Functional variability in adult spinal deformity before and after surgery: towards improved functional outcome after multi-level spinal fusion

Adult Spinal Deformity (ASD), mainly caused by degeneration of discs and spinal joints, is a condition that affects the elderly (> 60 years), with a prevalence of 36%. Out of this percentage, 44% are referred to surgical treatment. However, even after surgery, post-operative QOL and physical functioning during Activities of Daily Living (ADL) remain remarkably low compared to healthy individuals and even to other chronic disorders such as heart failure or diabetes. Current clinical evaluation and treatment mostly focus on static radiographic alignment parameters that can be corrected through spinal fusion surgery. However, recent studies have questioned whether radiographic parameters are the best way to determine QOL. Literature has shown that nearly 40% of QOL is influenced by demographic parameters, comorbidity, and general health, with only 2% attributed to radiographic parameters, leaving approximately 60% unexplained. To improve this the goal of our research is to add objectively measured functional parameters to the current clinical ASD framework to explain QOL. Our research aims to focus more on biopsychosocial, patient- tailored care with the following objectives: 1 To identify the drivers of QOL and functional impairment in ASD. 2 To measure the impact of multi-level spinal fusion surgery on the functional profile of the patient with ASD. 3 To identify biopsychosocial prognostic factors for improved functional outcome after multi-level spinal fusion surgery.