期刊
NEUROSURGERY
卷 78, 期 6, 页码 851-861出版社
OXFORD UNIV PRESS INC
DOI: 10.1227/NEU.0000000000001116
关键词
Adult spinal deformity; Complications; Nonoperative treatment; Outcomes; Scoliosis; Surgery
资金
- DePuy Synthes
- SRS
- National Institutes of Health
- DePuy Synthesis Spine
- AO
- NuVasive
- K2M
- Medicrea
- Zimmer Spine
- Stryker
- AOSpine
- DepuySynthes Globus Medtronic
- Medtronic International Spine Study Group Foundation
- DePuy Spine
- Medtronic
- k2
BACKGROUND:High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed.OBJECTIVE:To compare outcomes of operative and nonoperative treatment for ASD.METHODS:This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age >18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence-to-lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up.RESULTS:Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P < .001) and had worse deformity based on pelvic tilt, pelvic incidence-to-lumbar lordosis mismatch, and sagittal vertical axis (P .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P < .001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P < .001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P < .001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had 1 complications.CONCLUSION:Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability.ABBREVIATIONS:ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisMCID, minimal clinically important differenceNRS, numeric rating scaleODI, Oswestry Disability IndexPI, pelvic incidenceSF-36, Short Form-36SRS-22r, Scoliosis Research Society-22rSVA, sagittal vertical axis
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