Investigating the Universality of Preoperative Health-Related Quality of Life (HRQoL) for Surgically Treated Spinal Deformity in Young Adults: A Propensity Score-Matched Comparison Between African and US Populations.
STUDY DESIGN
Retrospective analysis of propensity score-matched (PSM) observational cohorts.


OBJECTIVES
To evaluate and compare preoperative health-related quality of life (HRQoL) scores and radiographic measurements of young African and US adults with spinal deformity (ASD).


SUMMARY OF BACKGROUND DATA
Young ASD patients in the United States are motivated more to correct coronal and sagittal plane deformities than to alleviate pain. Motivations for surgical correction in young ASD patients in Africa have not been previously investigated.


METHODS
Retrospective review of two large databases of African and US patients with ASD. African patients who underwent ASD surgery were PSM by age, gender, and pelvic tilt with US patients. Preoperative radiographic parameters and HRQoL scores (ODI, SRS-22r, back/leg pain) were compared between cohorts. Pearson correlations used to evaluate relationships between radiographic parameters and HRQoL scores.


RESULTS
Fifty-four US patients (average age 22.9 ± 4.9 years; 0% African American) and 54 African patients (24.6 ± 7.2 years) met inclusion criteria. Compared to the United States, African patients had significantly lower body mass index (21.1 ± 3.3 vs. 24.6 ± 7.2) and more severe scoliosis, coronal malalignment, and sagittal malalignment (p < .05). Africans also had significantly better Oswestry Disability Index (12.8 vs. 17.7), worse Scoliosis Research Society questionnaire (SRS-22r)-Appearance (2.5 vs. 3.2), SRS-Function (3.3 vs. 3.9), and SRS-Total (3.2 vs. 3.5) scores than US patients (p < .05). SRS-Appearance scores correlated with Cobb angles of the upper thoracic (r = -0.321), thoracic (r = -0.277), and thoracolumbar (r = -0.300) curves for US patients. For African patients, global sagittal alignment and C7 inclination correlated with SRS-Appearance (r = -0.347, -0.346, respectively).


CONCLUSIONS
Young African ASD patients have significantly more severe deformity, less disability, and worse SRS-22r scores preoperatively than a matched cohort of US patients. Spinal deformity and associated poor self-image appear to be the major drivers of surgical intervention in this cohort. Global malalignment in African patients is most closely correlated with appearance scores and should be surgically addressed accordingly.


LEVEL OF EVIDENCE
Level III.
['Harris|Bradley Y|BY|', 'Roth|Matthew F|MF|', 'Diebo|Bassel G|BG|', 'Bess|Shay|S|', 'Theologis|Alexander A|AA|', 'Scheer|Justin K|JK|', 'Schwab|Frank J|FJ|', 'Lafage|Virginie|V|', 'Ames|Christopher P|CP|', 'Hodes|Richard|R|', 'Ayamga|Jennifer|J|', 'Boachie-Adjei|Oheneba|O|', '|||']
D000293:Adolescent D000328:Adult D000349:Africa D005260:Female D006304:Health Status D006801:Humans D008297:Male D057216:Propensity Score D011788:Quality of Life D012189:Retrospective Studies D013131:Spine D016896:Treatment Outcome D055815:Young Adult
HRQoL Adult spinal deformity African spinal deformity