title: The selection of operative versus nonoperative treatment in patients with adult scoliosis.
abstract: METHODS
  Retrospective case-control matched series.
  
  
  OBJECTIVE
  The purpose of this study is to define factors that influence the patient and surgeon in the selection of surgical versus nonsurgical treatment for adult scoliosis.
  
  
  BACKGROUND
  There is no literature that specifically examines why adult scoliosis patients and/or their surgeons choose surgical versus nonsurgical treatment.
  
  
  METHODS
  This study analyzes a prospective multicentered database for adult spinal deformity. A logistic regression technique was used to perform case-control matching. A total of 161 matched pairs were compared for radiographic characteristics, questionnaire responses, and standardized outcome measures.
  
  
  RESULTS
  Nonsurgical patients had greater preoperative medical risk factors. Surgical patients had larger thoracic (51 degrees vs. 44 degrees, P = 0.006) and thoracolumbar/lumbar curves (55 degrees vs. 43 degrees, P = 0.000). Surgical patients had more frequent leg pain (47% vs. 35%, P = 0.04). They reported a higher mean level of daily back pain (P = 0.008) and more frequent moderate-to-severe back pain over the past 6 months (P = 0.03). There were also significant differences in perception of appearance and social function between the cohorts.
  
  
  CONCLUSIONS
  This study emphasizes the complexity of surgical decision making for adult scoliosis patients. It also underscores the importance of patient-based health status measures in evaluating the adult scoliosis patient.
authors.affiliation: Department of Orthopaedic Surgery, University of Louisville School of Medicine and the Kenton D. Leatherman Spine Center, Louisville, KY, USA. tallgeyer@spinemds.com
authors.forename: Steven D
authors.initials: SD
authors.lastname: Glassman
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
authors.forename: Stephen L
authors.initials: SL
authors.lastname: Ondra
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016022:Case-Control Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D017060:Patient Satisfaction; D011446:Prospective Studies; D012189:Retrospective Studies; D012307:Risk Factors; D012600:Scoliosis / Q000453:epidemiology / Q000534:rehabilitation* / Q000601:surgery*