O2079: Patient's Perceived Flexibility After a Spinal Fusion

Background: Surgical intervention aims to prevent progression, as well as achieve optimal and permanent correction of spinal deformity. Solid spinal fusions have shown to fulfill these objectives, making it the preferred treatment option among surgeons. Historically, spinal fusion has been associated with loss of functional flexibility in patients postoperatively and that distal fusions affect flexibility more, however recent literature is straying from this common belief. The aim of this study is to assess a PSF in terms of a patient’s perceived flexibility.

Methods: This study included 311 participants, 287 AIS patients who underwent PSF between 2016-2022, and 24 non-operative control patients. Data was collected retrospectively through radiographic and chart review, as well as via phone or email. Out of 287 patients who were contacted, 253 had a working phone or email listed in the EHR. Among those, 159 patients responded to the survey (62.8% response rate). The survey asked various questions on flexibility such as toe-touch, trunk rotation, activity levels etc. Likert scale ranging from 1 (indicating severely limited flexibility and sedentary lifestyles) to 10 (representing high flexibility and activity levels).

Results: 184 patients underwent PSF, with lowest instrumented vertebra of T9 -L4. 151 patients were fused to L3/L4 and 33 patients were fused to T12/L1. Demographic information, including age, BMI, pre- and postop major curves, curve correction and levels fused were similar between the two groups (p > 0.05). Both L3/L4 patients and T12/L1 patients had an average 3.0-day hospital stay (p = 0.90).
Preoperatively, self-assessed flexibility (L3/4: 7.0 vs T12/L1: 7.5 p = 0.76) and activity levels Likert scale results (7.0 vs 7.0, p = 0.80) were similar between groups. Postoperatively, both groups had similar flexibility (6.0 vs 7.0, p = 0.11) and activity levels (6.5 vs 8.0, p = 0.08). Flexibility levels did not change between pre- and postoperative visit for L3/L4 (p = 0.32) or T12/L1 (p = 0.87) patients.
L1+ patients were significantly less likely to be able to touch their toes pre (86.5% vs. 57.2%, p=0.02) and post-surgery (75.8% vs. 52.1%, p=0.17) and neither significantly changed after surgery (86.5% vs. 75.8%, p=0.20; 57.2% vs. 52.1%, p=0.70). These groups were similar to the control group before (p=0.21) and after (p=0.43) surgery. L3/L4 patients returned to unrestricted gym and competitive at an average of 6.8 months and 7.0 months versus 6.3 months and 7.1 months for T12/L1 (p = 0.48, p=0.35).

Conclusion: Our study’s findings suggest that adolescent’s flexibility levels post-op returned to the same level as they were pre-op. This is contrary to the common conception that fusion to L3/L4 restricts patients' flexibility, sports activities, and ability to touch toes, therefore this belief should be further investigated being cognizant of a patient’s subjective perception of their own flexibility.