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The Costs and Benefits of Nonoperative Management for Adult Scoliosis

Glassman, Steven D., MD*†; Carreon, Leah Y., MD, MSc; Shaffrey, Christopher I., MD; Polly, David W., MD§; Ondra, Stephen L., MD; Berven, Sigurd H., MD; Bridwell, Keith H., MD**

doi: 10.1097/BRS.0b013e3181b0f2f8
Health Services Research

Study Design. A prospective cohort of adult scoliosis patients treated nonoperatively had a minimum of 2-year follow-up during which time data were collected on the type and quantity of nonoperative treatment used.

Objective. To quantify the use, cost, and effectiveness of nonoperative treatment for adult scoliosis.

Summary of Background Data. A 2007 systematic review of nonsurgical treatment in adult scoliosis revealed minimal data, and concluded that evidence for nonoperative care was lacking.

Methods. Duration of use and frequency of visits were collected for 8 specific treatment methods: medication, physical therapy, exercise, injections/blocks, chiropractic care, pain management, bracing, and bed rest. Costs for each intervention were determined using the Medicare Fee schedule. Outcome measures were the SRS-22, SF-12, and ODI. Analysis was performed for the entire group, and for subsets of high (ODI, >40), mid (ODI = 21–40) and low (ODI, ≤20) symptom patients.

Results. A total of 123 patients (111 females, 12 males) with a mean age of 53.3 (18–79) years were evaluated. In 55 scoliosis patients who received no treatment, the only significant change in HRQOL measures over the 2-year period was in SRS satisfaction subscore (0.3 points, P = 0.014). Among the 68 adult scoliosis patients who used nonoperative resources, there was no significant change in any of the HRQOL outcome parameters. Mean treatment cost over the 2-year period was $10,815. Mean cost over the 2-year period averaged $9704 in the low symptom patients, $11,116 in the mid symptom, and $14,022 in the high symptom patients.

Conclusion. This study questions the value of nonoperative treatment commonly used for adult scoliosis patients. Documented costs are substantial and no improvement in health status was observed. An important caveat is that treatment was not randomized and therefore the treatment group might have deteriorated if not for the treatment they received.

This study questions the value of nonoperative treatment commonly used for adult scoliosis patients. Documented costs are substantial and no improvement in health status was observed. An important caveat is that treatment was not randomized and therefore the treatment group might have deteriorated if not for the treatment they received.

From the *Department of Orthopaedic Surgery, University of Louisville School of Medicine, Louisville, KY; †Leatherman Spine Center, Louisville, KY; ‡Department of Neurological Surgery, University of Virginia, Charlottesville, VA; §Department of Orthopaedics, University of Minnesota, Minneapolis, MN; ¶Department of Neurosurgery, Northwestern University, Chicago, IL; ∥Department of Orthopaedic Surgery, University of California, San Francisco, CA; and **Department of Orthopedic Surgery, WA University School of Medicine, St. Louis, MO.

Acknowledgment date: March 16, 2009. Acceptance date: May 4, 2009.

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

Corporate/Industry funds were received in support of this work. One or more of the author(s) has/have received or will receive benefits for personal or professional use from a commercial party related directly or indirectly to the subject of this manuscript: e.g., honoraria, gifts, consultancies, royalties, stocks, stock options, decision making position.

Address correspondence and reprint requests to Steven D. Glassman, MD, Department of Orthopaedic Surgery, University of Louisville School of Medicine, 210 East Gray Street, Suite 900, Louisville, KY 40202; E-mail: tallgeyer@spinemds.com

© 2010 Lippincott Williams & Wilkins, Inc.