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

Study Design. Cross-sectional survey and retrospective review of prospectively collected data. Objective. To investigate return to activities among patients with adult spinal deformity (ASD) after long-segment fusion to the pelvis. Background. No prior studies have assessed the extent and timing of return to employment, driving, and walking among a single cohort of patients with ASD. Patients and Methods. Patients who underwent thoracolumbar ASD surgery between 2016 and 2021 with ≥ 1-year follow-up were included (posterior-only, ≥3 levels of fusion to pelvis). A cross-sectional survey was implemented to evaluate preoperative and postoperative activity tolerance. Patients were categorized into (1) better/unchanged or (2) worse groups based on their postoperative activity tolerance to allow for comparison of demographics and perioperative variables. Results. Ninety-five patients were included [mean age: 64.3 ± 10.1 yr; body mass index (BMI): 27.3 ± 6.1 kg/m2; levels fused: 8 (range: 3-16); follow-up: 43.5 mo]. 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. Seventy-five (97.4%) patients returned to driving (4.1 ± 10.8 mo) and 44 (88.0%) patients returned to work (5.4 ± 8.0 mo). Patients with decreased walking tolerance were more likely to have greater lumbar lordosis correction (37.2 ± 10.5° vs. 18.6 ± 16.7°, P = 0.02) and worse Patient-Reported Outcomes Measurement Information System-Physical Function 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). Patients requiring the use of a postoperative assistive walking device were more likely to have undergone revision fusion (66.7% vs. 27.5%, P = 0.003), exhibit greater BMI (31.4 ± 7.2 vs. 26.5 ± 5.6 kg/m2, P = 0.004), longer operative times (285.1 ± 79.9 vs. 244.5 ± 63.4 min, P = 0.03), and worse Patient-Reported Outcomes Measurement Information System-Physical Function at long-term follow-up (39.9 ± 5.1 vs. 47.7 ± 10.5, P = 0.04). Conclusion. Despite the reduced range of motion caused by spinopelvic fusion, a majority of patients are able to successfully return to activities of daily living after deformity surgery.