Patients with adult spinal deformity (ASD) have levels of disability similar to patients with cancer, diabetes, heart disease, and lung disease. The level of disability increases with increasing sagittal malalignment. Shay Bess, MD, Medical Center of the Rockies, Presbyterian/ St Luke's Medical Center, Denver, Colorado, USA, presented recent data from a 2-year prospective multicenter analysis, titled “Operative Treatment of ASD Improves Disease State and Physical Function Regardless of Age and Deformity Type, While Nonoperative Treatment Has No Impact”[Fu KM et al. Spine. 2014] indicating that operative treatment of ASD improves short-form health survey (SF-36) physical component scores (PCS) although they remain below the 25th percentile of US norms.

The analysis evaluated the impact of operative vs nonoperative treatment of ASD in 497 patients with ASD and no prior surgery. Other objectives were to assess the ability of treatment to restore patients with ASD to normal physical function levels, identify which deformity types are responsive to which treatment types, evaluate the ability of treatment type to improve health status, and determine the disease state correlates after treatment for different deformity types.

Patients were grouped by deformity type, location, and severity: primarily coronal (scoliosis > 20°, sagittal vertical axis [SVA] < 5 cm, located in the thoracic, lumbar, or both areas); primarily sagittal (scoliosis < 20°, SVA > 5 cm vs > 10 cm); and mixed deformity (scoliosis > 20°, SVA > 5 cm). The primary outcome measures (SF-36 PCS and mental component score [MCS]) were assessed at baseline and at 2-year follow-up and compared with US normative and disease specific SFG-36 PCS and MCS scores and US population norm-based scoring (NBS). A minimal clinically important difference was defined as 3 NBS points.

The mean age was 51.6 years, with a mean degree of scoliosis of 47.5°, mean SVA of 2.3 cm, and mean PCS of 39.8. Two-year follow-up was available for 61% (303/497) of the patients. Of these, 148 received operative treatment while 155 received nonoperative treatment. At baseline, patients in the nonoperative group had worse sagittal alignment and more mixed deformity (Table 1). The nonoperative group also had a worse PCS (P < .0001) and slightly higher MCS (P = .0040).

Patients receiving operative treatment improved significantly (PCS 34.5 at baseline vs 43.4 at 2 years; P < .05) over the 2-year follow-up but never reached the US norm. There was no change for those patients receiving nonoperative treatment (44.6 at baseline vs 43.8 at 2 years; Figure 1).

The results were similar when the data were analyzed based on age with operative patients improving and nonoperative patients remaining the same or declining. However, only in the youngest (aged 20–30 years) and oldest (aged 70–80 years) groups did the operative patients reach the norm for their generation. This was also true for type of deformity. Operative treatment was associated with improvement in all deformity types with the largest improvement seen in patients with lumbar scoliosis and SVA > 10 cm.