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Decision-making factors in the treatment of adult spinal deformity

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Abstract

Purpose

We aimed to elucidate the factors for the decision-making process in the treatment of adult spinal deformity (ASD), including sagittal parameters, that impact health-related quality of life (HRQOL).

Methods

A multicenter prospective ASD database was retrospectively reviewed. The demographic data, HRQOL, and radiographic measures were analyzed using multivariate analyses in younger (≤ 50 years) and older (> 50 years) age groups.

Results

This study included 414 patients (134 surgical and 280 nonsurgical; mean age 30.7 years) in the younger age group and 575 patients (323 surgical and 252 nonsurgical; mean age 65.8 years) in the older age group. Worse HRQOL measures drove surgical treatment, both in younger and older patients. The SRS-22 self-image score was the most differentiating domain, both in the younger and older age groups, and an additional significant factor in the older age group was pain and disability. Coronal deformity drove surgical treatment for the younger age group; however, older surgical patients were less likely to have coronal malalignment. Sagittal parameters were associated with the decision-making process. Greater pelvic incidence minus lumbar lordosis mismatch in the younger age group and smaller lumbar lordosis index in the older age group were most correlated with the decision to undergo surgery.

Conclusions

Aside from the HRQOL measures and coronal deformity, sagittal parameters were identified as significant factors for the decision-making process in the ASD population, and the lack of lumbar lordosis in relation to pelvic incidence was a strong driver to pursue surgical treatment.

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Acknowledgements

Cawley DT: Irish Orthopaedic Association, Irish Institute of Trauma and Orthopaedic Surgery, Société Francaise de Chirurgie Orthopédique et Traumatologique; Pellise F: DePuy Synthes, K2 M; Perez-Grueso F.S: DePuy Synthes, K2 M; Acaroglu E: Fondation Cotrel, DePuy Synthes, Medtronic, Consultant: Medtronic, AOSpine; Alanay A; DePuy Synthes Consultant: DePuy Spine, Stryker, Medtronic; Obeid I: DePuy Synthes; ESSG: DePuy Synthes.

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Authors and Affiliations

  1. L’Institut de la Colonne Vertébrale, Bordeaux University Hospital, Place Amélie Raba-Léon, 33076, Bordeaux, France

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

  2. Department of Orthopedic Surgery, Osaka Medical College, Osaka, Japan

    Takashi Fujishiro

  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

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  1. Takashi Fujishiro
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  2. Louis Boissière
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  3. Derek Thomas Cawley
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  4. Daniel Larrieu
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  9. Frank Kleinstück
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  10. Emre Acaroglu
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  11. Ahmet Alanay
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  12. Ibrahim Obeid
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On behalf of European Spine Study Group, ESSG

Corresponding author

Correspondence to Takashi Fujishiro.

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

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  • DOI: https://doi.org/10.1007/s00586-018-5572-6

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