European Spine Journal

, Volume 27, Issue 9, pp 2312–2321 | Cite as

Decision-making factors in the treatment of adult spinal deformity

  • Takashi Fujishiro
  • 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
  • On behalf of European Spine Study Group, ESSG
Original Article



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.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Adult 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.

Supplementary material

586_2018_5572_MOESM1_ESM.pptx (215 kb)
Supplementary material 1 (PPTX 216 kb)
586_2018_5572_MOESM2_ESM.pdf (93 kb)
Supplementary material 2 (PDF 94 kb)


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Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Takashi Fujishiro
    • 1
    • 2
  • Louis Boissière
    • 1
  • Derek Thomas Cawley
    • 1
  • Daniel Larrieu
    • 1
  • Olivier Gille
    • 1
  • Jean-Marc Vital
    • 1
  • Ferran Pellisé
    • 3
  • Francisco Javier Sanchez Pérez-Grueso
    • 4
  • Frank Kleinstück
    • 5
  • Emre Acaroglu
    • 6
  • Ahmet Alanay
    • 7
  • Ibrahim Obeid
    • 1
  • On behalf of European Spine Study Group, ESSG
  1. 1.L’Institut de la Colonne VertébraleBordeaux University HospitalBordeauxFrance
  2. 2.Department of Orthopedic SurgeryOsaka Medical CollegeOsakaJapan
  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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