Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study

Abstract

Purpose

The aim of this study was to evaluate factors that distinguish between patients with adult spinal deformity (ASD) with and without an indication for surgery, irrespective of their final treatment.

Methods

Baseline variables (demographics, medical history, outcome measures, coronal, sagittal and neurologic parameters) were evaluated in a multicentre, prospective cohort of patients with ASD. Multivariable analyses were carried out for idiopathic and degenerative patients separately with the dependent variable being “indication for surgery” and baseline parameters as independent variables.

Results

In total, 342 patients with degenerative ASD and 624 patients with idiopathic ASD were included in the multivariable models. In patients with degenerative ASD, the parameters associated with having an indication for surgery were greater self-rated disability on the Oswestry Disability Index [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02–1.07] and a lower thoracic kyphosis (OR 0.97 95% CI 0.95–0.99), whereas in patients with idiopathic ASD, it was lower (worse) SRS self-image scores (OR 0.45 95% CI 0.32–0.64), a higher value for the major Cobb angle (OR 1.03 95% CI 1.01–1.05), lower age (OR 0.96 95% CI 0.95–0.98), prior decompression (OR 3.76 95% CI 1.00–14.08), prior infiltration (OR 2.23 95% CI 1.12–4.43), and the presence of rotatory subluxation (OR 1.98 95% CI 1.11–3.54) and sagittal subluxation (OR 4.38 95% CI 1.61–11.95).

Conclusion

Specific sets of variables were found to be associated with an indication for surgery in patients with ASD. These should be investigated in relation to patient outcomes for their potential to guide the future development of decision aids in the treatment of ASD.

Graphical abstract

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Fig. 1

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Acknowledgements

The European Spine Study Group is sponsored by a Johnson and Johnson DePuy-Synthes Spine research grant.

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Correspondence to S. Richner-Wunderlin.

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None of the authors has any potential conflict of interest.

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Richner-Wunderlin, S., Mannion, A.F., Vila-Casademunt, A. et al. Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study. Eur Spine J 28, 127–137 (2019). https://doi.org/10.1007/s00586-018-5754-2

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Keywords

  • Adult spinal deformity
  • Indication for surgery
  • Decision-making
  • Multivariable analyses
  • Prognostic factors