Counseling Guidelines for Anticipated Postsurgical Improvements in Pain, Function, Mental Health, and Self-image for Different Types of Adult Spinal Deformity

Breton Line, Shay Bess, Virginie Lafage, Christopher Ames, Douglas Burton, Han Jo Kim, Munish C Gupta, Robert Hart, Eric Klineberg, Michael Kelly, Khaled Kebaish, Richard Hostin, Gregory Mundis, Frank Schwab, Christopher Shaffrey, Justin S. Smith

Research output: Contribution to journalArticlepeer-review


Study Design.Retrospective analysis of a multicenter prospective adult spinal deformity (ASD) database.Objective.Quantify postoperative improvements in pain, function, mental health, and self-image for different ASD types.Summary of Background Data.Medical providers are commonly requested to counsel patients on anticipated improvements in specific health domains including pain, function, and self-image following surgery. ASD is a heterogeneous condition; therefore, health domain improvements may vary according to deformity type. Few studies have quantified outcomes for specific ASD types.Methods.Surgically treated ASD patients (=4 levels fused) prospectively enrolled into a multicenter database, minimum 2-year follow-up, were categorized into ASD types according to Scoliosis Research Society-Schwab ASD classification (THORACIC, LUMBAR, DOUBLE, SAGITTAL, MIXED). Demographic, radiographic, operative, and patient reported outcome measures (NRS back and leg pain, SRS-22r, SF-36) data were evaluated. Preoperative and last postoperative values for pain, physical and social function, mental health, and self-image were evaluated, improvements in each domain were quantified, and domain scores compared to generational normative values. Postoperative improvements were also calculated for three age cohorts (<45 yr, 45-65 yr, and >65 yr) within each deformity type.Results.359 of 564 patients eligible for study (mean age 57.9 yr, mean scoliosis 43.4°, mean SVA 63.3mm, mean 11.7 levels fused) had =2 yr follow-up. Domain improvements for the entire ASD population were 45.1% for back pain, 41.3% for leg pain, 27.1% for physical function, 35.9% for social function, 62.0% for self-image, and 22.6% for mental health (P<0.05). LUMBAR, SAGITTAL, and MIXED had greatest improvements in pain and function, while THORACIC and DOUBLE had greatest improvements in self-image. Self-image was the most impacted preoperative domain and demonstrated the greatest postoperative improvement for all ASD types.Conclusion.ASD patients demonstrated quantifiable postoperative improvements in pain, self-image, physical and social function, and mental health; however, improvements differed between ASD types. Further research is needed to understand specific patient expectations for ASD treatment.Level of Evidence: 3.

Original languageEnglish (US)
Pages (from-to)1118-1127
Number of pages10
Issue number16
StatePublished - Aug 15 2020


  • adult spinal deformity
  • improvement
  • patient-reported outcome measures
  • surgery

ASJC Scopus subject areas

  • Orthopedics and Sports Medicine
  • Clinical Neurology


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