title: Functional Limitations Due to Lumbar Stiffness in Adults With and Without Spinal Deformity.
abstract: METHODS
  Cross-sectional analysis.
  
  
  OBJECTIVE
  To compare Lumbar Stiffness Disability Index (LSDI) scores between asymptomatic adults and patients with spinal deformity.
  
  
  BACKGROUND
  The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. Baseline disability levels of patients with adult spinal deformity (ASD) are high as measured by multiple validated outcome tools. Baseline lumbar stiffness-related disability has not been assessed in adults with and without spinal deformity.
  
  
  METHODS
  The LSDI and Scoliosis Research Society-22r (SRS-22r) were submitted to a group of asymptomatic adult volunteers. Additionally, a multicenter cross-sectional cohort analysis of patients with ASD from 10 centers was conducted. Baseline LSDI and SRS-22r were completed for both operatively and nonoperatively treated patients with deformity.
  
  
  RESULTS
  The LSDI was completed by 176 asymptomatic volunteers and 693 patients with ASD. Mean LSDI score for asymptomatic volunteers was 3.4 +/- 6.3 out of a maximum score of 100, with significant correlation between increasing age and higher (worse) LSDI score (r = 0.30, P = 0.0001). Of the patients with spinal deformity undergoing analysis, 301 subsequently underwent surgery and 392 were subsequently treated nonoperatively. Operative patients had significantly higher preoperative LSDI scores than both nonoperative patients and asymptomatic volunteers (29.9 vs. 17.3 vs. 3.4, P < 0.0001 for both). For patients with ASD, significant correlations were found between LSDI and SRS-22 Pain and Function subscales (r = -0.75 and -0.76, respectively; P < 0.0001 for both).
  
  
  CONCLUSIONS
  LSDI scores are low among asymptomatic volunteers, although stiffness-related disability increases with increasing age. Patients with ASD report substantial stiffness-related disability even prior to surgical fusion. Stiffness-related disability correlates with pain- and function-related disability measures among patients with spinal deformity.
authors.affiliation: Department of Orthopaedics, Warren Alpert School of Medicine, Brown University, Providence, RI†Department of Neurosurgery, University of Virginia, Charlottesville, VA‡Department of Orthopedics and Rehabilitation, Oregon Health and Science University, Portland, OR§Department of Neurosurgery, University of California-San Francisco Medical Center, San Francisco, CA¶Department of Orthopaedic Surgery, Rocky Mountain Hospital for Children, Denver, CO∥Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, New York, NY**Department of Orthopaedic Surgery, University of California-Davis, Sacramento, CA††Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas City, KS‡‡San Diego Center for Spinal Disorders, La Jolla, CA; and§§International Spine Study Group (ISSG).
authors.forename: Alan H
authors.initials: AH
authors.lastname: Daniels
authors.forename: Justin S
authors.initials: JS
authors.lastname: Smith
authors.forename: Jayme
authors.initials: J
authors.lastname: Hiratzka
authors.forename: Christopher P
authors.initials: CP
authors.lastname: Ames
authors.forename: Shay
authors.initials: S
authors.lastname: Bess
authors.forename: Christopher I
authors.initials: CI
authors.lastname: Shaffrey
authors.forename: Frank J
authors.initials: FJ
authors.lastname: Schwab
authors.forename: Virginie
authors.initials: V
authors.lastname: Lafage
authors.forename: Eric O
authors.initials: EO
authors.lastname: Klineberg
authors.forename: Doug
authors.initials: D
authors.lastname: Burton
authors.forename: Greg M
authors.initials: GM
authors.lastname: Mundis
authors.forename: Breton
authors.initials: B
authors.lastname: Line
authors.forename: Robert A
authors.initials: RA
authors.lastname: Hart
mesh_terms: D000203:Activities of Daily Living; D000293:Adolescent; D000328:Adult; D000368:Aged; D003430:Cross-Sectional Studies; D004185:Disability Evaluation; D006233:Persons with Disabilities; D005260:Female; D006801:Humans; D007738:Kyphosis / Q000503:physiopathology* / Q000601:surgery; D008159:Lumbar Vertebrae / Q000503:physiopathology* / Q000601:surgery; D008161:Lumbosacral Region / Q000503:physiopathology* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D011788:Quality of Life; D012600:Scoliosis / Q000503:physiopathology* / Q000601:surgery; D013123:Spinal Fusion; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D055815:Young Adult