European Spine Journal

, Volume 28, Issue 7, pp 1652–1660 | Cite as

Adult spinal deformity surgical decision-making score

Part 1: development and validation of a scoring system to guide the selection of treatment modalities for patients below 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 simple scoring system: the adult spinal deformity (ASD) surgical decision-making (ASD-SDM) score, which is specific to the decision-making process for ASD patients aged below 40 years.


A multicentre prospective ASD database was retrospectively reviewed. The scoring system was developed using data from a derivation cohort and was internally validated in a validation cohort. The accuracy of the ASD-SDM score was assessed using the area under the receiver operating characteristic curve (AUC).


A total of 316 patients were randomly divided into derivation (253 patients, 80%) and validation (63 patients, 20%) cohorts. A 10-point scoring system was created from four variables: self-image score in the Scoliosis Research Society-22 score, coronal Cobb angle, pelvic incidence minus lumbar lordosis mismatch, and relative spinopelvic alignment, and the surgical indication was graded into low (score 0–4), moderate (score 5–7), and high (score 8–10) surgical indication groups. In the validation cohort, the AUC for selecting surgical management according to the ASD-SDM score was 0.789 (SE 0.057, P < 0.001, 95% CI 0.655–0.880). The percentage of patients treated surgically were 21.1%, 55.0%, and 80.0% in the low, moderate, and high surgical indication groups, respectively.


The ASD-SDM score, to the best of our knowledge, is the first algorithm to guide the decision-making process for the ASD population and could be one of the indices for aiding the selection of treatment for ASD.

Graphical abstract

These slides can be retrieved under Electronic Supplementary Material.


Adult spinal deformity Surgical indication Decision-making process Scoliosis Scoring system 



Grants/research support: Cawley DT: Irish Orthopaedic Association, Irish Institute of Trauma and Orthopaedic Surgery, Société Francaise de Chirurgie Orthopédique et Traumatologique; Pellise F: Depuy Synthes, K2M; Perez-Grueso F.S: Depuy Synthes, K2M; Acaroglu E: Fondation Cotrel, Deputy 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_2019_5932_MOESM1_ESM.pptx (23.2 mb)
Supplementary material 1 (PPTX 23742 kb)
586_2019_5932_MOESM2_ESM.docx (39 kb)
Supplementary material 2 (DOCX 39 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 CollegeOsakaJapan
  2. 2.Bordeaux University HospitalL’Institut de la Colonne VertébraleBordeauxFrance
  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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