title: Pain and disability determine treatment modality for older patients with adult scoliosis, while deformity guides treatment for younger patients.
abstract: METHODS
  Multi-center, retrospective review.
  
  
  OBJECTIVE
  Identify age associated clinical and radiographic features correlating with AS treatment.
  
  
  BACKGROUND
  Little information exists about factors determining treatment for adult scoliosis (AS). Existing studies have not evaluated age stratified differences.
  
  
  METHODS
  Multicenter, retrospective review of 290 patients treated for AS. Patients divided into operative (OP) or nonoperative (NON), and age stratified into 3 groups (G1 = <50 years, G2 = 50-65 years, G3 = >65 years). Demographic and spinopelvic radiographic parameters evaluated. Health-related quality of life (HRQL) measures included SRS-22, Oswestry Disability Index (ODI), visual analog pain scale.
  
  
  RESULTS
  Treatment groups (OP, n = 137; NON, n = 153) demonstrated similar age (OP = 52.7 years; NON = 55.5 years; P > 0.05) and comorbidities. OP had larger thoracic curves than NON (OP = 51 degrees, NON = 45 degrees; P < 0.05). OP had worse HRQL scores than NON (SRS = 2.95 vs. 3.12, P < 0.05; ODI = 33.4 vs. 28.7, P < 0.05; visual analog pain scale = 6.9 vs. 5.6, P < 0.05, respectively). Age stratification of OP demonstrated larger curves in G1 and G2 versus G3, progressively worsening sagittal imbalance in older age groups, and worse HRQL scores in G3 versus G1 and G2. Age stratification of NON demonstrated worsening sagittal imbalance with age, however, other radiographic values and HRQL scores were similar between all NON age groups. Treatment stratification of age groups demonstrated G1-OP had greater deformity than G1-NON (mean thoracic curve: G1-OP = 53 degrees, G1-NON = 43 degrees; P < 0.05) but similar HRQL values. Whereas G2 and G3-OP had similar radiographic coronal and sagittal values as G2 and G3-NON, but worse HRQL scores.
  
  
  CONCLUSIONS
  Counter to previous reports, age, comorbidities, and sagittal balance did not influence treatment modality for AS. Operative treatment for younger patients was driven by increased coronal plane deformity. Conversely, pain and disability mandated treatment for older patients, independent of radiographic measures. These findings suggest that AS patients do not become uniformly disabled with age, and that disability can not be solely predicted by radiographic findings. These data should be considered when considering treatment for AS.
authors.affiliation: Rocky Mountain Hospital for Children, Department of Orthopaedic Surgery, Denver, CO 80218, USA. shay_bess@hotmail.com
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Oheneba
authors.initials: O
authors.lastname: Boachie-Adjei
authors.forename: Doug
authors.initials: D
authors.lastname: Burton
authors.forename: Matthew
authors.initials: M
authors.lastname: Cunningham
authors.forename: Chris
authors.initials: C
authors.lastname: Shaffrey
authors.forename: Alexis
authors.initials: A
authors.lastname: Shelokov
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Kirkham
authors.initials: K
authors.lastname: Wood
authors.forename: Behrooz
authors.initials: B
authors.lastname: Akbarnia
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010146:Pain / Q000209:etiology / Q000503:physiopathology; D059408:Pain Management; D010147:Pain Measurement; D018579:Patient Selection; D026741:Physical Therapy Modalities; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications / Q000175:diagnosis / Q000628:therapy*; D012720:Severity of Illness Index; D013123:Spinal Fusion; D055815:Young Adult