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

Publication ,  Journal Article
Smith, JS; Lafage, V; Shaffrey, CI; Schwab, F; Lafage, R; Hostin, R; OʼBrien, M; Boachie-Adjei, O; Akbarnia, BA; Mundis, GM; Errico, T ...
Published in: Neurosurgery
June 2016

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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Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

June 2016

Volume

78

Issue

6

Start / End Page

851 / 861

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Diseases
  • Quality of Life
  • Prospective Studies
  • Propensity Score
  • Orthopedic Procedures
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans
 

Citation

APA
Chicago
ICMJE
MLA
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Smith, J. S., Lafage, V., Shaffrey, C. I., Schwab, F., Lafage, R., Hostin, R., … International Spine Study Group, . (2016). Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up. Neurosurgery, 78(6), 851–861. https://doi.org/10.1227/NEU.0000000000001116
Smith, Justin S., Virginie Lafage, Christopher I. Shaffrey, Frank Schwab, Renaud Lafage, Richard Hostin, Michael OʼBrien, et al. “Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up.Neurosurgery 78, no. 6 (June 2016): 851–61. https://doi.org/10.1227/NEU.0000000000001116.
Smith, Justin S., et al. “Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up.Neurosurgery, vol. 78, no. 6, June 2016, pp. 851–61. Pubmed, doi:10.1227/NEU.0000000000001116.
Smith JS, Lafage V, Shaffrey CI, Schwab F, Lafage R, Hostin R, OʼBrien M, Boachie-Adjei O, Akbarnia BA, Mundis GM, Errico T, Kim HJ, Protopsaltis TS, Hamilton DK, Scheer JK, Sciubba D, Ailon T, Fu K-MG, Kelly MP, Zebala L, Line B, Klineberg E, Gupta M, Deviren V, Hart R, Burton D, Bess S, Ames CP, International Spine Study Group. Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up. Neurosurgery. 2016 Jun;78(6):851–861.
Journal cover image

Published In

Neurosurgery

DOI

EISSN

1524-4040

Publication Date

June 2016

Volume

78

Issue

6

Start / End Page

851 / 861

Location

United States

Related Subject Headings

  • Treatment Outcome
  • Spinal Diseases
  • Quality of Life
  • Prospective Studies
  • Propensity Score
  • Orthopedic Procedures
  • Neurology & Neurosurgery
  • Middle Aged
  • Male
  • Humans