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



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.


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.


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).


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.

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