67. The value of overall assessment in adult degenerative scoliosis patients: short- and long-term effect of surgical intervention on static and dynamic balance, gait and pain level

BACKGROUND CONTEXT In the diagnosis and treatment of adult spinal deformities, static radiographic measurements in the sagittal and coronal anatomical planes and patient-reported outcome measures (PROMs) serve as the gold standard for assessment of spinal alignment and deformity. However, there is a lack of published literature on their relation to objective functional outcome measures (FOMs) among patients afflicted with adult spinal deformity. Adult spinal deformity (ASD) is due to degeneration, functional decline is partly due to loss of postural stability and neuromuscular capacity and coordination. Objective functional measures (eg, static standing and walking alignment) cover more information than just radiographic alignment in the ASD population. Gait and dynamic balance analysis can reveal functional compensatory alignment changes where static imaging is limited. Previous studies have shown improvement in postoperative gait, approximating non-ASD control cohorts but still symptomatic. Many studies have shown surgical reconstruction in ASD patients has improved patient outcomes, but not overall assessment of objective function along with psychological factors. Therefore, a more comprehensive standard outcome measurement is needed. PURPOSE To determine the one-year effects of spinal alignment on function in ASD patients following surgical treatment using radiographic parameters, 3D gait and balance analysis, PROMs, and psychological tests and compared to healthy control. STUDY DESIGN/SETTING Nonrandomized, prospective study. PATIENT SAMPLE Forty-three symptomatic ASD patients, 24 age-matched control. OUTCOME MEASURES Gait spatiotemporal parameters, dynamic balance as measurement by balance effort and Cone of Economy (CoE) dimensions, radiograph alignment measurements, PROMs, and psychological factors. METHODS Patients performed dynamic balance and gait evaluations prior to surgery (Pre), 3 months (Post3), and 12 months (Post12) postoperatively. Patients also completed full-length, head-to-toe, micro-dose X-rays along with PROMs, and psychological questionnaires. Balance effort and CoE dimensions were measured by total sway and range of sway, respectively. Repeated measurement analysis of variance (ANOVA) and one-way ANOVA were used to determine differences in radiographic, dynamic balance, gait, and PROMs parameters at Post3 and Post12 and to the match control group. RESULTS Significant improvements in radiographic alignment were found in Cobb angle ( CONCLUSIONS This is the first study to provide insight into a comprehensive global assessment of ASD surgery patients’ function which includes complete objective functional and psychological outcomes in addition to standard PROMs and radiographic alignment. Balance effort and CoE limits improved at all time points post-operatively and ultimately matched the controls at 12 months. Similar to the significant improvement in static and dynamic balance in these patient groups, gait parameters also improved Post3 and Post12 to closely resemble the control group and continued to improve over time. Our findings present a more comprehensive set of outcome metrics, which, once combined, provide a more detailed and sensitive assessment of overall treatment outcomes. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.