Which Daily Functions Are Most Affected by Stiffness Following Total Lumbar Fusion

Study Design. Retrospective review of a multicenter, prospective adult spinal deformity (ASD) database. Objective. The objective was to evaluate the impact of stiffness on activities of daily living (ADL) after instrumented total lumbar fusions to the pelvis; specifically between patients with the upper-most instrumented vertebra (UIV) within the upper thoracic (UT) versus the thoracolumbar (TL) region. Summary of Background Data. The Lumbar Stiffness Disability Index (LSDI) has been validated and used in clinical studies as a self-reported outcomes tool; however, the impact of stiffness on the 10 specific ADLs comprising the LSDI has not been evaluated. Methods. A retrospective comparison of prospectively collected pre- and 2-year minimum postoperative answers to the 10 questions comprising the LSDI among patients with ASD was conducted. Cohorts were defined based on the UIV as UT (T1-T6) or TL (T9-L1). Results. 134 patients were included (UT:64, TL:70). Both groups had statistically similar changes in all individual LSDI scores at 2 years versus preoperative values (P > 0.05l) with the exception of questions #2 (Bend through your waist to put socks and shoes on) and #8 (bathe lower half of body) in which UT reported increased difficulty (P < 0.05). Both groups had statistically similar individual LSDI question scores with the exception of 2-year question #4 (hygiene after toileting) in which UT had a significantly worse score (P < 0.05). Conclusion. Patients with ASD undergoing instrumented total lumbar fusions to the ilium report limited changes from baseline in the ability to perform the 10 ADL functions of the LSDI and had limited differences in final scores regardless of whether the UIV was in the UT or TL region. Domains showing the greatest change from baseline involved dressing or bathing the lower half of the body among patients with UT. The only domain for which UT had greater impairment was in performing personal hygiene functions after toileting. Level of Evidence: 3