PMID- 37728175
OWN - NLM
STAT- MEDLINE
DCOM- 20231204
LR  - 20240122
IS  - 1547-5646 (Electronic)
IS  - 1547-5646 (Linking)
VI  - 39
IP  - 6
DP  - 2023 Dec 1
TI  - Economic burden of nonoperative treatment of adult spinal deformity.
PG  - 751-756
LID - 10.3171/2023.7.SPINE23195 [doi]
AB  - OBJECTIVE: The purpose of this study was to investigate the cost utility of 
      nonoperative treatment for adult spinal deformity (ASD). METHODS: Nonoperatively 
      and operatively treated patients who met database criteria for ASD and in whom 
      complete radiographic and health-related quality of life data at baseline and at 
      2 years were available were included. A cost analysis was completed on the 
      PearlDiver database assessing the average cost of nonoperative treatment prior to 
      surgical intervention based on previously published treatments (NSAIDs, 
      narcotics, muscle relaxants, epidural steroid injections, physical therapy, and 
      chiropractor). Utility data were calculated using the Oswestry Disability Index 
      (ODI) converted to SF-6D with published conversion methods. Quality-adjusted life 
      years (QALYs) used a 3% discount rate to account for residual decline in life 
      expectancy (78.7 years). Minor and major comorbidities and complications were 
      assessed according to the CMS.gov manual's definitions. Successful nonoperative 
      treatment was defined as a gain in the minimum clinically importance difference 
      (MCID) in both ODI and Scoliosis Research Society (SRS)-pain scores, and failure 
      was defined as a loss in MCID or conversion to operative treatment. Patients with 
      baseline ODI </= 20 and continued ODI of </= 20 at 2 years were considered 
      nonoperative successful maintenance. The average utilization of nonoperative 
      treatment and cost were applied to the ASD cohort. RESULTS: A total of 824 
      patients were included (mean age 58.24 years, 81% female, mean body mass index 
      27.2 kg/m2). Overall, 75.5% of patients were in the operative and 24.5% were in 
      the nonoperative cohort. At baseline patients in the operative cohort were 
      significantly older, had a greater body mass index, increased pelvic tilt, and 
      increased pelvic incidence-lumbar lordosis mismatch (all p < 0.05). With respect 
      to deformity, patients in the operative group had higher rates of severe (i.e., 
      ++) sagittal deformity according to SRS-Schwab modifiers for pelvic tilt, 
      sagittal vertical axis, and pelvic incidence-lumbar lordosis mismatch (p < 0.05). 
      At 2 years, patients in the operative cohort showed significantly increased rates 
      of a gain in MCID for physical component summary of SF-36, ODI, and SRS-activity, 
      SRS-pain, SRS-appearance, and SRS-mental scores. Cost analysis showed the average 
      cost of nonoperative treatment 2 years prior to surgical intervention to be 
      $2041. Overall, at 2 years patients in the nonoperative cohort had again in ODI 
      of 0.36, did not show a gain in QALYs, and nonoperative treatment was determined 
      to be cost-ineffective. However, a subset of patients in this cohort underwent 
      successful maintenance treatment and had a decrease in ODI of 1.1 and a gain in 
      utility of 0.006 at 2 years. If utility gained for this cohort was sustained to 
      full life expectancy, patients' cost per QALY was $18,934 compared to a cost per 
      QALY gained of $70,690.79 for posterior-only and $48,273.49 for combined approach 
      in patients in the operative cohort. CONCLUSIONS: Patients with ASD undergoing 
      operative treatment at baseline had greater sagittal deformity and greater 
      improvement in health-related quality of life postoperatively compared to 
      patients treated nonoperatively. Additionally, patients in the nonoperative 
      cohort overall had an increase in ODI and did not show improvement in utility 
      gained. Patients in the nonoperative cohort who had low disability and sagittal 
      deformity underwent successful maintenance and cost-effective treatment.
FAU - Passias, Peter G
AU  - Passias PG
AD  - 1Departments of Orthopaedic and Neurologic Surgery, Division of Spine, NYU 
      Langone Medical Center; New York Spine Institute, New York, New York.
FAU - Ahmad, Waleed
AU  - Ahmad W
AD  - 1Departments of Orthopaedic and Neurologic Surgery, Division of Spine, NYU 
      Langone Medical Center; New York Spine Institute, New York, New York.
FAU - Dave, Pooja
AU  - Dave P
AD  - 1Departments of Orthopaedic and Neurologic Surgery, Division of Spine, NYU 
      Langone Medical Center; New York Spine Institute, New York, New York.
FAU - Lafage, Renaud
AU  - Lafage R
AD  - 2Department of Orthopedics, Hospital for Special Surgery, New York, New York.
FAU - Lafage, Virginie
AU  - Lafage V
AD  - 2Department of Orthopedics, Hospital for Special Surgery, New York, New York.
FAU - Mir, Jamshaid
AU  - Mir J
AD  - 1Departments of Orthopaedic and Neurologic Surgery, Division of Spine, NYU 
      Langone Medical Center; New York Spine Institute, New York, New York.
FAU - Klineberg, Eric O
AU  - Klineberg EO
AD  - 3Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New 
      York.
FAU - Kabeish, Khaled M
AU  - Kabeish KM
AD  - 4Department of Orthopaedic Surgery, Johns Hopkins Medical Center, Baltimore, 
      Maryland.
FAU - Gum, Jeffrey L
AU  - Gum JL
AD  - 5Norton Leatherman Spine Center, Louisville, Kentucky.
FAU - Line, Breton G
AU  - Line BG
AD  - 6Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. 
      Luke's/Rocky Mountain Hospital for Children, Denver, Colorado.
FAU - Hart, Robert
AU  - Hart R
AD  - 7Department of Orthopaedic Surgery, Swedish Neuroscience Institute, Seattle, 
      Washington.
FAU - Burton, Douglas
AU  - Burton D
AD  - 8Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas 
      City, Kansas.
FAU - Smith, Justin S
AU  - Smith JS
AD  - 9Department of Neurosurgery, University of Virginia, Charlottesville, Virginia.
FAU - Ames, Christopher P
AU  - Ames CP
AD  - 8Department of Orthopaedic Surgery, University of Kansas Medical Center, Kansas 
      City, Kansas.
FAU - Shaffrey, Christopher I
AU  - Shaffrey CI
AD  - 10Department of Neurological Surgery, University of California, San Francisco, 
      California.
FAU - Schwab, Frank
AU  - Schwab F
AD  - 2Department of Orthopedics, Hospital for Special Surgery, New York, New York.
FAU - Hostin, Richard
AU  - Hostin R
AD  - 11Department of Orthopaedic Surgery, Southwest Scoliosis Center, Dallas, Texas; 
      and.
FAU - Buell, Thomas
AU  - Buell T
AD  - 12Department of Neurological Surgery, University of Pittsburgh School of 
      Medicine, Pittsburgh, Pennsylvania.
FAU - Hamilton, D Kojo
AU  - Hamilton DK
AD  - 12Department of Neurological Surgery, University of Pittsburgh School of 
      Medicine, Pittsburgh, Pennsylvania.
FAU - Bess, Shay
AU  - Bess S
AD  - 6Department of Spine Surgery, Denver International Spine Clinic, Presbyterian St. 
      Luke's/Rocky Mountain Hospital for Children, Denver, Colorado.
LA  - eng
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230915
PL  - United States
TA  - J Neurosurg Spine
JT  - Journal of neurosurgery. Spine
JID - 101223545
SB  - IM
MH  - Humans
MH  - Adult
MH  - Female
MH  - Middle Aged
MH  - Male
MH  - *Lordosis/surgery
MH  - Quality of Life
MH  - Financial Stress
MH  - Retrospective Studies
MH  - *Scoliosis/surgery
MH  - Treatment Outcome
MH  - Pain
OTO - NOTNLM
OT  - adult spinal deformity
OT  - cost
OT  - management
OT  - nonoperative
OT  - pain
EDAT- 2023/09/20 12:51
MHDA- 2023/12/04 12:42
CRDT- 2023/09/20 07:13
PHST- 2023/03/30 00:00 [received]
PHST- 2023/07/24 00:00 [accepted]
PHST- 2023/12/04 12:42 [medline]
PHST- 2023/09/20 12:51 [pubmed]
PHST- 2023/09/20 07:13 [entrez]
AID - 10.3171/2023.7.SPINE23195 [doi]
PST - epublish
SO  - J Neurosurg Spine. 2023 Sep 15;39(6):751-756. doi: 10.3171/2023.7.SPINE23195. 
      Print 2023 Dec 1.