PMID- 30801373
OWN - NLM
STAT- MEDLINE
DCOM- 20191021
LR  - 20200114
IS  - 1535-1386 (Electronic)
IS  - 0021-9355 (Print)
IS  - 0021-9355 (Linking)
VI  - 101
IP  - 4
DP  - 2019 Feb 20
TI  - Operative Versus Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis.
PG  - 338-352
LID - 10.2106/JBJS.18.00483 [doi]
LID - 338-352
AB  - BACKGROUND: The effectiveness of operative compared with nonoperative treatment 
      at initial presentation (no prior fusion) for adult lumbar scoliosis has not, to 
      our knowledge, been evaluated in controlled trials. The goals of this study were 
      to evaluate the effects of operative and nonoperative treatment and to assess the 
      benefits of these treatments to help treating physicians determine whether 
      patients are better managed operatively or nonoperatively. METHODS: Patients with 
      adult symptomatic lumbar scoliosis (aged 40 to 80 years, with a coronal Cobb 
      angle measurement of >/=30 degrees  and an Oswestry Disability Index [ODI] score of >/=20 or 
      Scoliosis Research Society [SRS]-22 score of </=4.0) from 9 North American centers 
      were enrolled in concurrent randomized or observational cohorts to evaluate 
      operative versus nonoperative treatment. The primary outcomes were differences in 
      the mean change from baseline in the SRS-22 subscore and ODI at 2-year follow-up. 
      For the randomized cohort, the initial sample-size calculation estimated that 41 
      patients per group (82 total) would provide 80% power with alpha equal to 0.05, 
      anticipating 10% loss to follow-up and 20% nonadherence in the nonoperative arm. 
      However, an interim sample-size calculation estimated that 18 patients per group 
      would be sufficient. RESULTS: Sixty-three patients were enrolled in the 
      randomized cohort: 30 in the operative group and 33 in the nonoperative group. 
      Two hundred and twenty-three patients were enrolled in the observational cohort: 
      112 in the operative group and 111 in the nonoperative group. The 
      intention-to-treat analysis of the randomized cohort found that, at 2 years of 
      follow-up, outcomes did not differ between the groups. Nonadherence was high in 
      the randomized cohort (64% nonoperative-to-operative crossover). In the 
      as-treated analysis of the randomized cohort, operative treatment was associated 
      with greater improvement at the 2-year follow-up in the SRS-22 subscore (adjusted 
      mean difference, 0.7 [95% confidence interval (CI), 0.5 to 1.0]) and in the ODI 
      (adjusted mean difference, -16 [95% CI, -22 to -10]) (p < 0.001 for both). 
      Surgery was also superior to nonoperative care in the observational cohort at 2 
      years after treatment on the basis of SRS-22 subscore and ODI outcomes (p < 
      0.001). In an overall responder analysis, more operative patients achieved 
      improvement meeting or exceeding the minimal clinically important difference 
      (MCID) in the SRS-22 subscore (85.7% versus 38.7%; p < 0.001) and the ODI (77.4% 
      versus 38.3%; p < 0.001). Thirty-four revision surgeries were performed in 24 
      (14%) of the operative patients. CONCLUSIONS: On the basis of as-treated and MCID 
      analyses, if a patient with adult symptomatic lumbar scoliosis is satisfied with 
      current spine-related health, nonoperative treatment is advised, with the 
      understanding that improvement is unlikely. If a patient is not satisfied with 
      current spine health and expects improvement, surgery is preferred. LEVEL OF 
      EVIDENCE: Therapeutic Level II. See Instructions for Authors for a complete 
      description of levels of evidence.
FAU - Kelly, Michael P
AU  - Kelly MP
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Lurie, Jon D
AU  - Lurie JD
AD  - Department of Medicine, Dartmouth Medical School, Hanover, New Hampshire.
FAU - Yanik, Elizabeth L
AU  - Yanik EL
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - Department of Neurological Surgery, University of Virginia, Charlottesville, 
      Virginia.
FAU - Baldus, Christine R
AU  - Baldus CR
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Boachie-Adjei, Oheneba
AU  - Boachie-Adjei O
AD  - FOCOS Orthopedic Hospital, Accra, Ghana.
FAU - Buchowski, Jacob M
AU  - Buchowski JM
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Carreon, Leah Y
AU  - Carreon LY
AD  - Norton Leatherman Spine Center, Louisville, Kentucky.
FAU - Crawford, Charles H 3rd
AU  - Crawford CH 3rd
AD  - Norton Leatherman Spine Center, Louisville, Kentucky.
FAU - Edwards, Charles 2nd
AU  - Edwards C 2nd
AD  - Mercy Medical Center, Baltimore, Maryland.
FAU - Errico, Thomas J
AU  - Errico TJ
AD  - NYU Hospital for Joint Diseases, New York, NY.
FAU - Glassman, Steven D
AU  - Glassman SD
AD  - Norton Leatherman Spine Center, Louisville, Kentucky.
FAU - Gupta, Munish C
AU  - Gupta MC
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Lenke, Lawrence G
AU  - Lenke LG
AD  - Department of Orthopedic Surgery, Columbia University, New York, NY.
FAU - Lewis, Stephen J
AU  - Lewis SJ
AD  - UHN-Orthopedics, Toronto Western Hospital, Toronto, Ontario, Canada.
FAU - Kim, Han Jo
AU  - Kim HJ
AD  - Hospital for Special Surgery, New York, NY.
FAU - Koski, Tyler
AU  - Koski T
AD  - Department of Neurological Surgery, Northwestern University, Evanston, Illinois.
FAU - Parent, Stefan
AU  - Parent S
AD  - Sainte-Justine University Hospital, Montreal, Quebec, Canada.
FAU - Schwab, Frank J
AU  - Schwab FJ
AD  - Hospital for Special Surgery, New York, NY.
FAU - Smith, Justin S
AU  - Smith JS
AD  - Department of Neurological Surgery, University of Virginia, Charlottesville, 
      Virginia.
FAU - Zebala, Lukas P
AU  - Zebala LP
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
FAU - Bridwell, Keith H
AU  - Bridwell KH
AD  - Department of Orthopedic Surgery, Washington University School of Medicine, St. 
      Louis, Missouri.
LA  - eng
GR  - R01 AR055176/AR/NIAMS NIH HHS/United States
PT  - Comparative Study
PT  - Journal Article
PT  - Multicenter Study
PT  - Observational Study
PT  - Randomized Controlled Trial
PL  - United States
TA  - J Bone Joint Surg Am
JT  - The Journal of bone and joint surgery. American volume
JID - 0014030
SB  - IM
CIN - J Bone Joint Surg Am. 2019 Feb 20;101(4):e16. PMID: 30801384
EIN - J Bone Joint Surg Am. 2019 Dec 18;101(24):e138. PMID: 31851112
CIN - Ann Transl Med. 2020 Apr;8(7):515. PMID: 32395559
MH  - Adult
MH  - Aged
MH  - Aged, 80 and over
MH  - Female
MH  - Humans
MH  - *Lumbar Vertebrae
MH  - Male
MH  - Medication Adherence
MH  - Middle Aged
MH  - Orthopedic Procedures/statistics & numerical data
MH  - Scoliosis/*therapy
MH  - Treatment Outcome
MH  - Watchful Waiting/statistics & numerical data
PMC - PMC6738555
EDAT- 2019/02/26 06:00
MHDA- 2019/10/23 06:00
PMCR- 2019/09/11
CRDT- 2019/02/26 06:00
PHST- 2019/02/26 06:00 [entrez]
PHST- 2019/02/26 06:00 [pubmed]
PHST- 2019/10/23 06:00 [medline]
PHST- 2019/09/11 00:00 [pmc-release]
AID - 00004623-201902200-00007 [pii]
AID - JBJS-D-18-00483 [pii]
AID - 10.2106/JBJS.18.00483 [doi]
PST - ppublish
SO  - J Bone Joint Surg Am. 2019 Feb 20;101(4):338-352. doi: 10.2106/JBJS.18.00483.