Outcomes of operative and nonoperative treatment for adult spinal deformity: A prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up

Justin S. Smith, Virginie Lafage, Christopher I. Shaffrey, Frank Schwab, Renaud Lafage, Richard Hostin, Michael O'brien, 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 ZebalaBreton Line, Eric Klineberg, Munish Gupta, Vedat Deviren, Robert Hart, Doug Burton, Shay Bess, Christopher P. Ames

Research output: Contribution to journalArticlepeer-review

106 Scopus citations


BACKGROUND: High-quality studies that compare operative and nonoperative treatment for adult spinal deformity (ASD) are needed. OBJECTIVE: To compare outcomes of operative and nonoperative treatment for ASD. METHODS: This 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. RESULTS: Two 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. CONCLUSION: Operative 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.

Original languageEnglish (US)
Pages (from-to)851-861
Number of pages11
Issue number6
StatePublished - Jun 1 2016


  • Adult spinal deformity
  • Complications
  • Nonoperative treatment
  • Outcomes
  • Scoliosis
  • Surgery

ASJC Scopus subject areas

  • Surgery
  • Clinical Neurology


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