• Peter G Passias, Waleed Ahmad, Peter Tretiakov, Oscar Krol, Frank Segreto, Renaud Lafage, Virginie Lafage, Alex Soroceanu, Alan Daniels, Jeffrey Gum, Breton Line, Andrew J Schoenfeld, Shaleen Vira, Robert Hart, Douglas Burton, Justin S Smith, Christopher P Ames, Christopher Shaffrey, Frank Schwab, Shay Bess, and International Spine Study Group.
• Departments of Orthopedic and Neurologic Surgery, NYU Langone Orthopedic Hospital, New York Spine Institute, New York , New York , USA.
• Neurosurgery. 2023 Aug 1; 93 (2): 480488480-488.

BackgroundAdult spinal deformity (ASD) represents a major cause of disability in the elderly population in the United States. Surgical intervention has been shown to reduce disability and pain in properly indicated patients. However, there is a small subset of patients in whom nonoperative treatment is also able to durably maintain or improve symptoms.ObjectiveTo examine the factors associated with successful nonoperative management in patients with ASD.MethodsWe retrospectively evaluated a cohort of 207 patients with nonoperative ASD, stratified into 3 groups: (1) success, (2) no change, and (3) failure. Success was defined as a gain in minimal clinically importance difference in both Oswestry Disability Index and Scoliosis Research Society-Pain. Logistic regression model and conditional inference decision trees established cutoffs for success according to baseline (BL) frailty and sagittal vertical axis.ResultsIn our cohort, 44.9% of patients experienced successful nonoperative treatment, 22.7% exhibited no change, and 32.4% failed. Successful nonoperative patients at BL were significantly younger, had a lower body mass index, decreased Charlson Comorbidity Index, lower frailty scores, lower rates of hypertension, obesity, depression, and neurological dysfunction (all P < .05) and significantly higher rates of grade 0 deformity for all Schwab modifiers (all P < .05). Conditional inference decision tree analysis determined that patients with a BL ASD-frailty index ≤ 1.579 (odds ratio: 8.3 [4.0-17.5], P < .001) were significantly more likely to achieve nonoperative success.ConclusionSuccess of nonoperative treatment was more frequent among younger patients and those with less severe deformity and frailty at BL, with BL frailty the most important determinant factor. The factors presented here may be useful in informing preoperative discussion and clinical decision-making regarding treatment strategies.Copyright © Congress of Neurological Surgeons 2023. All rights reserved.

19 keywords...

hide…