Evaluation of Discrepancy Between Radiographic Success and Patient Satisfaction in Adult Spinal Deformity Surgery

BACKGROUND AND OBJECTIVES: Considering the high surgical invasiveness of adult spinal deformity surgery, patient-perceived satisfaction may not necessarily follow good radiographic results. This study investigated the incidence and risk factors for the discrepancy between radiographic success and patient satisfaction after adult spinal deformity surgery. METHODS: We retrospectively analyzed 195 patients (mean age, 68.3 years) who underwent ≥4 level fusion surgery including the pelvis and achieved radiographic success as assessed by surgeons (that is, optimal alignment, no mechanical complications, and no revision surgery). The patients were divided into two groups according to Scoliosis Research Society (SRS)-22 satisfaction scores: less satisfied (score <4.0) and highly satisfied (score ≥4.0) groups. Preoperative and postoperative 2-year clinical and radiographic variables were analyzed to predict the lower satisfaction. RESULTS: The clinical outcomes, including visual analogue scale, SRS-22, and Shor Form (SF)-36, significantly improved postoperatively, while modified lumbar stiffness disability index (M-LSDI) significantly worsened postoperatively. In bivariate comparisons, the total fusion length was significantly greater in the less satisfied group than in the highly satisfied group (6.9 vs 6.1). Preoperative and 2-year postoperative radiographic parameters were comparable between the groups. The preoperative SF-36 mental component score, 2-year visual analogue scale, 2-year Oswestry disability index, 2-year SRS-22, 2-year SF-36, and 2-year M-LSDI scores were significantly worse in the less satisfied group than in the highly satisfied group. The multivariate regression analysis revealed that the 2-year M-LSDI score was a single independent risk factor for less satisfaction (odds ratio = 1.290, 95% CI = 1.032-1.611, P = .025). CONCLUSION: A sizable proportion (24.1%) of patients were dissatisfied with the surgical outcomes despite satisfactory radiographic results. Although the patients benefited from surgery for pain and functional improvement, postoperative lumbar stiffness-related functional disabilities adversely affected patient satisfaction. Therefore, before deciding on surgical treatment, patients should be fully informed of this trade-off between pain/disability and lumbar stiffness.