Return to Activities of Daily Living After Fusion to the Pelvis for Adult Spinal Deformity Correction

Introduction: Prior studies on return to activities of daily living (ADLs) among adult spinal deformity (ASD) patients are sparse. Attaining a sufficient understanding of recovery trends is critical for surgical decision-making and patient counseling. Thus, the objective of the present study was to determine the proportion of patients exhibiting improvements in ADLs after ASD surgery and identify which demographic and perioperative variables are associated with increased disability postoperatively.

Methods: Patients who underwent thoracolumbar ASD surgery between 2016-2021 with ≥1 year follow-up were included (posterior-only, ≥3 levels of fusion to pelvis). Preoperative and postoperative activity tolerance was assessed via a survey. Patients were categorized into (1)Better/Unchanged or (2)Worse groups based on their postoperative activity tolerance.

Results: 95 patients were included (mean age: 64.3 ± 10.1 years; body mass index (BMI): 27.3 ± 6.1 kg/m2; levels fused: 8; follow-up: 43.5 months). Most patients endorsed improved capacity to walk (improved: 64.2%, unchanged: 17.9%, worse: 17.9%) and navigate stairs (improved: 52.6%, unchanged: 33.7%, worse: 13.7%) postoperatively. Among the 77 patients who drove preoperatively, 75 (97.4%) returned to driving an average of 4.1 ± 10.8 months postoperatively. Among the 48 patients who worked preoperatively, 44 (88.0%) returned to work an average of 5.4 ± 8.0 months postoperatively. Twenty-five (26.3%) patients used an assistive walking device preoperatively and 15 (60.0%) stopped postoperatively. Patients with decreased walking tolerance were more likely to have worse Patient-Reported Outcomes Measurement Information System Physical Function (PROMIS-PF) at long-term follow-up (40.2 ± 11.0 vs. 48.0 ± 9.6, p=0.03). Patients with decreased ability to navigate stairs were more likely to have undergone revision fusion (69.2% vs. 28.0%, p=0.003) and have greater BMI (30.7 ± 5.8 vs. 26.7 ± 6.0 kg/m2, p=0.04).

Conclusion : Most patients experienced improvements in their capacity to walk and navigate stairs postoperatively, as well as successful return to both driving and work. Higher body mass index and revision fusion were the most commonly implicated factors among patients expressing reduced postoperative activity tolerance. These findings suggest that deformity surgery is successful in improving patients’ daily functioning.