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The Factors That Play a Role in the Decision-Making Process of Adult Deformity Patients

Pekmezci, Murat, MD; Berven, Sigurd H., MD; Hu, Serena S., MD; Deviren, Vedat, MD

doi: 10.1097/BRS.0b013e3181851ba6
Health Services Research

Study Design. Retrospective matched cohort.

Objective. To investigate the factors that may affect the decision-making process of adult deformity patients.

Summary of Background Data. Adult deformity is a significant cause of morbidity in the elderly population. Despite high complication rates a significant number of patients still prefer operative treatment. Analysis of the factors that drive these patients to operative treatment would help surgeons to better evaluate these patients.

Methods. Adult deformity patients who are evaluated in a single institute were reviewed. The inclusion criteria were being >18 years old, having a coronal curve magnitude of >30°, having no previous surgery or associated neuromuscular or inflammatory condition, having completed SF-12, SRS-30, and Oswestry Disability Index questionnaires in the initial visit, and having a complete set of radiographs. The demographic data as well as back and leg pain incidences and magnitudes were collected. The eligible patients were compared first as age-gender-curve type matched cohorts.

Results. Functional domain scores particularly walking in Oswestry Disability Index and vitality in the SRS-30 were significantly worse in the operative treatment group, whereas the pain scores were similar in both groups in all outcomes assessment questionnaires. Besides, there was no difference among 2 groups with respect to either the incidence or the magnitude of back or leg pain.

Conclusion. These results suggest that functional limitations are more important than pain for adult deformity patients when deciding for operative or nonoperative treatment.

Analysis of an age, gender, and curve type matched cohort of adult deformity patients revealed that deterioration of the functional status of the patients, particularly walking, is more important than pain in the decision-making process of adult deformity patients.

From the Department of Orthopedic Surgery, University of California San Francisco, San Francisco, CA.

Acknowledgment date: January 7, 2008. Revision date: May 16, 2008. Acceptance date: May 26, 2008.

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

No funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the subject of this manuscript.

Address correspondence and reprint requests to Vedat Deviren, MD, Department of Orthopedic Surgery, University of California San Francisco, 500 Parnassus Ave, MUW 320, San Francisco, CA, 94143; E-mail:

© 2009 Lippincott Williams & Wilkins, Inc.