Factors associated with having an indication for surgery in adult spinal deformity: an international european multicentre study

Richner-Wunderlin S., Mannion A. F., Vila-Casademunt A., Pellise F., Serra-Burriel M., Seifert B., ...More

European Spine Journal, vol.28, no.1, pp.127-137, 2019 (SCI-Expanded) identifier identifier identifier

  • Publication Type: Article / Article
  • Volume: 28 Issue: 1
  • Publication Date: 2019
  • Doi Number: 10.1007/s00586-018-5754-2
  • Journal Name: European Spine Journal
  • Journal Indexes: Science Citation Index Expanded (SCI-EXPANDED), Scopus
  • Page Numbers: pp.127-137
  • Keywords: Adult spinal deformity, Indication for surgery, Decision-making, Multivariable analyses, Prognostic factors, IDIOPATHIC SCOLIOSIS, OPERATIVE TREATMENT, DISABILITY, INSTRUMENT, SYMPTOMS, DECISION, PAIN
  • Acibadem Mehmet Ali Aydinlar University Affiliated: Yes


PurposeThe aim of this study was to evaluate factors that distinguish between patients with adult spinal deformity (ASD) with and without an indication for surgery, irrespective of their final treatment.MethodsBaseline variables (demographics, medical history, outcome measures, coronal, sagittal and neurologic parameters) were evaluated in a multicentre, prospective cohort of patients with ASD. Multivariable analyses were carried out for idiopathic and degenerative patients separately with the dependent variable being indication for surgery and baseline parameters as independent variables.Results In total, 342 patients with degenerative ASD and 624 patients with idiopathic ASD were included in the multivariable models. In patients with degenerative ASD, the parameters associated with having an indication for surgery were greater self-rated disability on the Oswestry Disability Index [odds ratio (OR) 1.04, 95% confidence interval (CI) 1.02-1.07] and a lower thoracic kyphosis (OR 0.97 95% CI 0.95-0.99), whereas in patients with idiopathic ASD, it was lower (worse) SRS self-image scores (OR 0.45 95% CI 0.32-0.64), a higher value for the major Cobb angle (OR 1.03 95% CI 1.01-1.05), lower age (OR 0.96 95% CI 0.95-0.98), prior decompression (OR 3.76 95% CI 1.00-14.08), prior infiltration (OR 2.23 95% CI 1.12-4.43), and the presence of rotatory subluxation (OR 1.98 95% CI 1.11-3.54) and sagittal subluxation (OR 4.38 95% CI 1.61-11.95).ConclusionSpecific sets of variables were found to be associated with an indication for surgery in patients with ASD. These should be investigated in relation to patient outcomes for their potential to guide the future development of decision aids in the treatment of ASD.