PMID- 26523966 OWN - NLM STAT- MEDLINE DCOM- 20161012 LR - 20181202 IS - 1878-1632 (Electronic) IS - 1529-9430 (Linking) VI - 16 IP - 2 DP - 2016 Feb TI - The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference. PG - 210-8 LID - S1529-9430(15)01628-9 [pii] LID - 10.1016/j.spinee.2015.10.043 [doi] AB - BACKGROUND CONTEXT: Adult spinal deformity (ASD) patients may gain minimal clinically important difference (MCID) in one or more of the health-related quality-of-life instruments without surgical intervention. The present study identifies the baseline characteristics of this subset of nonoperative patients and proposes predictors of those most likely to benefit. PURPOSE: The study aims to determine the factors that affect likelihood of nonoperative patients to reach MCID. STUDY DESIGN/SETTING: This is a retrospective review of a prospective, multicenter database. PATIENT SAMPLE: The study includes nonoperative ASD patients. OUTCOME MEASURES: Health-related quality-of-life measures, including the Scoliosis Research Society (SRS)-22 questionnaire, were used. METHODS: The study used a multicenter database of 215 nonoperative patients with ASD and with minimum 2-year follow-up. Using a multivariate analysis, two groups were compared to identify possible predictors: those who reached MCID in the SRS pain or activity (N=86) at 2 years and those who did not reach MCID (N=129). A subgroup multivariate analysis of patients with a deficit (potential improvement) in both SRS pain and activity (N=84) was performed. Data collection was supported by a grant from DePuy for the International Spine Study Group Foundation. RESULTS: At baseline, the nonoperative patients who reached MCID had a significantly lower SRS pain score (3.0 vs. 3.6), smaller thoracolumbar Cobb (TL Cobb) angle (29.6 degrees vs. 36.5 degrees ; 87 patients with SRS-Schwab classification of lumbar or double), lower sacral slope (33.1 degrees vs. 36.4 degrees ), and less lumbar lordosis (46.5 degrees vs. 52.8 degrees ) (all p<.05). The SRS pain and TL Cobb were significant predictors for reaching MCID. The pelvic incidence minus lumbar lordosis (PI-LL) was significant on univariate analysis but not on multivariate analysis (7.5 degrees vs. 2.6 degrees ; p=.14). In the subset of severely disabled patients, worse vertebral obliquity was a predictor for not achieving MCID (p<.05). CONCLUSIONS: Nonoperative ASD patients who achieved MCID in SRS activity or pain had a lower baseline SRS pain score and less coronal deformity in the TL region. Greater baseline pain offers significant room for potential improvement, which may be important in identifying ASD patients who have the potential to reach MCID nonoperatively. Coronal deformities in the TL region and associated vertebral obliquity may negatively impact potential for improvement in nonoperative care. CI - Copyright (c) 2015 Elsevier Inc. All rights reserved. FAU - Liu, Shian AU - Liu S AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Diebo, Bassel G AU - Diebo BG AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Henry, Jensen K AU - Henry JK AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Smith, Justin S AU - Smith JS AD - Department of Neurosurgery, University of Virginia Medical Center, Charlottesville, VA 800212, USA. FAU - Hostin, Richard AU - Hostin R AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Boulevard, #810, Plano, TX, USA. FAU - Cunningham, Matthew E AU - Cunningham ME AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Mundis, Gregory AU - Mundis G AD - Scripps Clinic Torrey Pines, 10666 N Torrey Pines Road, La Jolla, CA 92037, USA. FAU - Ames, Christopher P AU - Ames CP AD - Department of Neurosurgery, University of California, San Francisco Medical Center, 400 Parnassus Street, San Francisco, CA, USA. FAU - Burton, Douglas AU - Burton D AD - Department of Orthopaedic Surgery, University of Kansas Medical Center, 3901 Rainbow Blvd, Kansas City, KS, 66160, USA. FAU - Bess, Shay AU - Bess S AD - Rocky Mountain Scoliosis and Spine Center, 2055 High St, Denver, CO 80205, USA. FAU - Akbarnia, Behrooz AU - Akbarnia B AD - Department of Orthopaedic Surgery, San Diego Center for Spinal Disorders, 4130 La Jolla Village Dr # 300, La Jolla, CA, 92037, USA. FAU - Hart, Robert AU - Hart R AD - Department of Orthopaedic Surgery, Oregon Health Sciences University, 3181 SW Sam Jackson Park Rd, Portland, OR, 97239, USA. FAU - Passias, Peter G AU - Passias PG AD - Department of Orthopaedic Surgery, NYU Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003, USA. FAU - Schwab, Frank J AU - Schwab FJ AD - Department of Orthopaedic Surgery, Hospital for Special Surgery, 535 East 70th Street, New York, NY 10021, USA. FAU - Lafage, Virginie AU - Lafage V AD - Department of Orthopaedic Surgery, Baylor Scoliosis Center, 4708 Alliance Boulevard, #810, Plano, TX, USA. Electronic address: virginie.lafage@gmail.com. CN - International Spine Study Group (ISSG) LA - eng PT - Journal Article PT - Research Support, Non-U.S. Gov't DEP - 20151031 PL - United States TA - Spine J JT - The spine journal : official journal of the North American Spine Society JID - 101130732 SB - IM MH - Adult MH - Aged MH - Female MH - Humans MH - Lordosis/pathology/*therapy MH - Male MH - Middle Aged MH - *Quality of Life MH - Scoliosis/pathology/*therapy MH - *Trauma Severity Indices MH - Treatment Outcome OTO - NOTNLM OT - HRQOL OT - Health-related quality of life OT - Nonoperative OT - Outcomes OT - Spinal deformity OT - Treatment EDAT- 2015/11/03 06:00 MHDA- 2016/10/13 06:00 CRDT- 2015/11/03 06:00 PHST- 2015/06/21 00:00 [received] PHST- 2015/09/18 00:00 [revised] PHST- 2015/10/22 00:00 [accepted] PHST- 2015/11/03 06:00 [entrez] PHST- 2015/11/03 06:00 [pubmed] PHST- 2016/10/13 06:00 [medline] AID - S1529-9430(15)01628-9 [pii] AID - 10.1016/j.spinee.2015.10.043 [doi] PST - ppublish SO - Spine J. 2016 Feb;16(2):210-8. doi: 10.1016/j.spinee.2015.10.043. Epub 2015 Oct 31.