Practical answers to frequently asked questions for shared decision-making in adult spinal deformity surgery

Abstract

OBJECTIVE The shared decision-making (SDM) process provides an opportunity to answer frequently asked questions (FAQs). The authors aimed to present a concise list of answers to FAQs to aid in SDM for adult spinal deformity (ASD) surgery. METHODS From a prospective, multicenter ASD database, patients enrolled between 2008 and 2016 who underwent fusions of 5 or more levels with a minimum 2-year follow-up were included. All deformity types were included to provide general applicability. The authors compiled a list of FAQs from patients undergoing ASD surgery and used a retrospective analysis to provide answers. All responses are reported as either the means or the proportions reaching the minimal clinically important difference at the 2-year follow-up interval. RESULTS Of 689 patients with ASD who were eligible for 2-year follow-up, 521 (76%) had health-related quality-of-life scores available at the time of that follow-up. The mean age at the initial surgery was 58.2 years, and 78% of patients were female. The majority (73%) underwent surgery with a posterior-only approach. The mean number of fused levels was 12.2. Revision surgery accounted for 48% of patients. The authors answered 12 FAQs as follows: 1. Will my pain improve? Back and leg pain will both be reduced by approximately 50%. 2. Will my activity level improve? Approximately 65% of patients feel improvement in their activity level. 3. Will I feel better about myself? More than 70% of patients feel improvement in their appearance. 4. Is there a chance I will get worse? 4.1% feel worse at 2 years postoperatively. 5. What is the likelihood I will have a complication? 67.8% will have a major or minor complication, with 47.8% having a major complication. 6. Will I need another surgery? 25.0% will have a reoperation within 2 years. 7. Will I regret having surgery? 6.5% would not choose the same treatment. 8. Will I get a blood transfusion? 73.7% require a blood transfusion. 9. How long will I stay in the hospital? You need to stay 8.1 days on average. 10. Will I have to go to the ICU? 76.0% will have to go to the ICU. 11. Will I be able to return to work? More than 70% will be working at 1 year postoperatively. 12. Will I be taller after surgery? You will be 1.1 cm taller on average. CONCLUSIONS The above list provides concise, practical answers to FAQs encountered in the SDM process while counseling patients for ASD surgery.