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  • Operatively Treated Young Adult Spinal Deformity (ASD) Patients (≤ 50 Years of Age) Have Larger Scoliosis and Worse Quality of Life than Nonoperative Patients Despite Normal Sagittal Alignment

    Final Number:

    Kai-Ming G. Fu MD PhD; Shay Bess MD; Christopher I. Shaffrey MD, FACS; Justin S. Smith MD PhD; Virginie Lafage PhD; Frank Schwab MD; Douglas C. Burton MD; Behrooz A. Akbarnia MD; Christopher P. Ames MD; Oheneba Boachie-Adjei MD; Robert Hart MD; Eric Klineberg MD; Munish Gupta MD; Praveen V. Mummaneni MD; International Spine Study Group

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2012 Annual Meeting

    Introduction: Sagittal spinal malalignment (SSM) is an established cause of pain in ASD, whereas scoliosis traditionally has not correlated with poor HRQOL. Young ASD patients typically do not have SSM. Purpose: evaluate clinical and radiographic features correlating with operative treatment in ASD patients age 18-50.

    Methods: Multi-center, prospective analysis of 208 consecutive ASD patients age 18-50, no prior history of spine surgery, treated OP or NONOP. ASD defined as: scoliosis=20°, sagittal vertical axis (SVA)=5cm, pelvic tilt (PT)=25°, or thoracic kyphosis (TK)>60°. Data collection included demographic, radiographic and baseline health related quality of life (HRQOL) measures: SRS-22, Oswestry Disability Index (ODI), SF-36, and NRS leg pain.

    Results: OP (n=51) and NONOP (n=157) had similar age (33.2 vs. 33.4 years) and Charlson comorbidity index (0.38 vs. 0.44), respectively (p>0.05). All baseline HRQOL values, except SRS-22 mental health, SF-36 MCS and NRS leg pain were worse for OP than NONOP: total SRS-22 (3.3 vs 3.7), SRS-22 subscales: activity (3.4 vs 3.7), self-image (3.3 vs 3.6), pain (2.8 vs 3.3), ODI (24 vs 17) and SF-36 PCS (47 vs 42; p<0.05, respectively). SRS-22 pain and ODI differences OP vs. NONOP reached minimal clinically important difference (MCID). OP had greater MT curve than NONOP (50° versus 42°, p<0.05). Sagittal alignment including SVA (-6.1mm vs -7.9mm), PT (14° vs 13°), and LL/PI mismatch (-3.8° vs -4.5°) were normal and similar OP vs. NON, respectively (p>0.05).

    Conclusions: Scoliotic deformity, rather than SSM, predicts surgery for ASD patients aged 18-50. OP patients had worse pain and disability HRQOL values than NONOP despite similar mental health profiles and anatomic sagittal alignment. Mean HRQOL values for both groups were not reflective of severe disability however differences in ODI and SRS-22 pain reached MCID. Further investigation is needed to evaluate causes of pain, disability, and treatment preference for young ASD patients.

    Patient Care: This research improves patient care by helping to clarify the factors that motivate younger adults with spinal deformity to seek surgical treatment.

    Learning Objectives: By the conclusion of this presentation, participants should: (1) appreciate that in younger adults with scoliosis the scoliotic deformity , rather than sagittal spinal malalignment, predicts surgical treatment, (2) appreciate that compared with young adults with scoliosis who elected for nonoperative treatment, those undergoing operative treatment had worse pain and disability, despite similar mental health profiles and anatomic sagittal alignment.


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