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

  • Takashi FujishiroEmail author
  • Louis Boissière
  • Derek Thomas Cawley
  • Daniel Larrieu
  • Olivier Gille
  • Jean-Marc Vital
  • Ferran Pellisé
  • Francisco Javier Sanchez Pérez-Grueso
  • Frank Kleinstück
  • Emre Acaroglu
  • Ahmet Alanay
  • Ibrahim Obeid
  • European Spine Study Group, ESSG
Original Article



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.


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).


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.


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.


Adult spinal deformity Decision-making process Surgical indication Surgical management Adult scoliosis Scoring system 


Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

586_2019_6068_MOESM1_ESM.docx (28 kb)
Supplementary material 1 (DOCX 28 kb)
586_2019_6068_MOESM2_ESM.pptx (2 mb)
Supplementary material 2 (PPTX 2028 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2019

Authors and Affiliations

  • Takashi Fujishiro
    • 1
    • 2
    Email author
  • Louis Boissière
    • 2
  • Derek Thomas Cawley
    • 2
  • Daniel Larrieu
    • 2
  • Olivier Gille
    • 2
  • Jean-Marc Vital
    • 2
  • Ferran Pellisé
    • 3
  • Francisco Javier Sanchez Pérez-Grueso
    • 4
  • Frank Kleinstück
    • 5
  • Emre Acaroglu
    • 6
  • Ahmet Alanay
    • 7
  • Ibrahim Obeid
    • 2
  • European Spine Study Group, ESSG
  1. 1.Department of Orthopedic SurgeryOsaka Medical CollegeTakatsuki-shiJapan
  2. 2.L’Institut de la Colonne VertébraleBordeaux University HospitalBordeauxFrance
  3. 3.Spine Surgery UnitHospital Universitario Val HebronBarcelonaSpain
  4. 4.Spine Surgery UnitHospital Universitario La PazMadridSpain
  5. 5.Spine CenterSchulthess KlinikZurichSwitzerland
  6. 6.Ankara Spine CenterAnkaraTurkey
  7. 7.Spine Surgery UnitAcibadem Maslak HospitalIstanbulTurkey

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