You could be reading the full-text of this article now if you...

If you have access to this article through your institution,
you can view this article in

Cost and Value of Spinal Deformity Surgery

Paulus, Megan Carroll MD*; Kalantar, Seyed Babak MD*; Radcliff, Kris MD

Spine:
doi: 10.1097/BRS.0000000000000150
Deformity
Abstract

Study Design. Literature review.

Objective. To assess (1) quality of life in patients with adult scoliosis who underwent nonoperative and/or surgical treatment, and (2) cost-effectiveness of different scoliosis treatment modalities.

Summary of Background Data. Recently, there has been an interest in examining quality of life of patients undergoing treatment for adult scoliosis, comparing the value of nonoperative versus operative management. This article reviews the current literature on treatment of adult scoliosis, in the hopes of drawing conclusions for the best approach to these patients.

Methods. MEDLINE and PubMed databases were searched to identify articles. Health-related quality of life measures included Oswestry Disability Index scores, Scoliosis Research Society (SRS) instrument scores, 12-Item Short Form Health Survey, and numerical rating scale for leg and/or back pain. Studies included were those involving patients with adult scoliosis who underwent primary surgery or nonoperative management. The studies that focused on the change in validated outcome scores from the onset of the study to final follow-up were found to be valuable. Studies on predominantly adolescent scoliosis and those that only measured postoperative outcomes scores were excluded.

Results. The SRS-22, Oswestry Disability Index, 12-Item Short Form Health Survey, and numerical rating scale were found to be validated for measuring quality of life in patients with scoliosis. Thirteen studies were included, which evaluated changes in health-related quality of life outcomes from baseline in surgical and nonsurgical treatment of adult scoliosis. There was a trend toward improved quality of life measures in patients undergoing surgical treatment for adult scoliosis.

Conclusion. Adults with painful and disabling scoliosis may benefit from surgical treatment compared with nonsurgical treatment, given the proper indications. Nonsurgical treatment does not seem to be cost-effective and has not shown to have a positive impact on quality of life, although there is a possibility that patients' health may have deteriorated if they did not receive the nonsurgical treatment. Future prospective studies focusing on the cost-effectiveness of adult scoliosis treatment and improvement of quality of life are needed to confirm the assertion of the current retrospective literature that surgery provides better quality of life than nonoperative treatment.

Level of Evidence: N/A

In Brief

Recently, there has been an interest in examining quality of life in patients undergoing treatment for adult spinal deformity, comparing the value of nonoperative versus operative management. This article reviews the current literature on the treatment of adult spinal deformity, in hopes of drawing conclusions for the best approach to these patients.

Author Information

*Department of Orthopaedics, Medstar Georgetown University Hospital, Washington, DC; and

Rothman Institute, Thomas Jefferson University, Philadelphia, PA.

Address correspondence and reprint requests to Megan Carroll Paulus, MD, Medstar Georgetown University Hospital, Department of Orthopaedics, 3800 Reservoir Road, 1 Gorman, Washington, DC 20007; E-mail: meganjcarroll@gmail.com

Acknowledgment date: July 9, 2013. First revision date: September 10, 2013. Second revision date: November 11, 2013. Acceptance date: November 19, 2013.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, royalties, stock/stock options and travel/accommodations/meeting expenses.

© 2014 by Lippincott Williams & Wilkins