Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity

A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up

for the International Spine Study Group

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69 Citations (Scopus)

Abstract

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

Original languageEnglish (US)
JournalNeurosurgery
DOIs
StateAccepted/In press - Nov 16 2015

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Scoliosis
Quality of Life
Lordosis
Therapeutics
Pain
Research
Leg
Health

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

@article{4cd3c264c6e64d3e982bf947e77f15ba,
title = "Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up",
abstract = "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",
author = "{for the International Spine Study Group} and Smith, {Justin S.} and Virginie Lafage and Shaffrey, {Christopher I.} and Frank Schwab and Renaud Lafage and Richard Hostin and Michael OʼBrien and Oheneba Boachie-Adjei and Akbarnia, {Behrooz A.} and Mundis, {Gregory M.} and Thomas Errico and Kim, {Han Jo} and Protopsaltis, {Themistocles S.} and Hamilton, {D. K.} and Scheer, {Justin K.} and Daniel Sciubba and Tamir Ailon and Fu, {Kai Ming G} and Kelly, {Michael P.} and Lukas Zebala and Breton Line and Eric Klineberg and Munish Gupta and Vedat Deviren and Robert Hart and Doug Burton and Shay Bess and Ames, {Christopher P.}",
year = "2015",
month = "11",
day = "16",
doi = "10.1227/NEU.0000000000001116",
language = "English (US)",
journal = "Neurosurgery",
issn = "0148-396X",
publisher = "Lippincott Williams and Wilkins",

}

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

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

JO - Neurosurgery

JF - Neurosurgery

SN - 0148-396X

ER -