title: Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity: A Prospective, Multicenter, Propensity-Matched Cohort Assessment With Minimum 2-Year Follow-up.
abstract: High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed.
  
  
  
  To compare outcomes of operative and nonoperative treatment for ASD.
  
  
  
  This is a multicenter, prospective analysis of consecutive ASD patients opting for operative or nonoperative care. Inclusion criteria were age >18 years and ASD. Operative and nonoperative patients were propensity matched with the baseline Oswestry Disability Index, Scoliosis Research Society-22r, thoracolumbar/lumbar Cobb angle, pelvic incidence-to-lumbar lordosis mismatch (PI-LL), and leg pain score. Analyses were confined to patients with a minimum of 2 years of follow-up.
  
  
  
  Two hundred eighty-six operative and 403 nonoperative patients met the criteria, with mean ages of 53 and 55 years, 2-year follow-up rates of 86% and 55%, and mean follow-up of 24.7 and 24.8 months, respectively. At baseline, operative patients had significantly worse health-related quality of life (HRQOL) based on all measures assessed (P < .001) and had worse deformity based on pelvic tilt, pelvic incidence-to-lumbar lordosis mismatch, and sagittal vertical axis (P ≤ .002). At the minimum 2-year follow-up, all HRQOL measures assessed significantly improved for operative patients (P < .001), but none improved significantly for nonoperative patients except for modest improvements in the Scoliosis Research Society-22r pain (P = .04) and satisfaction (P < .001) domains. On the basis of matched operative-nonoperative cohorts (97 in each group), operative patients had significantly better HRQOL at follow-up for all measures assessed (P < .001), except Short Form-36 mental component score (P = .06). At the minimum 2-year follow-up, 71.5% of operative patients had ≥1 complications.
  
  
  
  Operative treatment for ASD can provide significant improvement of HRQOL at a minimum 2-year follow-up. In contrast, nonoperative treatment on average maintains presenting levels of pain and disability.
  
  
  
  ASD, adult spinal deformityHRQOL, health-related quality of lifeLL, lumbar lordosisMCID, minimal clinically important differenceNRS, numeric rating scaleODI, Oswestry Disability IndexPI, pelvic incidenceSF-36, Short Form-36SRS-22r, Scoliosis Research Society-22rSVA, sagittal vertical axis.
authors.affiliation: *Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, Virginia; ‡Department of Orthopedic Surgery, NYU Hospital for Joint Diseases, New York, New York; §Department of Orthopedic Surgery, Baylor Scoliosis Center, Plano, Texas; ¶Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York; ‖San Diego Center for Spinal Disorders, La Jolla, California; #Department of Neurosurgery, University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania; **Department of Neurosurgery, Northwestern University Medical Center, Chicago, Illinois; ‡‡Department of Neurosurgery, Johns Hopkins University School of Medicine, Baltimore, Maryland; §§Department of Neurosurgery, Weill Cornell Medical College, New York City, New York; ¶¶Department of Orthopedic Surgery, Washington University, St. Louis, Missouri; ‖‖Department of Orthopedic Surgery, Rocky Mountain Hospital for Children, Denver, Colorado; ##Department of Orthopedic Surgery, University of California Davis, Sacramento, California; ***Department of Orthopedic Surgery, University of California San Francisco, San Francisco, California; ‡‡‡Department of Orthopedic Surgery, Oregon Health Sciences University, Portland, Oregon; §§§Department of Orthopedic Surgery, University of Kansas Medical Center, Kansas City, Kansas; ¶¶¶Department of Neurosurgery, University of California San Francisco, San Francisco, California.
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mesh_terms: D000328:Adult; D000072700:Conservative Treatment; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures; D057216:Propensity Score; D011446:Prospective Studies; D011788:Quality of Life; D013122:Spinal Diseases / Q000628:therapy*; D016896:Treatment Outcome