Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up

• Published in: Neurosurgery Vol. 78; no. 6; pp. 851 - 861
• Main Authors: Smith, Justin S., Lafage, Virginie, Shaffrey, Christopher I., Schwab, Frank, Lafage, Renaud, Hostin, Richard, OʼBrien, Michael, Boachie-Adjei, Oheneba, Akbarnia, Behrooz A., Mundis, Gregory M., Errico, Thomas, Kim, Han Jo, Protopsaltis, Themistocles S., Hamilton, D. Kojo, Scheer, Justin K., Sciubba, Daniel, Ailon, Tamir, Fu, Kai-Ming G., Kelly, Michael P., Zebala, Lukas, Line, Breton, Klineberg, Eric, Gupta, Munish, Deviren, Vedat, Hart, Robert, Burton, Doug, Bess, Shay, Ames, Christopher P.
• Format: Journal Article
• Language: English
• Published: United States Copyright by the Congress of Neurological Surgeons 01.06.2016; Wolters Kluwer Health, Inc
• Subjects: Adult; Conservative Treatment; Female; Follow-Up Studies; Humans; Male; Middle Aged; Neurosurgery; Orthopedic Procedures; Pain; Propensity Score; Prospective Studies; Quality of Life; Scoliosis; Spinal Diseases - therapy; Treatment Outcome
• ISSN: 0148-396X; 1524-4040; 1524-4040
• DOI: 10.1227/NEU.0000000000001116

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