Persistent activity limitations and fear of falling after surgical correction of adult spinal deformity

Abstract

Background Spinal realignment surgery for adult spinal deformity improves radiographic alignment and patient-reported outcomes, but it remains unclear whether these gains translate into recovery of activity-level function and reduced fear of falling. Therefore, this study aims to determine whether (1) objective activity limitations and fear of falling change following ASD realignment surgery, and (2) whether trajectories differ across deformity subtypes.

Method Fifty patients undergoing adult spinal deformity correction were assessed preoperatively, and at 6 months and 1 year postoperatively. Patient-reported outcomes were collected alongside objective functional impairment using the Function Assessment Scale for Spinal Deformity and fear of falling using the Falls Efficacy Scale-International. Patients were classified as decompensated sagittal malalignment, compensated sagittal malalignment, or coronal malalignment. Longitudinal changes and subgroup differences were analyzed using linear mixed-effects models.

Findings Patient-reported outcomes improved postoperatively, whereas functional impairment did not change over time (p = .618) and fear of falling remained high (p = .370). Decompensated sagittal malalignment was associated with lower functional performance (p = .011) and higher fear of falling (p = .010) compared with coronal malalignment. No subgroup-by-time interactions were observed for functional impairment (p = .988) or fear of falling (p = .251).

Interpretation After realignment surgery in adult spinal deformity, improvements in radiographic alignment and patient-reported outcomes did not translate into recovery of objective activity-level function or reduction of fear of falling within one year. These findings support the need for postoperative strategies targeting dynamic balance and persistent compensatory movement patterns.