TY - JOUR
T1 - Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity
T2 - A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up
AU - for the International Spine Study Group
AU - Smith, Justin S.
AU - Lafage, Virginie
AU - Shaffrey, Christopher I.
AU - Schwab, Frank
AU - Lafage, Renaud
AU - Hostin, Richard
AU - OʼBrien, Michael
AU - Boachie-Adjei, Oheneba
AU - Akbarnia, Behrooz A.
AU - Mundis, Gregory M.
AU - Errico, Thomas
AU - Kim, Han Jo
AU - Protopsaltis, Themistocles S.
AU - Hamilton, D. K.
AU - Scheer, Justin K.
AU - Sciubba, Daniel
AU - Ailon, Tamir
AU - Fu, Kai Ming G
AU - Kelly, Michael P.
AU - Zebala, Lukas
AU - Line, Breton
AU - Klineberg, Eric Otto
AU - Gupta, Munish
AU - Deviren, Vedat
AU - Hart, Robert
AU - Burton, Doug
AU - Bess, Shay
AU - Ames, Christopher P.
PY - 2015/11/16
Y1 - 2015/11/16
N2 - BACKGROUND:: High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed. OBJECTIVE:: To compare outcomes of operative and nonoperative treatment for ASD. METHODS:: This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age >18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence–to–lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up. RESULTS:: Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P <.001) and had worse deformity based on pelvic tilt, pelvic incidence–to–lumbar lordosis mismatch, and sagittal vertical axis (P ≤ .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P <.001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P <.001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P <.001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had ≥1 complications. CONCLUSION:: Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability. ABBREVIATIONS:: ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisMCID, minimal clinically important differenceNRS, numeric rating scaleODI, Oswestry Disability IndexPI, pelvic incidenceSF-36, Short Form-36SRS-22r, Scoliosis Research Society-22rSVA, sagittal vertical axis
AB - BACKGROUND:: High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed. OBJECTIVE:: To compare outcomes of operative and nonoperative treatment for ASD. METHODS:: This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age >18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence–to–lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up. RESULTS:: Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P <.001) and had worse deformity based on pelvic tilt, pelvic incidence–to–lumbar lordosis mismatch, and sagittal vertical axis (P ≤ .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P <.001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P <.001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P <.001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had ≥1 complications. CONCLUSION:: Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability. ABBREVIATIONS:: ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisMCID, minimal clinically important differenceNRS, numeric rating scaleODI, Oswestry Disability IndexPI, pelvic incidenceSF-36, Short Form-36SRS-22r, Scoliosis Research Society-22rSVA, sagittal vertical axis
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U2 - 10.1227/NEU.0000000000001116
DO - 10.1227/NEU.0000000000001116
M3 - Article
C2 - 26579966
AN - SCOPUS:84947461545
JO - Neurosurgery
JF - Neurosurgery
SN - 0148-396X
ER -