Skip to main content

Advertisement

SpringerLink
Log in

Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity

  • Original Article
  • Published:
European Spine Journal Aims and scope Submit manuscript

Abstract

Purpose

We aimed to develop and internally validate a scoring system, the adult spinal deformity surgical decision-making (ASD-SDM) score, to guide the decision-making process for ASD patients aged above 40 years.

Methods

A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation set and was internally validated in a validation set. The performance of the ASD-SDM score for predicting surgical management was assessed using the area under the receiver operating characteristic curve (AUC).

Results

A total of 702 patients were included for analysis in the present study. The scoring system developed based on 562 patients, ranging from 0 to 12 points, included five parameters: leg pain scored by the numerical rating scale; pain and self-image domains in the Scoliosis Research Society-22 score; coronal Cobb angle; and relative spinopelvic alignment. Surgical indication was graded as low (score 0 to 4), moderate (score 5 to 7), and high (score 8 to 12) groups. In the validation set of 140 patients, the AUC for predicting surgical management according to the ASD-SDM score was 0.797 (standard error = 0.037, P < 0.001, 95% confidence interval = 0.714 to 0.861), and in the low, moderate, and high surgical indication groups, 23.7%, 43.5%, and 80.4% of the patients, respectively, were treated surgically.

Conclusions

The ASD-SDM score demonstrated reliability, with higher scores indicating a higher probability of surgery. This index could aid in the selection of surgery for ASD patients in clinical settings.

Graphic abstract

These slides can be retrieved under Electronic Supplementary Material.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Schwab F, Dubey A, Gamez L et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30:1082–1085

    Article  Google Scholar 

  2. Schwab F, Dubey A, Pagala M et al (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28:602–606. https://doi.org/10.1097/01.BRS.0000049924.94414.BB

    Article  PubMed  Google Scholar 

  3. Schwab FJ, Smith VA, Biserni M et al (2002) Adult scoliosis: a quantitative radiographic and clinical analysis. Spine 27:387–392

    Article  Google Scholar 

  4. Pellisé F, Vila-Casademunt A, Ferrer M et al (2015) Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions. Eur Spine J 24:3–11. https://doi.org/10.1007/s00586-014-3542-1

    Article  PubMed  Google Scholar 

  5. Aebi M (2005) The adult scoliosis. Eur Spine J 14:925–948. https://doi.org/10.1007/s00586-005-1053-9

    Article  PubMed  Google Scholar 

  6. Lowe T, Berven SH, Schwab FJ et al (2006) The SRS classification for adult spinal deformity: building on the King/Moe and Lenke classification systems. Spine 31:S119–S125. https://doi.org/10.1097/01.brs.0000232709.48446.be

    Article  PubMed  Google Scholar 

  7. Terran J, Schwab F, Shaffrey CI et al (2013) The SRS-Schwab adult spinal deformity classification. Neurosurgery 73:559–568. https://doi.org/10.1227/NEU.0000000000000012

    Article  PubMed  Google Scholar 

  8. Liu S, Diebo BG, Henry JK et al (2016) The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference. Spine J 16:210–218. https://doi.org/10.1016/j.spinee.2015.10.043

    Article  PubMed  Google Scholar 

  9. Glassman SD, Berven S, Kostuik J et al (2006) Nonsurgical resource utilization in adult spinal deformity. Spine 31:941–947. https://doi.org/10.1097/01.brs.0000209318.32148.8b

    Article  PubMed  Google Scholar 

  10. Acaroglu RE, Dede Ö, Pellisé F et al (2016) Adult spinal deformity: a very heterogeneous population of patients with different needs. Acta Orthop Traumatol Turc 50:57–62. https://doi.org/10.3944/AOTT.2016.14.0421

    Article  PubMed  Google Scholar 

  11. Acaroglu E, Guler UO, Olgun ZD et al (2015) Multiple regression analysis of factors affecting health-related quality of life in adult spinal deformity. Spine Deform 3:360–366. https://doi.org/10.1016/j.jspd.2014.11.004

    Article  PubMed  Google Scholar 

  12. Bradford DS, Tay BK, Hu SS (1999) Adult scoliosis: surgical indications, operative management, complications, and outcomes. Spine 24:2617–2629

    Article  CAS  Google Scholar 

  13. Fujishiro T, Boissiere L, Cawley DT et al (2018) Decision-making factors in the treatment of adult spinal deformity. Eur Spine J 27:2312–2321. https://doi.org/10.1007/s00586-018-5572-6

    Article  PubMed  Google Scholar 

  14. Bess S, Boachie-Adjei O, Burton D et al (2009) Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients. Spine 34:2186–2190. https://doi.org/10.1097/BRS.0b013e3181b05146

    Article  PubMed  Google Scholar 

  15. Bridwell KH, Berven S, Glassman S et al (2007) Is the SRS-22 instrument responsive to change in adult scoliosis patients having primary spinal deformity surgery? Spine 32:2220–2225. https://doi.org/10.1097/BRS.0b013e31814cf120

    Article  PubMed  Google Scholar 

  16. Fujishiro T, Boissiere L, Cawley DT et al (2019) Adult spinal deformity surgical decision-making score. Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 40 years with adult spinal deformity. Eur Spine J. https://doi.org/10.1007/s00586-019-05932-3

    Article  PubMed  Google Scholar 

  17. Boissiere L, Yilgor C, Larrieu D et al (2017) A single sagittal parameter for decision making in ASD? Eur Spine J 26:S258–S259. https://doi.org/10.1007/s00586-017-5224-2

    Article  Google Scholar 

  18. Smith JS, Fu K-M, Urban P et al (2008) Neurological symptoms and deficits in adults with scoliosis who present to a surgical clinic: incidence and association with the choice of operative versus nonoperative management. J Neurosurg Spine 9:326–331. https://doi.org/10.3171/SPI.2008.9.10.326

    Article  PubMed  Google Scholar 

  19. Neuman BJ, Baldus C, Zebala LP et al (2016) Patient factors that influence decision making: randomization versus observational nonoperative versus observational operative treatment for adult symptomatic lumbar scoliosis. Spine 41:E349–E358. https://doi.org/10.1097/BRS.0000000000001222

    Article  PubMed  PubMed Central  Google Scholar 

  20. Fu K-MG, Smith JS, Sansur CA et al (2010) Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis. Neurosurgery 66:42–47. https://doi.org/10.1227/01.NEU.0000361999.29279.E6

    Article  PubMed  Google Scholar 

  21. Pekmezci M, Berven SH, Hu SS et al (2009) The factors that play a role in the decision-making process of adult deformity patients. Spine 34:813–817. https://doi.org/10.1097/BRS.0b013e3181851ba6

    Article  PubMed  Google Scholar 

  22. Glassman SD, Schwab FJ, Bridwell KH et al (2007) The selection of operative versus nonoperative treatment in patients with adult scoliosis. Spine 32:93–97. https://doi.org/10.1097/01.brs.0000251022.18847.77

    Article  PubMed  Google Scholar 

  23. Charlson ME, Pompei P, Ales KL et al (1987) A new method of classifying prognostic comorbidity in longitudinal studies: development and validation. J Chronic Dis 40:373–383

    Article  CAS  Google Scholar 

  24. Haher TR, Gorup JM, Shin TM et al (1999) Results of the scoliosis research society instrument for evaluation of surgical outcome in adolescent idiopathic scoliosis. a multicenter study of 244 patients. Spine 24:1435–1440

    Article  CAS  Google Scholar 

  25. Bridwell KH, Cats-Baril W, Harrast J et al (2005) The validity of the SRS-22 instrument in an adult spinal deformity population compared with the Oswestry and SF-12: a study of response distribution, concurrent validity, internal consistency, and reliability. Spine 30:455–461

    Article  Google Scholar 

  26. Yilgor C, Sogunmez N, Boissiere L et al (2017) Global alignment and proportion (GAP) score: development and validation of a new method of analyzing spinopelvic alignment to predict mechanical complications after adult spinal deformity surgery. J Bone Joint Surg Am 99:1661–1672. https://doi.org/10.2106/JBJS.16.01594

    Article  PubMed  Google Scholar 

  27. Obeid I, Boissiere L, Yilgor C et al (2016) Global tilt: a single parameter incorporating spinal and pelvic sagittal parameters and least affected by patient positioning. Eur Spine J 25:3644–3649. https://doi.org/10.1007/s00586-016-4649-3

    Article  CAS  PubMed  Google Scholar 

  28. Guler UO, Yuksel S, Yakici S et al (2016) Analysis of the reliability of surgeons’ ability to differentiate between idiopathic and degenerative spinal deformity in adults radiologically. What descriptive parameters help them decide? Eur Spine J 25:2401–2407. https://doi.org/10.1007/s00586-015-4366-3

    Article  PubMed  Google Scholar 

  29. Takemoto M, Boissiere L, Novoa F et al (2016) Sagittal malalignment has a significant association with postoperative leg pain in adult spinal deformity patients. Eur Spine J 25:2442–2451. https://doi.org/10.1007/s00586-016-4616-z

    Article  PubMed  Google Scholar 

  30. Cawley DT, Larrieu D, Fujishiro T et al (2018) NRS20: combined back and leg pain score: a simple and effective assessment of adult spinal deformity. Spine 43:1184–1192. https://doi.org/10.1097/BRS.0000000000002633

    Article  PubMed  Google Scholar 

  31. Smith JS, Shaffrey CI, Glassman SD et al (2013) Clinical and radiographic parameters that distinguish between the best and worst outcomes of scoliosis surgery for adults. Eur Spine J 22:402–410. https://doi.org/10.1007/s00586-012-2547-x

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Orthopedic Surgery, Osaka Medical College, 2-7, Daigakumachi, Takatsuki-shi, Osaka, 569-8686, Japan

    Takashi Fujishiro

  2. L’Institut de la Colonne Vertébrale, Bordeaux University Hospital, Bordeaux, France

    Takashi Fujishiro, Louis Boissière, Derek Thomas Cawley, Daniel Larrieu, Olivier Gille, Jean-Marc Vital & Ibrahim Obeid

  3. Spine Surgery Unit, Hospital Universitario Val Hebron, Barcelona, Spain

    Ferran Pellisé

  4. Spine Surgery Unit, Hospital Universitario La Paz, Madrid, Spain

    Francisco Javier Sanchez Pérez-Grueso

  5. Spine Center, Schulthess Klinik, Zurich, Switzerland

    Frank Kleinstück

  6. Ankara Spine Center, Ankara, Turkey

    Emre Acaroglu

  7. Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey

    Ahmet Alanay

Authors
  1. Takashi Fujishiro
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Louis Boissière
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Derek Thomas Cawley
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Daniel Larrieu
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Olivier Gille
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jean-Marc Vital
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Ferran Pellisé
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Francisco Javier Sanchez Pérez-Grueso
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Frank Kleinstück
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Emre Acaroglu
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Ahmet Alanay
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Ibrahim Obeid
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

European Spine Study Group, ESSG

Corresponding author

Correspondence to Takashi Fujishiro.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 28 kb)

Supplementary material 2 (PPTX 2028 kb)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Fujishiro, T., Boissière, L., Cawley, D.T. et al. Adult spinal deformity surgical decision-making score. Part 2: development and validation of a scoring system to guide the selection of treatment modalities for patients above 40 years with adult spinal deformity. Eur Spine J 29, 45–53 (2020). https://doi.org/10.1007/s00586-019-06068-0

Download citation

  • Received:

  • Revised:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00586-019-06068-0

Keywords

Search

Navigation