title: Function and Clinical Symptoms are the Main Factors that Motivate Thoracolumbar Adult Scoliosis Patients to Pursue Surgery.
abstract: METHODS
  A retrospective two-cohort comparative analysis of data collected prospectively in an adult deformity multicenter database.
  
  
  OBJECTIVE
  The aim of this study was to define the radiographic and clinical parameters that motivate adult thoracolumbar (TL) scoliosis patients to undergo surgery.
  
  
  BACKGROUND
  TL curves are a primary concern in adulthood, and it is necessary to establish why patients are motivated to seek surgical intervention.
  
  
  METHODS
  Patients with only main TL/lumbar (TL/L) idiopathic curves were included, defined as Schwab type L curves and Schwab type D curves in which thoracic curves were <40° and the difference between the TL/L-MT Cobb was ≥15°. Demographic data, health-related quality of life (HRQOL) questionnaires, and 14 different radiological preoperative parameters were assessed. Surgical versus conservative cohorts were compared with the Student t test, Chi-square, and the Mann-Whitney U test.
  
  
  RESULTS
  A total of 184 patients met the inclusion criteria. Ninety-four were treated conservatively (C), while 90 underwent surgery (S). No differences were found between groups in terms of demographic or radiographic preoperative data. Age (C: 57.5 ± 18 vs. S: 54.2 ± 18 yr; P = 0.18), coronal TL/L Cobb (C: 52.3° ± 15 vs. S: 50.6° ± 13; P = 0.61), and sagittal alignment (SVA C: 3.1 cm ± 5.7 vs. S: 4.9 cm ± 6.4; P = 0.054) were similar. No differences were found in pelvic parameters (pelvic incidence, pelvic tilt, sacral slope), apical translation, coronal balance, lumbar rotatory subluxation, or lumbar lordosis. However, significant differences were found in HRQOL questionnaires. Surgical patients initially had worse COMI scores (C: 4.6 ± 2.3 vs. S: 6 ± 2.3; P = 0.001), worse ODI scores (C: 27.7 ± 16 vs. S: 38.9 ± 20; P = 0.000), worse SF-36 physical (C: 40.9 ± 8.5 vs. S: 36 ± 9.5; P = 0.001) and mental scores (C: 45.8 ± 12 vs. S: 42.2 ± 11.8; P = 0.032), and worse SRS-22 scores in all domains with mean values under 3.1 points (range = 2.4-3.1). In both SF-36 physical and SRS-22 function, differences between groups were higher than the minimum clinically important difference.
  
  
  CONCLUSIONS
  After analyzing a large multicenter database, we found that only clinical factors-particularly function impairment-motivated adult TL scoliosis patients to undergo surgery. Demographic and radiographic parameters did not seem to influence decision-making.
  
  
  METHODS
  3.
authors.affiliation: Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Javier
authors.initials: J
authors.lastname: Pizones
authors.affiliation: Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Mar
authors.initials: M
authors.lastname: Pérez Martin-Buitrago
authors.affiliation: Spine Unit, Department of Orthopedic Surgery, Hospital Universitario La Paz, Madrid, Spain.
authors.forename: Francisco Javier Sánchez
authors.initials: FJS
authors.lastname: Perez-Grueso
authors.affiliation: Spine Research Unit, Vall d'Hebron Institute of Research, Barcelona, Spain.
authors.forename: Alba
authors.initials: A
authors.lastname: Vila-Casademunt
authors.affiliation: Spine Surgery Unit, Acibadem Maslak Hospital, Istanbul, Turkey.
authors.forename: Ahmet
authors.initials: A
authors.lastname: Alanay
authors.affiliation: Spine Surgery Unit, Pellegrin University Hospital, Bordeaux, France.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Obeid
authors.affiliation: Department of Orthopedics, Schulthess Klinik, Zurich, Switzerland.
authors.forename: Frank
authors.initials: F
authors.lastname: Kleinstück
authors.affiliation: Orthopedic Spine Unit, Ankara Spine Center, Ankara, Turkey.
authors.forename: Emre R
authors.initials: ER
authors.lastname: Acaroglu
authors.affiliation: Spine Surgery Unit, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
authors.forename: Ferran
authors.initials: F
authors.lastname: Pellisé
mesh_terms: D000328:Adult; D000368:Aged; D003657:Decision Making; D005260:Female; D006304:Health Status; D006801:Humans; D008159:Lumbar Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D009042:Motivation; D011788:Quality of Life; D012189:Retrospective Studies; D012600:Scoliosis / Q000000981:diagnostic imaging / Q000523:psychology / Q000601:surgery*; D013904:Thoracic Vertebrae / Q000000981:diagnostic imaging / Q000601:surgery*; D016896:Treatment Outcome