Diabetics were less likely to improve their pain and more instrumented levels led to less improvement sitting, whereas fusing to the sacrum was more likely to improve walking.