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  • Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multi-Center Matched and Unmatched Cohort Assessment with Minimum 2-Year Follow-Up

    Final Number:

    Justin S. Smith MD PhD; Virginie Lafage PhD; Christopher I. Shaffrey MD, FACS; Frank Schwab MD, PhD; Richard A. Hostin MD; Oheneba Boachie-Adjei MD; Justin K Scheer BS; Behrooz A. Akbarnia MD; Eric Klineberg MD; Munish Gupta 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: Adults with spinal deformity present with pain and disability. Our objective was to compare outcomes for op and nonop treatment for ASD based on a prospective, multi-center patient population.

    Methods: Multicenter, prospective analysis of consecutive ASD patients. Inclusion criteria: age>18 yr and ASD. Propensity scores were used to match 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: 689 patients met criteria, including 286 op and 403 nonop, with mean ages of 53 and 55yrs, minimum 2-yr 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<0.001) and had worse deformity based on pelvic tilt, PI-LL, and C7SVA (p<0.002). Before reaching min 2-yr follow-up 38 nonop patients converted to op treatment and were analyzed in the op group. At min 2-yr follow-up all HRQL measures assessed significantly improved for op patients (p<0.001), but none of these measures improved significantly for nonop patients (p>0.11). 97 matched op-nonop 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<0.001), but the 97 matched nonop patients lacked significant improvement in any of the HRQL measures (p>0.20). Paired op-nonop 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). Operative overall minor and major complication rates were 53% and 40%, respectively.

    Conclusions: Op treatment for ASD can provide significant improvement of HRQL measures at min 2-yr follow-up. In contrast, nonop treatment appears to at best maintain presenting levels of pain and disability.

    Patient Care: The results of this study will improve patient care by providing further evidence for the benefits of operative treatment in ASD, which can improve patient education aiding in the decision process between operative and non-operative treatment.

    Learning Objectives: By the conclusion of this session, participants should be able to: 1) discuss operative management of ASD improving HRQOL over non-operative management and 2) understand that non-operative management of ASD maintains patients’ current pain and disability.


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