• Alan H Daniels, Justin S Smith, Jayme Hiratzka, Christopher P Ames, Shay Bess, Christopher I Shaffrey, Frank J Schwab, Virginie Lafage, Eric O Klineberg, Doug Burton, Greg M Mundis, Breton Line, Robert A Hart, and International Spine Study Group (ISSG).
• 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).
• Spine. 2015 Oct 15; 40 (20): 159916041599-604.

Study DesignCross-sectional analysis.ObjectiveTo compare Lumbar Stiffness Disability Index (LSDI) scores between asymptomatic adults and patients with spinal deformity.Summary Of Background DataThe 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.MethodsThe 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.ResultsThe 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).ConclusionLSDI 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.

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