Male sex may not be associated with worse outcomes in primary all-posterior adult spinal deformity surgery: a multicenter analysis

Abstract

<jats:sec><jats:title>OBJECTIVE</jats:title><jats:p>Adolescent spine deformity studies have shown that male patients require longer surgery and have greater estimated blood loss (EBL) and complications compared with female patients. No studies exist to support this relationship in adult spinal deformity (ASD). The purpose of this study was to investigate associations between sex and complications, deformity correction, and health-related quality of life (HRQOL) in patients with ASD. It was hypothesized that male ASD patients would have greater EBL, longer surgery, and more complications than female ASD patients.</jats:p></jats:sec><jats:sec><jats:title>METHODS</jats:title><jats:p>A multicenter ASD cohort was retrospectively queried for patients who underwent primary posterior-only instrumented fusions with a minimum of 5 levels fused. The minimum follow-up was 2 years. Primary outcomes were EBL, operative time, intra-, peri-, and postoperative complications, radiographic correction, and HRQOL outcomes (Oswestry Disability Index, SF-36, and Scoliosis Research Society-22r Questionnaire). Poisson multivariate regression was used to control for age, comorbidities, and levels fused.</jats:p></jats:sec><jats:sec><jats:title>RESULTS</jats:title><jats:p>Ninety male and 319 female patients met the inclusion criteria. Male patients had significantly greater mean EBL (2373 ml vs 1829 ml, p = 0.01). The mean operative time, transfusion requirements, and final radiographic measurements did not differ between sexes. Similarly, changes in HRQOL showed no significant differences. Finally, there were no sex differences in the incidence of complications (total, major, or minor) at any time point after controlling for age, body mass index, comorbidities, and levels fused.</jats:p></jats:sec><jats:sec><jats:title>CONCLUSIONS</jats:title><jats:p>Despite higher EBL, male ASD patients did not experience more complications or require less deformity correction at the 2-year follow-up. HRQOL scores similarly showed no sex differences. These findings differ from adolescent deformity studies, and surgeons can counsel patients that sex is unlikely to influence the outcomes and complication rates of primary all-posterior ASD surgery.</jats:p></jats:sec>

Effect modifiers for patient-reported outcomes in operatively and nonoperatively treated patients with adult symptomatic lumbar scoliosis: a combined analysis of randomized and observational cohorts

“…An appropriate interpretation may be that males do not do worse with ASLS surgery, a finding consistent with prior adult deformity studies. 8 Patients with higher BMI (≥ 25 kg/cm 2 ) did not have inferior outcomes compared to patients with lower BMI and had higher average improvements, although we do not classify BMI as a formal effect modifier as the observed differences were less than the MDMD. Our observations may reflect the postoperative metabolic needs of ASLS patients, with a greater caloric reserve offering the opportunity for greater PRO improvement, but we have no current data to verify that hypothesis.…”

Age and Gender Confound PROMIS Scores in Spine Patients With Back and Neck Pain

“…The resulting scores range from 0 to 100, with larger numbered outcomes representing more back or neck disability, respectively. 13 , 15 …”

“…The resulting scores range from 0 to 100, with larger numbered outcomes representing more back or neck disability, respectively. 13,15 The VAS is a single question that asks patients to rate pain on a 10-cm line. The chosen point corresponds to a score that ranges from 0 to 10, with scores closer to 10 demonstrating worse pain.…”

“…Disability metrics such as ODI are influenced by factors such as age, gender, race, and socioeconomic status. 13 , 14 Furthermore, NDI is affected by both psychosocial and physical impairments. 15 Both age and socioeconomic status confound VAS scores.…”

Direct Pars Defect Tubular Decompression and TLIF for the Treatment of Low-Grade Adult Isthmic Spondylolisthesis: Surgical Challenges and Nuances of a Muscle-Sparing Minimally Invasive Approach

“…Under general anesthesia, patients are positioned prone on a radiolucent Jackson table. In the presented cases, intraoperative lateral and anteroposterior (AP) fluoroscopy is utilized to guide the approach, but, if available, neuronavigation-assisted techniques could also be utilized to minimize X-rays' exposure [ 11 ].…”