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type=\u0022text\/css\u0022 rel=\u0022stylesheet\u0022 href=\u0022\/\/d282kpwvnogo5m.cloudfront.net\/sites\/default\/files\/advagg_css\/css__ce2QY63WIanKyr8eSq7eavr1XQRRmFD6ZSmwpyJi8lM__zXwFqpqmxrZOXXcd_TpBQpjuELbmIP9wBR5UuTDWAO4__YJWWMMdfCJuAFm5cUEp88OsodhO3ZA-2lzRfoBsSlk4.css\u0022 media=\u0022all\u0022 \/\u003E\n\u003Clink rel=\u0027stylesheet\u0027 type=\u0027text\/css\u0027 href=\u0027\/sites\/all\/modules\/contrib\/panels\/plugins\/layouts\/onecol\/onecol.css\u0027 \/\u003E\u003C\/head\u003E\u003Cbody\u003E\u003Cdiv class=\u0022panels-ajax-tab-panel panels-ajax-tab-panel-sageoa-tab-art\u0022\u003E\u003Cdiv class=\u0022panel-display panel-1col clearfix\u0022 \u003E\n  \u003Cdiv class=\u0022panel-panel panel-col\u0022\u003E\n    \u003Cdiv\u003E\u003Cdiv class=\u0022panel-pane pane-highwire-markup\u0022 \u003E\n  \n      \n  \n  \u003Cdiv class=\u0022pane-content\u0022\u003E\n    \u003Cdiv class=\u0022highwire-markup\u0022\u003E\u003Cdiv xmlns=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022 id=\u0022content-block-markup\u0022 xmlns:xhtml=\u0022http:\/\/www.w3.org\/1999\/xhtml\u0022\u003E\u003Cdiv class=\u0022article fulltext-view \u0022\u003E\u003Cspan class=\u0022highwire-journal-article-marker-start\u0022\u003E\u003C\/span\u003E\u003Cdiv class=\u0022section abstract\u0022 id=\u0022abstract-1\u0022\u003E\u003Ch2\u003ESummary\u003C\/h2\u003E\n            \u003Cp id=\u0022p-1\u0022\u003EEvidence to date suggests that surgical treatment can improve pain and disability in adults with symptomatic spinal deformity. However, most previous studies were small, retrospective series without direct comparisons with nonoperative treatment approaches. The aim of this study, Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum Two-Year Follow-up was to compare minimum 2-year outcomes for operative and nonoperative treatment for ASD in a prospective population, using both matched and unmatched cohorts.\u003C\/p\u003E\n         \u003C\/div\u003E\u003Cul class=\u0022kwd-group\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cul class=\u0022kwd-group clinical-trial\u0022\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics Clinical Trials\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003ESpine Conditions\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedics\u003C\/li\u003E\u003Cli class=\u0022kwd\u0022\u003EOrthopaedic Procedures\u003C\/li\u003E\u003C\/ul\u003E\u003Cdiv class=\u0022section\u0022 id=\u0022sec-1\u0022\u003E\n         \n         \u003Cp id=\u0022p-2\u0022\u003EEvidence to date suggests that surgical treatment can improve pain and disability in adults with symptomatic spinal deformity. However, most previous studies were small, retrospective series without direct comparisons with nonoperative treatment approaches. The aim of this study, Outcomes of Operative and Nonoperative Treatment for Adult Spinal Deformity (ASD): A Prospective, Multicenter Matched and Unmatched Cohort Assessment with Minimum Two-Year Follow-up [Smith JS et al. \u003Cem\u003ESpine\u003C\/em\u003E. 2014], presented by Justin S. Smith, MD, PhD, University of Virginia Health System, Charlottesville, Virginia, USA, was to compare minimum 2-year outcomes for operative and nonoperative treatment for ASD in a prospective population, using both matched and unmatched cohorts.\u003C\/p\u003E\n         \u003Cp id=\u0022p-3\u0022\u003EThe patients (n = 689) were recruited from a multicenter database for ASD through the International Spine Study Group. They were classified as operative (n = 286) or nonoperative (n = 403) based on the initial management approach. At baseline and follow-up, the patients completed health-related quality of life (HRQOL) measures, including the Scoliosis Research Society Questionnaire-22 (SRS-22), Oswestry Disability Index (ODI), Short Form-36 Health Survey (SF-36) physical component score (PCS), and measures of back and leg pain.\u003C\/p\u003E\n         \u003Cp id=\u0022p-4\u0022\u003EIncluded patients (aged \u0026gt; 18 years) had a diagnosis of ASD and at least one of the following: coronal Cobb angle \u2265 20\u00b0, sagittal vertical access \u0026gt; 5 cm, pelvic tilt \u2265 25\u00b0, and thoracic kyphosis \u2265 60\u00b0. Outcomes were compared within and between surgical and nonsurgical groups using unmatched and propensity-matched cohorts. The propensity-matched cohort was matched according to baseline ODI, SRS-22, leg pain score, pelvic incidence-lumbar lordosis (PI-LL) mismatch, and maximum thoracolumbar\/lumbar Cobb angle.\u003C\/p\u003E\n         \u003Cp id=\u0022p-5\u0022\u003EAt baseline, patients in the operative group (n = 246) had significantly worse HRQOL measures (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) and mean body mass index (\u003Cem\u003EP\u003C\/em\u003E = .003) compared with those in the nonoperative group (n = 223). The operative group also had significantly worse mean coronal balance (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), sagittal balance (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), pelvic tilt (\u003Cem\u003EP\u003C\/em\u003E = .002), and PI-LL (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001) at baseline.\u003C\/p\u003E\n         \u003Cp id=\u0022p-6\u0022\u003EAt a minimum 2-year follow-up, for unmatched outcomes, patients in the operative group (n = 246) had significant improvements from baseline in ODI (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), SF-36 score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), SRS-22 score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), numeric rating scale (NRS) back pain score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), and NRS leg pain score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001), whereas the nonoperative group (n = 223) had no significant improvements from baseline in these measures (\u003Ca id=\u0022xref-table-wrap-1-1\u0022 class=\u0022xref-table\u0022 href=\u0022#T1\u0022\u003ETable 1\u003C\/a\u003E). The operative group had significantly improved mean back pain score compared with the nonoperative group (\u003Cem\u003EP\u003C\/em\u003E = .001).\u003C\/p\u003E\n         \u003Cdiv id=\u0022T1\u0022 class=\u0022table pos-float\u0022\u003E\u003Cdiv class=\u0022table-inline\u0022\u003E\u003Cdiv class=\u0022callout\u0022\u003E\u003Cspan\u003EView this table:\u003C\/span\u003E\u003Cul class=\u0022callout-links\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022\/\u0022 class=\u0022table-expand-inline\u0022 data-table-url=\u0022\/highwire\/markup\/15399\/expansion?postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media%2Chighwire_embed\u0026amp;table-expand-inline=1\u0022 html=\u00221\u0022 fragment=\u0022#\u0022 external=\u00221\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView inline\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022\/highwire\/markup\/15399\/expansion?width=1000\u0026amp;height=500\u0026amp;iframe=true\u0026amp;postprocessors=highwire_figures%2Chighwire_math%2Chighwire_inline_linked_media\u0022 class=\u0022colorbox colorbox-load table-expand-popup\u0022 rel=\u0022gallery-fragment-tables\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView popup\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15399\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cdiv class=\u0022table-caption\u0022\u003E\u003Cspan class=\u0022table-label\u0022\u003ETable 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-7\u0022 class=\u0022first-child\u0022\u003EImpact of Nonoperative vs Operative Treatment on Outcomes\u003C\/p\u003E\n            \u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-11\u0022\u003EA total of 97 matched operative-nonoperative pairs were identified based on propensity scores. The only parameter that was significantly different between the operative and nonoperative pairs was mean age (51.4 vs 58.0; \u003Cem\u003EP\u003C\/em\u003E = .003). Among the matched pairs, the operative group had significant improvements from baseline and vs the nonoperative group in ODI score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001 both comparisons; \u003Ca id=\u0022xref-fig-1-1\u0022 class=\u0022xref-fig\u0022 href=\u0022#F1\u0022\u003EFigure 1\u003C\/a\u003E), SRS-22 total score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001 both comparisons), SF-36 PCS (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001 both comparisons), back pain score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001 both comparisons), and leg pain score (\u003Cem\u003EP\u003C\/em\u003E \u0026lt; .001 both comparisons). The nonoperative group lacked significant improvements from baseline in any of the measures, except for the SRS-22 (\u003Cem\u003EP\u003C\/em\u003E = .021).\u003C\/p\u003E\n         \u003Cdiv id=\u0022F1\u0022 class=\u0022fig pos-float  odd\u0022\u003E\u003Cdiv class=\u0022highwire-figure\u0022\u003E\u003Cdiv class=\u0022fig-inline-img-wrapper\u0022\u003E\u003Cdiv class=\u0022fig-inline-img\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/8\/F1.large.jpg?width=800\u0026amp;height=600\u0026amp;carousel=1\u0022 title=\u0022Operative vs Nonoperative Treatment: Impact on Disability\u0022 class=\u0022fragment-images colorbox-load\u0022 rel=\u0022gallery-fragment-images-503722488\u0022 data-figure-caption=\u0022Operative vs Nonoperative Treatment: Impact on Disability\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003E\u003Cimg class=\u0022fragment-image\u0022 alt=\u0022Figure 1.\u0022 src=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/8\/F1.medium.gif\u0022\/\u003E\u003C\/a\u003E\u003C\/div\u003E\u003C\/div\u003E\u003Cul class=\u0022highwire-figure-links inline\u0022\u003E\u003Cli class=\u00220 first\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/8\/F1.large.jpg?download=true\u0022 class=\u0022highwire-figure-link highwire-figure-link-download\u0022 title=\u0022Download Figure 1.\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload figure\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00221\u0022\u003E\u003Ca href=\u0022http:\/\/d282kpwvnogo5m.cloudfront.net\/content\/spmdc\/14\/50\/8\/F1.large.jpg\u0022 class=\u0022highwire-figure-link highwire-figure-link-newtab\u0022 target=\u0022_blank\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EOpen in new tab\u003C\/a\u003E\u003C\/li\u003E\u003Cli class=\u00222 last\u0022\u003E\u003Ca href=\u0022\/highwire\/powerpoint\/15398\u0022 class=\u0022highwire-figure-link highwire-figure-link-ppt\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EDownload powerpoint\u003C\/a\u003E\u003C\/li\u003E\u003C\/ul\u003E\u003C\/div\u003E\u003Cdiv class=\u0022fig-caption attrib\u0022\u003E\u003Cspan class=\u0022fig-label\u0022\u003EFigure 1.\u003C\/span\u003E \n               \u003Cp id=\u0022p-12\u0022 class=\u0022first-child\u0022\u003EOperative vs Nonoperative Treatment: Impact on Disability\u003C\/p\u003E\n            \u003Cq class=\u0022attrib\u0022 id=\u0022attrib-1\u0022\u003EData are presented for 97 propensity-matched operative-nonoperative pairs. \u003Cem\u003EP\u003C\/em\u003E values were calculated with the paired \u003Cem\u003Et\u003C\/em\u003E test.\u003C\/q\u003E\u003Cq class=\u0022attrib\u0022 id=\u0022attrib-2\u0022\u003EReproduced with permission from JS Smith, MD, PhD.\u003C\/q\u003E\u003Cdiv class=\u0022sb-div caption-clear\u0022\u003E\u003C\/div\u003E\u003C\/div\u003E\u003C\/div\u003E\n         \u003Cp id=\u0022p-13\u0022\u003EPatients electing nonoperative treatment tend to have less deformity and less pain and disability than patients choosing to undergo surgery. Surgical treatment for ASD can provide significant improvements in HRQOL at a minimum 2-year follow-up. Nonoperative treatment appears to maintain presenting levels of pain and disability.\u003C\/p\u003E\n      \u003C\/div\u003E\u003Cul class=\u0022copyright-statement\u0022\u003E\u003Cli class=\u0022fn\u0022 id=\u0022copyright-statement-1\u0022\u003E\u00a9 2015 MD Conference Express\u00ae\u003C\/li\u003E\u003C\/ul\u003E\u003Cspan class=\u0022highwire-journal-article-marker-end\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Cspan id=\u0022related-urls\u0022\u003E\u003C\/span\u003E\u003C\/div\u003E\u003Ca href=\u0022http:\/\/mdc.sagepub.com\/content\/14\/50\/8.abstract\u0022 class=\u0022hw-link hw-link-article-abstract\u0022 data-icon-position=\u0022\u0022 data-hide-link-title=\u00220\u0022\u003EView Summary\u003C\/a\u003E\u003C\/div\u003E  \u003C\/div\u003E\n\n  \n  \u003C\/div\u003E\n\u003C\/div\u003E\n  \u003C\/div\u003E\n\u003C\/div\u003E\n\u003C\/div\u003E\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_figures.js?nzlsvd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_openurl.js?nzlsvd\u0022\u003E\u003C\/script\u003E\n\u003Cscript type=\u0022text\/javascript\u0022 src=\u0022http:\/\/mdc.sagepub.com\/sites\/all\/modules\/highwire\/highwire\/plugins\/highwire_markup_process\/js\/highwire_tables.js?nzlsvd\u0022\u003E\u003C\/script\u003E\n\u003C\/body\u003E\u003C\/html\u003E"}