The benefit of non-operative treatment for adult spinal deformity: Identifying predictors for reaching a minimal clinically important difference

Shian Liu, Bassel G. Diebo, Jensen K. Henry, Justin S. Smith, Richard Hostin, Matthew E. Cunningham, Gregory Mundis, Christopher P. Ames, Douglas Burton, Shay Bess, Behrooz Akbarnia, Robert Hart, Peter G. Passias, Frank J. Schwab, Virginie Lafage

Research output: Contribution to journalArticle

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Background Context: Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of non-operative patients and proposes predictors of those most likely to benefit. Purpose: The study aims to determine the factors that affect likelihood of non-operative patients to reach MCID. Study Design/Setting: This is a retrospective review of a prospective, multicenter database. Patient Sample: The study includes non-operative ASD patients. Outcome Measures: Health-related quality-of-life measures, including the Scoliosis Research Society (SRS)-22 questionnaire, were used. Methods: The study used a multicenter database of 215 non-operative patients with ASD and with minimum 2-year follow-up. Using a multivariate analysis, two groups were compared to identify possible predictors: those who reached MCID in the SRS pain or activity (N=86) at 2 years and those who did not reach MCID (N=129). A subgroup multivariate analysis of patients with a deficit (potential improvement) in both SRS pain and activity (N=84) was performed. Data collection was supported by a grant from DePuy for the International Spine Study Group Foundation. Results: At baseline, the non-operative patients who reached MCID had a significantly lower SRS pain score (3.0 vs. 3.6), smaller thoracolumbar Cobb (TL Cobb) angle (29.6° vs. 36.5°; 87 patients with SRS-Schwab classification of lumbar or double), lower sacral slope (33.1° vs. 36.4°), and less lumbar lordosis (46.5° vs. 52.8°) (all p

Original languageEnglish (US)
JournalSpine Journal
Publication statusAccepted/In press - Jun 21 2015



  • Health-related quality of life
  • Non-operative
  • Outcomes
  • Spinal deformity
  • Treatment

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

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