European Spine Journal

, Volume 24, Issue 1, pp 3–11 | Cite as

Impact on health related quality of life of adult spinal deformity (ASD) compared with other chronic conditions

  • Ferran PelliséEmail author
  • Alba Vila-Casademunt
  • Montse Ferrer
  • Montse Domingo-Sàbat
  • Juan Bagó
  • Francisco J. S. Pérez-Grueso
  • Ahmet Alanay
  • A. F. Mannion
  • Emre Acaroglu
  • European Spine Study Group, ESSG
Original Article



Medical and health policy providers should be aware of the impact of adult spinal deformity (ASD) on health-related quality of life (HRQL). The purpose of this study was to compare the relative burden of four chronic conditions with that of ASD.


The International Quality of Life Assessment project gathered data from 24,936 people and published the SF-36 scores of patients with self-reported arthritis, chronic lung disease, diabetes and congestive heart failure from 8 industrialized countries (3 continents) Alonso et al. (Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13:283–298, 2004). We compared these with the SF-36 baseline data of consecutive patients with ASD enrolled in a prospective multicentre international database with the following inclusion criteria: age >18 years and scoliosis >20°, sagittal vertical axis >5 cm, pelvic tilt >25° or thoracic kyphosis >60°. Four ASD groups were considered: all ASD patients, surgical candidates (preop HRQL scores), and non-surgical candidates with and without previous surgery. Adjusted estimates of the impact of chronic disease were calculated using separate multivariate linear regression models. Individuals without chronic conditions were used as the reference group. Coefficients for each chronic condition and ASD represent the difference compared with this healthy group.


766 patients (mean age 45.8 years) met the inclusion criteria for ASD. The scores on all SF-36 domains were lower in ASD patients than in any other chronic condition. Differences between ASD and the other chronic conditions were always greater than the reported minimal clinically important differences. When compared with individuals reporting no medical conditions, SF-36 scores from the population with self-reported chronic conditions ranged from −2.5 to −14.1. Comparable scores for patients with ASD ranged from −10.9 to −45.0. Physical function, role physical and pain domains showed the worst scores. Surgical candidates with ASD displayed the worst HRQL scores (−17.4 to −45.0) and patients previously operated the best (−10.9 to −33.3); however, even the latter remained worse than any scores for the other self-reported chronic conditions.


The global burden of ASD was huge compared with other self-reported chronic conditions in the general population of eight industrialized countries. The impact of ASD on HRQL warrants the same research and health policy attention as other important chronic diseases.


SF-36 Adult spinal deformity Impact on HRQL IQOLA project Chronic diseases 


Conflict of interest

This article was partially funded by a Depuy Synthes Research Grant.


  1. 1.
  2. 2.
    McCarthy I, O’Brien M, Ames C, Robinson C, Errico T, Polly DW et al (2014) Incremental cost-effectiveness of adult spinal deformity surgery: observed quality-adjusted life years with surgery compared with predicted quality-adjusted life years without surgery. Neurosurg Focus 36(5):E3PubMedCrossRefGoogle Scholar
  3. 3.
    Martin BI, Deyo RA, Mirza SK, Turner JA, Comstock BA, Hollingworth W et al (2008) Expenditures and health status among adults with back and neck problems. JAMA J Am Med Assoc 299(6):656–664CrossRefGoogle Scholar
  4. 4.
    Terran J, McHugh BJ, Fischer CR, Lonner B, Warren D, Glassman S et al (2014) Surgical treatment for adult spinal deformity: projected cost effectiveness at 5-year follow-up. Ochsner J 14(1):14–22PubMedCentralPubMedGoogle Scholar
  5. 5.
    Alonso J, Ferrer M, Gandek B, Ware JE, Aaronson NK, Mosconi P et al (2004) Health-related quality of life associated with chronic conditions in eight countries: results from the International Quality of Life Assessment (IQOLA) Project. Qual Life Res Int J Qual Life Asp Treat Care Rehabil 13(2):283–298CrossRefGoogle Scholar
  6. 6.
    Baldus C, Bridwell K, Harrast J, Shaffrey C, Ondra S, Lenke L et al (2011) The Scoliosis Research Society Health-Related Quality of Life (SRS-30) age-gender normative data: an analysis of 1346 adult subjects unaffected by scoliosis. Spine 36(14):1154–1162PubMedCrossRefGoogle Scholar
  7. 7.
    Obeid I, Lafage V, Alanay A, Vital J-M, Gille O, Bourgli A (2013) Global tilt: a new sagittal plane parameter combining spinal balance and pelvic compensatory mechanisms. VancouverGoogle Scholar
  8. 8.
    Pellisé F, Domingo-Sàbat M, Alanay A, Bagó J, Vila-Casademunt A, Villanueva C et al (2012) Impact of radiographic parameters on HRQoL in adult spinal deformity. The “Lordosis Gap” better than Lumbar Lordosis? Abstracts for Oral Presentations for EuroSpine, May Amsterdam. Eur Spine J 21(S3):269–337CrossRefGoogle Scholar
  9. 9.
    Schwab F, Ungar B, Blondel B, Buchowski J, Coe J, Deinlein D et al (2012) Scoliosis research society-schwab adult spinal deformity classification: a validation study. Spine 37(12):1077–1082PubMedCrossRefGoogle Scholar
  10. 10.
    Saklad M (1941) Grading of patients for surgical procedures. Anesthesiology 2:281–284CrossRefGoogle Scholar
  11. 11.
    Cohen J (1998) Statistical Power Analysis for the Behavioral Sciences, 2nd edn. Lawrence Erlbaum Associates, HillsdaleGoogle Scholar
  12. 12.
  13. 13.
    Fu K-MG, Bess S, Schwab F, Lafage V, Smith JS, Ames CP et al (2012) Health impact comparison of different disease states and population norms to adult spinal deformity (ASD): a call for medical attention. Podium presentation, ChicagoGoogle Scholar
  14. 14.
    Schwab F, Dubey A, Gamez L, El Fegoun AB, Hwang K, Pagala M et al (2005) Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine 30(9):1082–1085PubMedCrossRefGoogle Scholar
  15. 15.
    Schwab F, Dubey A, Pagala M, Gamez L, Farcy JP (2003) Adult scoliosis: a health assessment analysis by SF-36. Spine 28(6):602–606PubMedGoogle Scholar
  16. 16.
    Dalstra Ja A, Kunst AE, Borrell C, Breeze E, Cambois E, Costa G et al (2005) Socioeconomic differences in the prevalence of common chronic diseases: an overview of eight European countries. Int J Epidemiol 34(2):316–326PubMedCrossRefGoogle Scholar
  17. 17.
    Berven S, Deviren V, Demir-Deviren S, Hu SS, Bradford DS (2003) Studies in the modified Scoliosis Research Society Outcomes Instrument in adults: validation, reliability, and discriminatory capacity. Spine 28(18):2164–2169 (discussion 2169)PubMedCrossRefGoogle Scholar
  18. 18.
    Ploumis A, Liu H, Mehbod AA, Transfeldt EE, Winter RB (2009) A correlation of radiographic and functional measurements in adult degenerative scoliosis. Spine 34(15):1581–1584PubMedCrossRefGoogle Scholar
  19. 19.
    Glassman SD, Carreon LY, Shaffrey CI, Polly DW, Ondra SL, Berven SH et al (2010) The costs and benefits of nonoperative management for adult scoliosis. Spine 35(5):578–582PubMedCrossRefGoogle Scholar
  20. 20.
    Zimmerman RM, Mohamed AS, Skolasky RL, Robinson MD, Kebaish KM (2010) Functional outcomes and complications after primary spinal surgery for scoliosis in adults aged forty years or older: a prospective study with minimum two-year follow-up. Spine 35(20):1861–1866PubMedCrossRefGoogle Scholar
  21. 21.
    Terran J, Schwab F, Shaffrey CI, Smith JS, Devos P, Ames CP et al (2013) The SRS-Schwab adult spinal deformity classification: assessment and clinical correlations based on a prospective operative and nonoperative cohort. Neurosurgery 73(4):559–568PubMedCrossRefGoogle Scholar
  22. 22.
    Whitmore RG, Stephen JH, Vernick C, Campbell PG, Yadla S, Ghobrial GM et al (2014) ASA grade and Charlson Comorbidity Index of spinal surgery patients: correlation with complications and societal costs. Spine J Off J North Am Spine Soc 14(1):31–38CrossRefGoogle Scholar
  23. 23.
    Paulus MC, Kalantar SB, Radcliff K (2014) Cost and value of spinal deformity surgery. Spine 39(5):388–393PubMedCrossRefGoogle Scholar
  24. 24.
    Lafage V, Schwab F, Patel A, Hawkinson N, Farcy J-P (2009) Pelvic tilt and truncal inclination: two key radiographic parameters in the setting of adults with spinal deformity. Spine 34(17):E599–E606PubMedCrossRefGoogle Scholar
  25. 25.
    Glassman SD, Bridwell K, Dimar JR, Horton W, Berven S, Schwab F (2005) The impact of positive sagittal balance in adult spinal deformity. Spine 30(18):2024–2029PubMedCrossRefGoogle Scholar
  26. 26.
    Smith JS, Shaffrey CI, Glassman SD, Berven SH, Schwab FJ, Hamill CL et al (2011) Risk-benefit assessment of surgery for adult scoliosis: an analysis based on patient age. Spine 36(10):817–824PubMedCrossRefGoogle Scholar
  27. 27.
    Sansur CA, Smith JS, Coe JD, Glassman SD, Berven SH, Polly DW et al (2011) Scoliosis research society morbidity and mortality of adult scoliosis surgery. Spine 36(9):E593–E597PubMedCrossRefGoogle Scholar
  28. 28.
    International Spine Study Group, Moal B, Lafage V, Smith JS, Ames CP, Jr M et al (2012) Clinical improvement through surgery for adult spinal deformity (ASD): what can be expected and who is likely to benefit most? Spine J 12(9):S153CrossRefGoogle Scholar
  29. 29.
    Valverde JC, Tormo M-J, Navarro C, Rodríguez-Barranco M, Marco R, Egea J-M et al (2006) Prevalence of diabetes in Murcia (Spain): a Mediterranean area characterised by obesity. Diabetes Res Clin Pract 71(2):202–209PubMedCrossRefGoogle Scholar
  30. 30.
    Cowie CC, Rust KF, Ford ES, Eberhardt MS, Byrd-Holt DD, Li C et al (2009) Full accounting of diabetes and pre-diabetes in the US population in 1988-1994 and 2005-2006. Diabetes Care 32(2):287–294PubMedCentralPubMedCrossRefGoogle Scholar
  31. 31.
    Miravitlles M, Soriano JB, García-Río F, Muñoz L, Duran-Tauleria E, Sanchez G et al (2009) Prevalence of COPD in Spain: impact of undiagnosed COPD on quality of life and daily life activities. Thorax 64(10):863–868PubMedCrossRefGoogle Scholar

Copyright information

© Springer-Verlag Berlin Heidelberg 2014

Authors and Affiliations

  • Ferran Pellisé
    • 1
    Email author
  • Alba Vila-Casademunt
    • 2
  • Montse Ferrer
    • 3
  • Montse Domingo-Sàbat
    • 2
  • Juan Bagó
    • 1
  • Francisco J. S. Pérez-Grueso
    • 4
  • Ahmet Alanay
    • 5
  • A. F. Mannion
    • 6
  • Emre Acaroglu
    • 7
  • European Spine Study Group, ESSG
  1. 1.Spine Surgery UnitHospital Vall d’Hebron, Traumathology Building 2nd FloorBarcelonaSpain
  2. 2.Spine Research UnitVall d’Hebron Institute of ResearchBarcelonaSpain
  3. 3.Health Services Research GroupIMIM (Hospital del Mar Medical Research Institute)BarcelonaSpain
  4. 4.Spine Surgery UnitHospital Universitario La PazMadridSpain
  5. 5.Spine Surgery UnitAcibadem UniversityIstambulTurkey
  6. 6.Spine CenterSchulthess KlinikZurichSwitzerland
  7. 7.Spine Surgery UnitAnkara Spine CenterAnkaraTurkey

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