Patients With Adult Spinal Deformity Treated Operatively Report Greater Baseline Pain and Disability Than Patients Treated Nonoperatively; However, Deformities Differ Between Age Groups

Abstract

Multicenter, prospective analysis of consecutive patients with adult spinal deformity (ASD). Identify age-related radiographical parameters associated with poor health-related quality of life (HRQOL) and treatment preferences for ASD. Patients with ASD report discrepant severities of disability. Understanding age-associated differences for reported disability and treatment preferences may improve ASD evaluation and treatment. Baseline demographic, radiographical, and HRQOL values were evaluated in a multicenter, prospective cohort of consecutive patients with ASD. ASD, age more than 18 years, and no prior spine surgery. Patients were grouped into those treated operatively (OP) or nonoperatively (NON) and stratified into 3 age groups: G1, 50 years or less; G2, 50 to 65 years; G3, 65 years or more. HRQOL measures included Scoliosis Research Society-22r questionnaire, Oswestry Disability Index, and Short Form-36 Health Survey. Four hundred ninety-seven patients (OP = 156, NON = 341) with a mean age of 50.4 years met inclusion criteria. The OP group was older (53.3 vs. 49.0 yr), had larger scoliosis (49.3° vs. 43.3°), larger sagittal vertical axis (SVA, 33.2 vs. 13.7 mm), greater pelvic incidence-lumbar lordosis mismatch (6.6°vs. 3.1°), and worse HRQOL scores than the NON group, respectively (P < 0.05). Age stratification demonstrated worsening of SVA, spinopelvic alignment (SPA), and HRQOL scores with increasing age (P < 0.05). Age/treatment stratification demonstrated that younger OP had greater scoliosis than NON (G1OP = 49.9°vs. G1NON = 42.2°; G2OP = 56°vs. G2NON = 47.2°; P < 0.05) but similar SPA as NON. Older OP had similar scoliosis, but larger SVA than NON (G3OP = 100.6 vs. G3NON = 66.4 mm; P < 0.05). OP in all age groups reported worse HRQOL than NON (P < 0.05). Poor HRQOL uniformly determined operative treatment for ASD. Spinal deformities differed between age groups. Younger OP had larger scoliosis but similar SPA and SVA than NON. Older OP had similar scoliosis but worse SVA than NON. Age-associated differences for poor HRQOL must be considered when evaluating patients with ASD. 2.