title: The Health Impact of Symptomatic Adult Spinal Deformity: Comparison of Deformity Types to United States Population Norms and Chronic Diseases.
abstract: METHODS
  A retrospective analysis of a prospective, multicenter database.
  
  
  OBJECTIVE
  The aim of this study was to evaluate the health impact of symptomatic adult spinal deformity (SASD) by comparing Standard Form Version 2 (SF-36) scores for SASD with United States normative and chronic disease values.
  
  
  BACKGROUND
  Recent data have identified radiographic parameters correlating with poor health-related quality of life for SASD. Disability comparisons between SASD patients and patients with chronic diseases may provide further insight to the disease burden caused by SASD.
  
  
  METHODS
  Consecutive SASD patients, with no history of spine surgery, were enrolled into a multicenter database and evaluated for type and severity of spinal deformity. Baseline SF-36 physical component summary (PCS) and mental component summary (MCS) values for SASD patients were compared with reported U.S. normative and chronic disease SF-36 scores. SF-36 scores were reported as normative-based scores (NBS) and evaluated for minimally clinical important difference (MCID).
  
  
  RESULTS
  Between 2008 and 2011, 497 SASD patients were prospectively enrolled and evaluated. Mean PCS for all SASD was lower than U.S. total population (ASD = 40.9; US = 50; P < 0.05). Generational decline in PCS for SASD patients with no other reported comorbidities was more rapid than U.S. norms (P < 0.05). PCS worsened with lumbar scoliosis and increasing sagittal vertical axis (SVA). PCS scores for patients with isolated thoracic scoliosis were similar to values reported by individuals with chronic back pain (45.5 vs 45.7, respectively; P > 0.05), whereas patients with lumbar scoliosis combined with severe sagittal malalignment (SVA >10 cm) demonstrated worse PCS scores than values reported by patients with limited use of arms and legs (24.7 vs 29.1, respectively; P < 0.05).
  
  
  CONCLUSIONS
  SASD is a heterogeneous condition that, depending upon the type and severity of the deformity, can have a debilitating impact on health often exceeding the disability of more recognized chronic diseases. Health care providers must be aware of the types of SASD that correlate with disability to facilitate appropriate diagnosis, treatment, and research efforts.
  
  
  METHODS
  3.
authors.affiliation: *Rocky Mountain Hospital for Children†Rocky Mountain Scoliosis & Spine, Denver, CO‡Cornell University School of Medicine, New York, NY§Emory University, Department of Economics, Atlanta, GA||New York University School of Medicine, Department of Orthopedic Surgery, New York, NY¶University of Virginia School of Medicine, Department of Neurosurgery, Charlottesville, VA#University of California San Francisco School of Medicine, Department of Neurosurgery, San Francisco**San Diego Center for Spinal Disorders, La Jolla, CA††Hospital for Special Surgery, Department of Orthopedic Surgery, New York, NY‡‡Washington University, Saint Louis, MO§§University of Kansas School of Medicine, Department of Orthopedic Surgery, Kansas City, KS||||University of Oregon School of Medicine, Department of Orthopedic Surgery, Portland, OR¶¶University of California Davis School of Medicine, Department of Orthopedic Surgery, Sacramento, CA##Johns Hopkins University School of Medicine, Department of Orthopedic Surgery, Baltimore, MD***Baylor Scoliosis Center, Plano, TX.
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Breton
authors.initials: B
authors.lastname: Line
authors.forename: Kai-Ming
authors.initials: KM
authors.lastname: Fu
authors.forename: Ian
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authors.lastname: McCarthy
authors.forename: Virgine
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authors.lastname: Schwab
authors.forename: Christopher
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authors.lastname: Shaffrey
authors.forename: Christopher
authors.initials: C
authors.lastname: Ames
authors.forename: Behrooz
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authors.lastname: Jo
authors.forename: Michael
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authors.lastname: Kelly
authors.forename: Douglas
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authors.lastname: Burton
authors.forename: Robert
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authors.lastname: Hart
authors.forename: Eric
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authors.lastname: Klineberg
authors.forename: Khaled
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authors.lastname: Kebaish
authors.forename: Richard
authors.initials: R
authors.lastname: Hostin
authors.forename: Gregory
authors.initials: G
authors.lastname: Mundis
authors.forename: Praveen
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authors.initials: JS
authors.lastname: Smith
mesh_terms: D000328:Adult; D000368:Aged; D002908:Chronic Disease; D005260:Female; D006304:Health Status; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011159:Population Surveillance; D011446:Prospective Studies; D012189:Retrospective Studies; D013122:Spinal Diseases / Q000000981:diagnostic imaging* / Q000453:epidemiology*; D014481:United States / Q000453:epidemiology