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  • Prospective, Multi-Center Assessment of Nonoperative Treatment Outcomes and Conversion to Operative Treatment for Adult Spinal Deformity: Minimum 2-Year Follow-Up

    Final Number:

    Justin S. Smith MD PhD; Christopher I. Shaffrey MD, FACS; Virginie Lafage PhD; Frank Schwab MD, PhD; Themistocles Protopsaltis MD; Eric Klineberg MD; Justin K Scheer BS; Munish Gupta MD; Kai-Ming G. Fu MD PhD; Richard A. Hostin MD; Vedat Deviren MD; Robert Hart MD; Douglas C. Burton MD; Shay Bess MD; Christopher P. Ames MD

    Study Design:
    Clinical Trial

    Subject Category:

    Meeting: Congress of Neurological Surgeons 2014 Annual Meeting

    Introduction: First-line treatment for ASD is typically nonop. Our objective was to assess outcomes of nonop care and compare those who converted to op vs those who remained nonop.

    Methods: This is a multicenter, prospective analysis of consecutive ASD patients electing for nonop care. Inclusion criteria: age>18 yr, ASD and min 2-yr follow-up or conversion to op care. Efforts were made to maximize standard multimodality nonop care.

    Results: Of 225 patients (mean age=53 yrs), 42(19%) converted to op at a mean of 12.5 mos. At baseline, those who converted to op had greater BMI (27.3vs25.2, p=0.041), greater pelvic tilt (23vs19deg, p=0.043), greater pelvic incidence to lumbar lordosis mismatch (11vs4deg, p=0.038), trend toward greater C7 SVA (70vs52 mm, p=0.075), greater ODI (37vs22, p<0.001), worse SF36PCS (35vs44, p<0.001) and MCS (45vs51, p=0.012), worse SRS-22 (3.0vs3.6, p<0.001), back (6.4vs4.4, p>0.001) and leg (4.4vs2.3, p<0.001) pain, but did not differ based on age (p=0.2), gender (p=0.3) or coronal Cobb angle (p=0.8). On multivariate analysis the only factors in the best-fit model were ODI (p=0.005) and SRS Appearance (p=0.032). Patients who converted to op had modest worsening of ODI (40vs37, p=0.085), SF36 PCS (33vs36; p=0.009) and back pain (7.1vs6.3, p=0.024) prior to surgery, but other outcomes and radiographic measures did not significantly change. Min 2-yr post-op follow-up was available for 27 who converted to op, and all HRQL measures improved significantly (p<0.007). Those remaining nonop had no clinically significant changes in HRQL during the observation period.

    Conclusions: Of 225 ASD patients treated nonop, the 19% who converted to op had greater baseline sagittal spinopelvic deformity and poorer outcomes scores. Surprisingly, appearance was a driver of operative conversion. These data suggest that nonop care at best maintains levels of pain and disability and patients with greater pain and disability tend to convert to op care.

    Patient Care: This data improves our understanding of non-operative care for ASD and aid in the identification of patients undergoing non-operative management likely to convert to operative management.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) Identify the nonop conversion to surgery rate in a large multicenter ASD patient population and 2) describe the factors that influence conversion to operative treatment


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