Open AccessComparison of Best versus Worst Clinical Outcomes for Adult Spinal Deformity Surgery: A Prospective, Multicenter Assessment with Minimum 2-Year Follow-Up
Author(s) -
Justin S. Smith,
Christopher I. Shaffrey,
Virginie Lafage,
Frank Schwab,
Themistocles S. Protopsaltis,
Eric O. Klineberg,
Munish C. Gupta,
Richard Hostin,
Kai Ming-Fu,
Alex Soroceanu,
Robert Hart,
Douglas Burton,
Shay Bess,
Christopher P. Ames
Publication year - 2015
Publication title -
global spine journal
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.398
H-Index - 26
eISSN - 2192-5690
pISSN - 2192-5682
DOI - 10.1055/s-0035-1554513
Subject(s) - medicine , pelvic tilt , oswestry disability index , prospective cohort study , spinal deformity , surgery , lumbar , cobb angle , low back pain , scoliosis , population , pelvis , alternative medicine , environmental health , pathology
Adults with spinal deformity typically present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multicenter patient population.Patients and Methods This is a multicenter, prospective analysis of consecutive patients with ASD electing for op or non-op care at enrollment. Inclusion criteria are age > 18 years and ASD. Propensity scores were used to match an op and nonop patients based on baseline (BL) ODI, SRS22, maximum thoracolumbar/lumbar Cobb angle, pelvic incidence to lumbar lordosis mismatch (PI–LL), and leg pain numeric rating scale (NRS) score.Results A total of 689 patients met criteria, including 286 op and 403 non-op, with mean ages of 53 and 55 years, minimum 2-year follow-up rates of 86 and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At BL, compared with nonop, op patients had significantly worse HRQL based on ODI, SRS22, SF36, and leg and back pain NRS ( p 0.11). Overall, 97 matched op–non-op pairs were identified based on propensity scores. At last follow-up, the 97 matched op patients had significant improvement in all HRQL measures assessed ( p 0.20). Paired op–non-op analysis demonstrated the op patients to have significantly better HRQL scores at follow-up for all measures assessed ( p < 0.001), except SF36 MCS ( p = 0.058). Overall minor and major complication rates for op patients were 53 and 40%, respectively.Conclusion Op treatment for ASD can provide significant improvement of HRQL measures at minimum 2-year follow-up. In contrast, non-op treatment appears to at best maintain presenting levels of pain and disability.