title: Patient Factors That Influence Decision Making: Randomization Versus Observational Nonoperative Versus Observational Operative Treatment for Adult Symptomatic Lumbar Scoliosis.
abstract: METHODS
  A prospective study with randomized and observational cohorts.
  
  
  OBJECTIVE
  The aim of this study was to determine baseline variables affecting adult symptomatic lumbar scoliosis (ASLS) decision making to participate in randomization (RAND), observational nonsurgical (OBS-NS), or observational surgical (OBS-S) cohorts.
  
  
  BACKGROUND
  Multiple factors play a key role in a patient's decision to be randomized or to choose an OBS-NS or OBS-S course for ASLS. Studies evaluating these factors are limited.
  
  
  METHODS
  Eligible candidates (patients with ASLS and no prior spinal fusion deformity surgery) from 9 centers participated in a RAND, OBS-NS, or OBS-S cohort study. Baseline variables (demographics, socioeconomics, patient-reported outcomes [PROs], Functional Treadmill Test, radiographs) were analyzed.
  
  
  RESULTS
  Two hundred ninety-five patients were enrolled: 67 RAND, 115 OBS-NS, 113 OBS-S. Subanalysis of older patients (60-80 years) found 54% of OBS-NS had college degrees compared with 82% of RAND and 71% of OBS-S (P = 0.010). Patients deciding to be part of a RAND cohort have similar clinical characteristics to the OBS-S cohort. OBS-S had more symptomatic spinal stenosis (57% vs. 39%, P = 0.029) and worse scores than OBS-NS on the basis of PROs (Back Pain Numerical Rating Scale [NRS 6.3 vs. 5.5, P = 0.007]; Scoliosis Research Society [SRS] Pain [2.8 vs. 3.0, P = 0.018], Function [3.1 vs. 3.4, P = 0.019] and Self-Image [2.7 vs. 3.1, P = 0.002]; Oswestry Disability Index (ODI) [36.9 vs. 31.8, P = 0.029]; post-Treadmill back [5.8 vs. 4.4, P = 0.002] and leg [4.3 vs. 3.1, P = 0.037] pain NRS and larger lumbar coronal Cobb angles (56.5 degrees vs. 48.8 degrees, P < 0.001). RAND had more baseline motor deficits (10.4% vs. 1.7%, P = 0.036) and worse scores than OBS-NS on the basis of ODI (38.8 vs. 31.8, P = 0.006), SRS Function [3.1 vs. 3.4, P = 0.034], and Self-Image [2.7 vs. 3.1, P = 0.007].
  
  
  CONCLUSIONS
  Patients with worse PROs, more back pain, more back and leg pain with ambulation, and larger lumbar Cobb angles are more inclined to select surgical over nonsurgical management.
authors.affiliation: *John Hopkins University, Baltimore, MD†Washington University, St. Louis, MO‡University of Virginia, Charlottesville, VA§Mercy Medical Center, Baltimore, MD¶Northwestern University, Chicago, IL||NYU Langone Medical Center, NYC, NY**Hospital for Special Surgery, NYC, NY††Norton Leatherman Spine Center, Louisville, KY‡‡Sainte-Justine University Hospital, Montreal, QC§§UHN Orthopaedics-Toronto Western Hospital, Toronto, ON¶¶Dartmouth College, Hanover, NH.
authors.forename: Brian J
authors.initials: BJ
authors.lastname: Neuman
authors.forename: Christine
authors.initials: C
authors.lastname: Baldus
authors.forename: Lukas P
authors.initials: LP
authors.lastname: Zebala
authors.forename: Michael P
authors.initials: MP
authors.lastname: Kelly
authors.forename: Christopher
authors.initials: C
authors.lastname: Shaffrey
authors.forename: Charles
authors.initials: C
authors.lastname: Edwards
authors.forename: Tyler
authors.initials: T
authors.lastname: Koski
authors.forename: Frank
authors.initials: F
authors.lastname: Schwab
authors.forename: Steven
authors.initials: S
authors.lastname: Glassman
authors.forename: Stefan
authors.initials: S
authors.lastname: Parent
authors.forename: Stephen
authors.initials: S
authors.lastname: Lewis
authors.forename: Lawrence G
authors.initials: LG
authors.lastname: Lenke
authors.forename: Jacob M
authors.initials: JM
authors.lastname: Buchowski
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Charles H
authors.initials: CH
authors.lastname: Crawford
authors.forename: Han Jo
authors.initials: HJ
authors.lastname: Kim
authors.forename: Virginia
authors.initials: V
authors.lastname: Lafage
authors.forename: Jon
authors.initials: J
authors.lastname: Lurie
authors.forename: Leah
authors.initials: L
authors.lastname: Carreon
authors.forename: Keith H
authors.initials: KH
authors.lastname: Bridwell
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D003657:Decision Making; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery; D008875:Middle Aged; D064887:Observational Studies as Topic; D018579:Patient Selection; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000523:psychology / Q000628:therapy; D057566:Self Report; D016896:Treatment Outcome