Comparison of operative and nonoperative treatment in patients with adult spinal deformity: a meta-analysis_West China Medical Journal

Authors：

AMU Yida , YAO Ruzhan ,  WANG Guanglin , WU Chengxi , XIONG Wei

Department of Orthopedics, West China Hospital, Sichuan University, Chengdu, Sichuan 610041, P. R. China;

Corresponding author：

WANG Guanglin, Email: wglfrank@163.com

Keywords：

Adult spinal deformity; Operative treatment; Nonoperative treatment; Efficacy; Meta-analysis

DOI：

10.7507/1002-0179.201907037

Video：

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Objective To systematically review the efficacy and safety of operative treatment versus nonoperative treatment in patients with adult spinal deformity (ASD).Methods PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure, WanFang Data, and CQVIP databases were searched for controlled studies about operative treatment versus nonoperative treatment for ASD published up till June 2019. ClinicalTrials.gov was searched for grey literatures informally published up till June 2019. Two reviewers independently screened literatures, extracted data, and assessed risk of bias. Meta-analysis was performed by using RevMan 5.3 and Stata 14.0 softwares.Results A total of 10 non-randomized controlled studies were included, including 1 601 patients. The pooled results indicated that the operative group was superior to the nonoperative group in ability improvement [the increment of Scoliosis Research Society-22 score: weighted mean difference (WMD)=0.70, 95% confidence interval (CI) (0.69, 0.70), P<0.000 01; the decrement of Oswestry Disability Index score: WMD=11.12, 95%CI (10.74, 11.50), P<0.000 01], pain relief [the decrement of Numeric Rating Scale score: WMD=3.25, 95%CI (3.16, 3.35), P<0.000 01], and Cobb correction [WMD=14.06°, 95%CI (13.60, 14.53)°, P<0.000 01]. The incidence of complications was higher in the operative group than that in the nonoperative group [relative risk=5.38, 95%CI (3.67, 7.88), P<0.000 01].Conclusions Surgery shows superior efficacy on ability improvement, pain relief, and Cobb correction compared with nonoperative treatment in ASD patients, though its incidence of complications is high. Nonoperative treatment is also an effective treatment for patients with poor physical condition and intolerance to surgery. Due to the limited quantity and quality of included studies, more high-quality studies are required to verify the above conclusions.

Citation： AMU Yida, YAO Ruzhan, WANG Guanglin, WU Chengxi, XIONG Wei. Comparison of operative and nonoperative treatment in patients with adult spinal deformity: a meta-analysis. West China Medical Journal, 2019, 34(9): 986-993. doi: 10.7507/1002-0179.201907037 Copy

1.	Kebaish KM, Neubauer PR, Voros GD, et al. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine (Phila Pa 1976), 2011, 36(9): 731-736.
2.	Mannion AF, Elfering A, Bago J, et al. Factor analysis of the SRS-22 outcome assessment instrument in patients with adult spinal deformity. Eur Spine J, 2018, 27(3): 685-699.
3.	Liang Y, Zhao YF, Wang TH, et al. Precision treatment of adult lumbar degenerative scoliosis complicated by lumbar stenosis with the use of selective nerve root block. World Neurosurg, 2018, 120: e970-e975.
4.	Du JP, Fan Y, Liu JJ, et al. Application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in the treatment of adult degenerative scoliosis: a clinical observation including 96 patients. World Neurosurg, 2017, 108(11): 791-797.
5.	Fu KM, Smith JS, Sansur CA. Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis. Neurosurgery, 2010, 66(1): 42-47.
6.	Shaw R, Skovrlj B, Cho SK. Association between age and complications in adult scoliosis surgery: an analysis of the scoliosis research society morbidity and mortality database. Spine (Phila Pa 1976), 2016, 41(6): 508-514.
7.	Sollmann N, Morandell C, Albers L, et al. Association of decision-making in spinal surgery with specialty and emotional involvement: the Indications in Spinal Surgery (Indiana) survey. Acta Neurochir (Wien), 2018, 160(3): 425-438.
8.	Berven SH, Kamper SJ, Germscheid NM, et al. An international consensus on the appropriate evaluation and treatment for adults with spinal deformity. Eur Spine J, 2018, 27(3): 585-596.
9.	Karimi MT, Kavyani M, Kamali M. Balance and gait performance of scoliotic subjects: a review of the literature. J Back Musculoskelet Rehabil, 2016, 29(3): 403-415.
10.	Liu S, Diebo BG, Henry JK, et al. The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference. Spine J, 2016, 16(2): 210-218.
11.	Yee TJ, Smith BW, Joseph JR, et al. Correlation between the Oswestry Disability Index and the 4-item short forms for physical function and pain interference from PROMIS. J Neurosurg Spine, 2019, 8(9): 1-6.
12.	Bokshan SL, Godzik J, Dalton J, et al. Reliability of the revised Scoliosis Research Society-22 and Oswestry Disability Index (ODI) questionnaires in adult spinal deformity when administered by telephone. Spine J, 2016, 16(9): 1042-1046.
13.	Kelly MP, Lurie JD, Yanik EL, et al. Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis. J Bone Joint Surg Am, 2019, 101(4): 338-352.
14.	Sciubba DM, Scheer JK, Yurter A, et al. Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J, 2016, 25(8): 2433-2441.
15.	Smith JS, Lafage V, Shaffrey CI, et al. Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery, 2016, 78(6): 851-861.
16.	Yuksel S, Ayhan S, Nabiyev V, et al. Minimum clinically important difference of the health-related quality of life scales in adult spinal deformity calculated by latent class analysis: is it appropriate to use the same values for surgical and nonsurgical patients?. Spine J, 2019, 19(1): 71-78.
17.	Kluba T, Dikmenli G, Dietz K, et al. Comparison of surgical and conservative treatment for degenerative lumbar scoliosis. Arch Orthop Trauma Surg, 2009, 129(1): 1-5.
18.	Smith JS, Shaffrey CI, Berven S, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976), 2009, 34(16): 1693-1698.
19.	Bridwell KH, Glassman S, Horton W, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976), 2009, 34(20): 2171-2178.
20.	Smith JS, Shaffrey CI, Berven SA, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery, 2009, 65(1): 86-94.
21.	Li G, Passias P, Kozanek M, et al. Adult scoliosis in patients over sixty-five years of age outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976), 2009, 34(20): 2165-2170.
22.	Fu KM, Bess S, Shaffrey CI, et al. Patients with adult spinal deformity treated operatively report greater baseline pain and disability than patients treated nonoperatively; however, deformities differ between age groups. Spine (Phila Pa 1976), 2014, 39(17): 1401-1407.
23.	Choi SH, Son SM, Goh TS, et al. Outcomes of operative and nonoperative treatment in patients with adult spinal deformity with a minimum 2-year follow-up: a meta-analysis. World Neurosurg, 2018, 120(11): e870-e876.
24.	Wang G, Hu J, Liu X, et al. Surgical treatments for degenerative lumbar scoliosis: a meta analysis. Eur Spine J, 2015, 24(8): 1792-1799.
25.	Smith JS, Shaffrey CI, Glassman SD, et al. Risk-Benefit assessment of surgery for adult scoliosis an analysis based on patient age. Spine (Phila Pa 1976), 2011, 36(10): 817-824.
26.	Aebi M. The adult scoliosis. Eur Spine J, 2005, 14(10): 925-948.
27.	Simon MJ, Halm HF, Quante M. Perioperative complications after surgical treatment in degenerative adult de novo scoliosis. BMC Musculoskelet Disord, 2018, 19(1): 1186-1196.
28.	Ploumis A, Albert TJ, Brown Z, et al. Healos graft carrier with bone marrow aspirate instead of allograft as adjunct to local autograft for posterolateral fusion in degenerative lumbar scoliosis: a minimum 2-year follow-up study clinical article. J Neurosurg Spine, 2010, 13(2): 211-215.
29.	Xie Y, Fu Q, Chen ZQ, et al. Comparison between two pedicle screw augmentation instrumentations in adult degenerative scoliosis with osteoporosis. BMC Musculoskelet Disord, 2011, 12(12): 286-292.
30.	Lateur G, Grobost P, Gerbelot J, et al. Efficacy of nighttime brace in preventing progression of idiopathic scoliosis of less than 25 degrees. Orthop Traumatol Surg Res, 2017, 103(2): 275-278.
31.	Ha Y, Oh JK, Smith JS, et al. Impact of movement disorders on management of spinal deformity in the elderly. Neurosurgery, 2015, 77(1): S173-S185.
32.	Maruyama T, Grivas TB, Kaspiris A. Effectiveness and outcomes of brace treatment: a systematic review. Physiother Theory Pract, 2011, 27(1): 26-42.

1. Kebaish KM, Neubauer PR, Voros GD, et al. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine (Phila Pa 1976), 2011, 36(9): 731-736.
2. Mannion AF, Elfering A, Bago J, et al. Factor analysis of the SRS-22 outcome assessment instrument in patients with adult spinal deformity. Eur Spine J, 2018, 27(3): 685-699.
3. Liang Y, Zhao YF, Wang TH, et al. Precision treatment of adult lumbar degenerative scoliosis complicated by lumbar stenosis with the use of selective nerve root block. World Neurosurg, 2018, 120: e970-e975.
4. Du JP, Fan Y, Liu JJ, et al. Application of gelatin sponge impregnated with a mixture of 3 drugs to intraoperative nerve root block combined with robot-assisted minimally invasive transforaminal lumbar interbody fusion surgery in the treatment of adult degenerative scoliosis: a clinical observation including 96 patients. World Neurosurg, 2017, 108(11): 791-797.
5. Fu KM, Smith JS, Sansur CA. Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis. Neurosurgery, 2010, 66(1): 42-47.
6. Shaw R, Skovrlj B, Cho SK. Association between age and complications in adult scoliosis surgery: an analysis of the scoliosis research society morbidity and mortality database. Spine (Phila Pa 1976), 2016, 41(6): 508-514.
7. Sollmann N, Morandell C, Albers L, et al. Association of decision-making in spinal surgery with specialty and emotional involvement: the Indications in Spinal Surgery (Indiana) survey. Acta Neurochir (Wien), 2018, 160(3): 425-438.
8. Berven SH, Kamper SJ, Germscheid NM, et al. An international consensus on the appropriate evaluation and treatment for adults with spinal deformity. Eur Spine J, 2018, 27(3): 585-596.
9. Karimi MT, Kavyani M, Kamali M. Balance and gait performance of scoliotic subjects: a review of the literature. J Back Musculoskelet Rehabil, 2016, 29(3): 403-415.
10. Liu S, Diebo BG, Henry JK, et al. The benefit of nonoperative treatment for adult spinal deformity: identifying predictors for reaching a minimal clinically important difference. Spine J, 2016, 16(2): 210-218.
11. Yee TJ, Smith BW, Joseph JR, et al. Correlation between the Oswestry Disability Index and the 4-item short forms for physical function and pain interference from PROMIS. J Neurosurg Spine, 2019, 8(9): 1-6.
12. Bokshan SL, Godzik J, Dalton J, et al. Reliability of the revised Scoliosis Research Society-22 and Oswestry Disability Index (ODI) questionnaires in adult spinal deformity when administered by telephone. Spine J, 2016, 16(9): 1042-1046.
13. Kelly MP, Lurie JD, Yanik EL, et al. Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis. J Bone Joint Surg Am, 2019, 101(4): 338-352.
14. Sciubba DM, Scheer JK, Yurter A, et al. Patients with spinal deformity over the age of 75: a retrospective analysis of operative versus non-operative management. Eur Spine J, 2016, 25(8): 2433-2441.
15. Smith JS, Lafage V, Shaffrey CI, et al. Outcomes of operative and nonoperative treatment for adult spinal deformity: a prospective, multicenter, propensity-matched cohort assessment with minimum 2-year follow-up. Neurosurgery, 2016, 78(6): 851-861.
16. Yuksel S, Ayhan S, Nabiyev V, et al. Minimum clinically important difference of the health-related quality of life scales in adult spinal deformity calculated by latent class analysis: is it appropriate to use the same values for surgical and nonsurgical patients?. Spine J, 2019, 19(1): 71-78.
17. Kluba T, Dikmenli G, Dietz K, et al. Comparison of surgical and conservative treatment for degenerative lumbar scoliosis. Arch Orthop Trauma Surg, 2009, 129(1): 1-5.
18. Smith JS, Shaffrey CI, Berven S, et al. Operative versus nonoperative treatment of leg pain in adults with scoliosis: a retrospective review of a prospective multicenter database with two-year follow-up. Spine (Phila Pa 1976), 2009, 34(16): 1693-1698.
19. Bridwell KH, Glassman S, Horton W, et al. Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study. Spine (Phila Pa 1976), 2009, 34(20): 2171-2178.
20. Smith JS, Shaffrey CI, Berven SA, et al. Improvement of back pain with operative and nonoperative treatment in adults with scoliosis. Neurosurgery, 2009, 65(1): 86-94.
21. Li G, Passias P, Kozanek M, et al. Adult scoliosis in patients over sixty-five years of age outcomes of operative versus nonoperative treatment at a minimum two-year follow-up. Spine (Phila Pa 1976), 2009, 34(20): 2165-2170.
22. Fu KM, Bess S, Shaffrey CI, et al. Patients with adult spinal deformity treated operatively report greater baseline pain and disability than patients treated nonoperatively; however, deformities differ between age groups. Spine (Phila Pa 1976), 2014, 39(17): 1401-1407.
23. Choi SH, Son SM, Goh TS, et al. Outcomes of operative and nonoperative treatment in patients with adult spinal deformity with a minimum 2-year follow-up: a meta-analysis. World Neurosurg, 2018, 120(11): e870-e876.
24. Wang G, Hu J, Liu X, et al. Surgical treatments for degenerative lumbar scoliosis: a meta analysis. Eur Spine J, 2015, 24(8): 1792-1799.
25. Smith JS, Shaffrey CI, Glassman SD, et al. Risk-Benefit assessment of surgery for adult scoliosis an analysis based on patient age. Spine (Phila Pa 1976), 2011, 36(10): 817-824.
26. Aebi M. The adult scoliosis. Eur Spine J, 2005, 14(10): 925-948.
27. Simon MJ, Halm HF, Quante M. Perioperative complications after surgical treatment in degenerative adult de novo scoliosis. BMC Musculoskelet Disord, 2018, 19(1): 1186-1196.
28. Ploumis A, Albert TJ, Brown Z, et al. Healos graft carrier with bone marrow aspirate instead of allograft as adjunct to local autograft for posterolateral fusion in degenerative lumbar scoliosis: a minimum 2-year follow-up study clinical article. J Neurosurg Spine, 2010, 13(2): 211-215.
29. Xie Y, Fu Q, Chen ZQ, et al. Comparison between two pedicle screw augmentation instrumentations in adult degenerative scoliosis with osteoporosis. BMC Musculoskelet Disord, 2011, 12(12): 286-292.
30. Lateur G, Grobost P, Gerbelot J, et al. Efficacy of nighttime brace in preventing progression of idiopathic scoliosis of less than 25 degrees. Orthop Traumatol Surg Res, 2017, 103(2): 275-278.
31. Ha Y, Oh JK, Smith JS, et al. Impact of movement disorders on management of spinal deformity in the elderly. Neurosurgery, 2015, 77(1): S173-S185.
32. Maruyama T, Grivas TB, Kaspiris A. Effectiveness and outcomes of brace treatment: a systematic review. Physiother Theory Pract, 2011, 27(1): 26-42.

West China Medical Journal

Comparison of operative and nonoperative treatment in patients with adult spinal deformity: a meta-analysis

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