• Justin S Smith, Virginie Lafage, Christopher I Shaffrey, Frank Schwab, Renaud Lafage, Richard Hostin, Michael OʼBrien, Oheneba Boachie-Adjei, Behrooz A Akbarnia, Gregory M Mundis, Thomas Errico, Han Jo Kim, Themistocles S Protopsaltis, D Kojo Hamilton, Justin K Scheer, Daniel Sciubba, Tamir Ailon, Kai-Ming G Fu, Michael P Kelly, Lukas Zebala, Breton Line, Eric Klineberg, Munish Gupta, Vedat Deviren, Robert Hart, Doug Burton, Shay Bess, Christopher P Ames, and International Spine Study Group.
• *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.
• Neurosurgery. 2016 Jun 1; 78 (6): 851-61.

BackgroundHigh-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed.ObjectiveTo compare outcomes of operative and nonoperative treatment for ASD.MethodsThis 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.ResultsTwo 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.ConclusionOperative 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.AbbreviationsASD, 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.

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