A Study of Risk Factors Associated with Clinical Outcomes Following Surgery for Degenerative Lumbar Scoliosis

Abstract Objective: To investigate the risk factors for the prognosis of degenerative lumbar scoliosis after surgery. Methods: A retrospective analysis was performed to compare the preoperative and postoperative clinical data to assess the prognosis, and to evaluate the patients after surgery by combining the Oswestry Disability Index (ODI) Quality of life. Based on different surgical outcomes, we divide patients into a better prognosis group and a poor prognosis group. Comprehensive risk factors were collected which may related to clinical outcomes included three aspects: patient general status, surgery-related data and imaging parameters. All risk factors were first analyzed through single risk factor analysis, and then multiple logistic regression analysis and Receiver Operating Characteristic (ROC) curves were used to analyze factors related to prognosis after orthopedic surgery. Results: One hundred and thirty-four patients with degenerative lumbar scoliosis who undergone posterior surgery were included in this study. There were 36 men and 98 women with a mean age of 59.4±7.8 years. After identifying potential risk factors that may affect postoperative efficacy through univariate logistic regression, multivariate logistic regression analysis showed that the subcutaneous fat tissue thickness (SFTT) (OR=0.410, P=0.043) , MRI-based vertebral bone quality (VBQ) (OR=0.076, P=0.037), Quantitative Computed Tomography (QCT) (OR=1.401, P=0.008) , degree of kyphosis correction (OR=1.399, P=0.021), sagittal balance correction distance (OR=2.634, P=0.011) were independent predictors of poor prognosis. ROC curve analysis showed that correction degree of kyphosis >20.23°(AUC=0.881, P=0.001), sagittal balance correction distance >2.92CM (AUC=0.834, P=0.001) , QCT >104.6mg/cm3(AUC=0.958, P=0.001)，VBQ <2.88(AUC=0.669, P=0.001)，SFTT <13.5 mm (AUC=0.740, P=0.001) were indicating good clinical efficacy. Conclusions: In patients with degenerative lumbar scoliosis, posterior decompression and fixed fusion surgery can significantly relieve pain and improve quality of life. Among the many factors that may affect prognosis, the correction of kyphosis and sagittal balance is particularly crucial for the postoperative quality of life. Due to the impact of SFTT, VBQ, and QCT on clinical prognosis, patients are encouraged to undergo anti-osteoporosis treatment and early lumbar and dorsal muscle exercise.