The selection of operative versus nonoperative treatment in patients with adult scoliosis

STUDY DESIGN. Retrospective case-control matched series. OBJECTIVE. The purpose of this study is to define factors that influence the patient and surgeon in the selection of surgical versus nonsurgical treatment for adult scoliosis. SUMMARY OF BACKGROUND DATA. There is no literature that specifically examines why adult scoliosis patients and/or their surgeons choose surgical versus nonsurgical treatment. METHODS. This study analyzes a prospective multicentered database for adult spinal deformity. A logistic regression technique was used to perform case-control matching. A total of 161 matched pairs were compared for radiographic characteristics, questionnaire responses, and standardized outcome measures. RESULTS. Nonsurgical patients had greater preoperative medical risk factors. Surgical patients had larger thoracic (51° vs. 44°, P = 0.006) and thoracolumbar/lumbar curves (55° vs. 43°, P = 0.000). Surgical patients had more frequent leg pain (47% vs. 35%, P = 0.04). They reported a higher mean level of daily back pain (P = 0.008) and more frequent moderate-to-severe back pain over the past 6 months (P = 0.03). There were also significant differences in perception of appearance and social function between the cohorts. CONCLUSIONS. This study emphasizes the complexity of surgical decision making for adult scoliosis patients. It also underscores the importance of patient-based health status measures in evaluating the adult scoliosis patient.