Clinical improvement through nonoperative treatment of adult spinal deformity: who is likely to benefit?

Abstract

<jats:sec> <jats:title>Object</jats:title> <jats:p>The goal of this study was to determine the outcome and risk factors in patients with adult spinal deformity (ASD) who elected to receive nonoperative care.</jats:p></jats:sec> <jats:sec> <jats:title>Methods</jats:title> <jats:p>In this retrospective study the authors reviewed a nonoperative branch of the International Spine Study Group database, derived from 10 sites across the US. Specific inclusion criteria included nonoperative treatment for ASD and the availability of Scoliosis Research Society (SRS)-22 scores and radiographic data at baseline (BL) and at 1-year (1Y) follow-up. Health-related quality of life measures were assessed using the SRS-22 and radiographic data. Changes in SRS-22 scores were evaluated by domain and expressed in number of minimum clinically important differences (MCIDs) gained or lost; BL and 1Y scores were also compared with age- and sex-matched normative references.</jats:p></jats:sec> <jats:sec> <jats:title>Results</jats:title> <jats:p>One hundred eighty-nine patients (mean age 53 years, 86% female) met inclusion criteria. Pain was the domain with the largest offset for 43% of patients, followed by the Appearance (23%), Activity (18%), and Mental (15%) domains. On average, patients improved 0.3 MCID in Pain over 1Y, without changes in Activity or Appearance. Baseline scores significantly impacted 1Y outcomes, with up to 85% of patients in the mildest category of deformity being classified as &lt; 1 MCID of normative reference at 1Y, versus 0% of patients with the most severe initial deformity. Baseline radiographic parameters did not correlate with outcome.</jats:p></jats:sec> <jats:sec> <jats:title>Conclusions</jats:title> <jats:p>Patients who received nonoperative care are significantly more disabled than age- and sex-matched normative references. The likelihood for a patient to reach SRS scores similar to the normative reference at 1Y decreases with increased BL disability. Nonoperative treatment is a viable option for certain patients with ASD, and up to 24% of patients demonstrated significant improvement over 1Y with nonoperative care.</jats:p></jats:sec>

Effectiveness of deformity-correction surgery for primary degenerative sagittal imbalance: a meta-analysis

“…6,41 The International Spine Study Group reported that patients who were treated nonoperatively for adult spinal deformity gained an average 0.27 MCID by the 1-year follow-up visit; of the patients who experienced significant improvement (defined as > 1 MCID), a 24% reduction in pain was revealed. 40 Thus, it was concluded that nonoperative treatment is a viable option for certain patients with adult spinal deformity of the mildest degree for whom surgery can be avoided; in contrast, patients with the worst baseline scores might be advised to proceed directly to surgery and avoid the unnecessary costs and prolonged discomfort of a futile nonoperative trial. 40 With respect to the outcome of limited surgery, a previous report indicated that the interbody fusion of short segments is ineffective at restoring sagittal balance.…”

“…40 Thus, it was concluded that nonoperative treatment is a viable option for certain patients with adult spinal deformity of the mildest degree for whom surgery can be avoided; in contrast, patients with the worst baseline scores might be advised to proceed directly to surgery and avoid the unnecessary costs and prolonged discomfort of a futile nonoperative trial. 40 With respect to the outcome of limited surgery, a previous report indicated that the interbody fusion of short segments is ineffective at restoring sagittal balance. In patients with PDSI, alternative surgical techniques, such as corrective osteotomy, should be considered before performing limited surgery.…”

Serious Adverse Events Significantly Reduce Patient-Reported Outcomes at 2-Year Follow-up

“…3, 24 , 3 Slobodyanyuk et al showed only 24% of patients treated nonoperatively had clinical improvement at 1 year. 4…”

“…2 Previous studies have suggested that nonoperative modalities are not effective in improving Patient Reported Outcomes (PROs) in Adult Symptomatic Lumbar Scoliosis (ASLS). 3, 4…”

Outcome measurements for post-epidural steroid injection pain relief in elderly patients with spinal stenosis: is the conservative approach an option?

“…In the last decade, epidural steroid injections (ESIs) have been used as a conservative method to control spinal pain. ESIs can be performed via an interlaminar, transforaminal, or caudal route (21).…”