Nonsurgical Resource Utilization in Adult Spinal Deformity
Summary: As limited data exists regarding utilization of non-surgical treatment for adult spinal deformity; our purpose was to quantify and analyze the use of non-surgical resources in adult deformity patients. The results of this study demonstrate that distinct high and low symptom adult deformity subgroups can be clearly identified. The type and extent of non-surgical interventions differed between groups, but both high and low symptom patients utilized substantial non-surgical treatment resources.
Purpose: The purpose of this study was to quantify and analyze the use of non-surgical resources in patients with adult spinal deformity since existing data is limited.
Methods: Demographics, surgical history, symptom assessment, SF-12, SRS-29, ODI, and nonsurgical treatment of 1061 patients in a prospective multi-center study of adult spinal deformity between January 2002 and June 2004 were reviewed. Resource utilization was documented by patient and physician questionnaires. Surgical (n=350), high symptom non-surgical (n=335) and low symptom nonsurgical groups (n=250) were identified. Resource utilization was compared across subgroups.
Results: Subgroups were similar with regard to age, gender and prior scoliosis surgery. High and low symptom non-surgical subgroups differed significantly on all reported health status measures (p<.0001). The low symptom group used exercise (33%), analgesics (24%), and pain management (22%) most often. The high symptom group used pain management (55%), with exercise and analgesics reported equally (38%). The high symptom group used significantly greater narcotics, epidural blocks, physical agent modalities (p<.001), analgesics (p<.01), pain management referral and bed rest (p<.02). Following study enrollment, the low symptom group had a decrease in pain management use from 22% to 8.4% (p<.001) and a decrease in analgesic use from 24% to 16% (p<.02). There was an increase in exercise from 33% to 66% (p<.001). For the high symptom group, there was a decrease in "no treatment" from 37% to 19% (p<.001), exercise from 55% to 43% (p<.01), and bracing from 5% to 2% (p<.02). The high symptom group had an increase in bed rest from 15% to 27%, analgesics from 38% to 62%, and pain management from 17% to 39% (p<.001).
Conclusions: This study demonstrates that distinct high and low symptom adult deformity subgroups can be clearly identified. While type and extent of interventions differed, both groups utilized substantial non-surgical treatment resources.