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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 degrees vs. 44 degrees, P = 0.006) and thoracolumbar/lumbar curves (55 degrees vs. 43 degrees, 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

Keywords : Adolescent,Adult,Aged,Aged,80 and over,Back,Back Pain,Case-Control Studies,Decision Making,epidemiology,Female,Health Status,Humans,Leg,Male,methods,Middle Aged,Pain,Patient Satisfaction,Patients,Prospective Studies,rehabilitation,Retrospective Studies,Risk,Risk Factors,Scoliosis,Spine,surgery,Universities,, Selection,Operative,Versus,Nonoperative, colicky pain symptoms

Date of Publication : 2007 Jan 1

Authors : Glassman SD;Schwab FJ;Bridwell KH;Ondra SL;Berven S;Lenke LG;

Organisation : Department of Orthopaedic Surgery, University of Louisville School of Medicine and the Kenton D. Leatherman Spine Center, Louisville, KY, USA. tallgeyer@spinemds.com

Journal of Publication : Spine (Phila Pa 1976 )

Pubmed Link : https://www.ncbi.nlm.nih.gov/pubmed/17202898

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