Decision-making factors in the treatment of adult spinal deformity
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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).
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.
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.
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.
KeywordsAdult spinal deformity Decision-making process Treatment Scoliosis Sagittal parameter Surgical indication
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.
Compliance with ethical standards
Conflict of interest
The authors declare that they have no conflict of interest.
- 1.Takemoto M, Obeid I, Boissiere L et al (2016) Surgical versus non-surgical treatment in adult spinal deformity: an observational study and propensity-adjusted analysis. In: Proceedings of the 51st annual meeting of the Scoliosis Research Society, Prague, Czech RepublicGoogle Scholar
- 6.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 CrossRefPubMedGoogle Scholar
- 7.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 CrossRefPubMedGoogle Scholar
- 8.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 CrossRefPubMedPubMedCentralGoogle Scholar
- 17.Boissiere L, Bourghli A, Vital J-M et al (2013) The lumbar lordosis index: a new ratio to detect spinal malalignment with a therapeutic impact for sagittal balance correction decisions in adult scoliosis surgery. Eur Spine J 22:1339–1345. https://doi.org/10.1007/s00586-013-2711-y CrossRefPubMedPubMedCentralGoogle Scholar
- 22.Takemoto M, Boissiere L, Vital J-M et al (2017) Are sagittal spinopelvic radiographic parameters significantly associated with quality of life of adult spinal deformity patients? Multivariate linear regression analyses for pre-operative and short-term post-operative health-related quality of life. Eur Spine J 26:2176–2186. https://doi.org/10.1007/s00586-016-4872-y CrossRefPubMedGoogle Scholar
- 23.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 CrossRefPubMedGoogle Scholar