Why Adult Scoliosis Patients Choose Surgery

Purpose: To define predictive factors which influence a patient's decision to select surgical versus nonsurgical treatment for adult scoliosis.

Methods: This is a retrospective case-control study of 161 matched surgical-nonsurgical pairs that were examined based upon radiographic parameters, questionnaire responses, and standardized health status measures. Matching was performed using logistic regression to allow matching based on age, gender, primary curve location and ODI.

Results: The surgical group had larger primary thoracic (51 versus 44, p=0.006) and thoracolumbar/lumbar Cobb angles (55 versus 43 , p=0.000). They also had significantly greater thoracolumbar/lumbar apical vertebral translation (p=0.001). Comparison of pre-operative factors revealed that nonsurgical patients had a higher BMI (p=0.03), a greater incidence of heart disease (p=0.04) and significantly poorer mean score on the SF-12 general health subscale (p=0.01). Surgical patients had lower scores on SF-12 role physical (p=0.03) and SF-12 bodily pain (p=0.04) scores.

There were significant differences with regard to the patients' perception of appearance and social function between the two groups. Surgical patients were more likely to report a change in their body shape over the past ten years (p 0.001), and were "very unhappy" with the shape of their back (p<0 .001). Nonsurgical patients were more likely to describe the appearance of their trunk as "good" while surgical select "fair" (p="0.03)." (39% versus 24%) say that back condition had no effect on personal relationships

Discussion: This study offers a unique insight into surgical decision making for adult scoliosis patients based upon patient based health status measures in a large sample of adult scoliosis patients. While this information is not a substitute for long term prospective outcome data, it may help surgeons to better understand the patient/surgeon decision making process and therefore to counsel patients more effectively.