title: Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up.
abstract: METHODS
  Retrospective review of a prospective, multicenter study.
  
  
  OBJECTIVE
  The purpose of this study was to assess the prevalence and severity of leg pain in adults with scoliosis and to assess whether surgery significantly improved leg pain compared with nonoperative management.
  
  
  BACKGROUND
  Patients with adult scoliosis characteristically present with pain. The presence of leg pain is an independent predictor of a patient's choice for operative over nonoperative care.
  
  
  METHODS
  Data were extracted from a prospective, multicenter database for adult spinal deformity. At enrollment and follow-up, patients complete the Oswestry Disability Index (ODI) and assessment of leg pain using the numerical rating scale (NRS) score, with 0 and 10 representing no pain and unbearable pain, respectively. Plan for operative or nonoperative treatment was made at enrollment. The vast majority of adult scoliosis patients seen in our surgical clinics have received nonoperative therapies and are being seen for a surgical evaluation. Patients are counseled regarding operative and nonoperative management options and are in general encouraged to maximize nonoperative treatments.
  
  
  RESULTS
  Two hundred eight (64%) of 326 adults with scoliosis had leg pain at presentation (mean NRS score = 4.7). Ninety-six patients with leg pain (46%) were managed operatively and 112 were treated nonoperatively. The operative group had higher baseline mean NRS score for leg pain (5.4 vs. 4.1, P < 0.001) and higher mean ODI (41 vs. 30, P < 0.001). At 2-year follow-up, nonoperative patients had no significant change in ODI or NRS score for leg pain (P = 0.2). In contrast, at 2-year follow-up surgically treated patients had significant improvement in mean NRS score for leg pain (5.4 vs. 2.2, P < 0.001) and ODI (41 vs. 24, P < 0.001). Compared with nonsurgically treated patients, at 2-year follow-up operative patients had lower mean NRS score for leg pain (2.2 vs. 3.8, P < 0.001) and mean ODI (24 vs. 31, P = 0.005).
  
  
  CONCLUSIONS
  Despite having started with significantly greater leg pain and disability, surgically treated patients at 2-year follow-up had significantly less leg pain and disability than nonoperatively treated patients. Surgical treatment has the potential to provide significant improvement of leg pain in adults with scoliosis.
authors.affiliation: Department of Neurosurgery, University of Virginia, Charlottesville, VA 22908, USA.
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Sigurd
authors.initials: S
authors.lastname: Berven
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: Christopher
authors.initials: C
authors.lastname: Hamill
authors.forename: William
authors.initials: W
authors.lastname: Horton
authors.forename: Stephen
authors.initials: S
authors.lastname: Ondra
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Michael
authors.initials: M
authors.lastname: Shainline
authors.forename: Kai-Ming G
authors.initials: KM
authors.lastname: Fu
authors.forename: Keith
authors.initials: K
authors.lastname: Bridwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016208:Databases, Factual / Q000706:statistics & numerical data; D004185:Disability Evaluation; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007866:Leg; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic / Q000706:statistics & numerical data; D017063:Outcome Assessment, Health Care / Q000379:methods / Q000706:statistics & numerical data; D010146:Pain / Q000150:complications / Q000601:surgery*; D059408:Pain Management; D010147:Pain Measurement; D012189:Retrospective Studies; D012600:Scoliosis / Q000150:complications*; D013997:Time Factors; D055815:Young Adult