Operative Versus Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis

作者：Michael P. Kelly, Jon D. Lurie, Elizabeth L. Yanik, Christopher I. Shaffrey, Christine R. Baldus, Oheneba Boachie–Adjei, Jacob M. Buchowski, Leah Y. Carreon, Charles H. Crawford, Charles C. Edwards, Thomas J. Errico, Steven D. Glassman, Munish Kumar Gupta, Lawrence G. Lenke, Stephen J. Lewis, Han Jo Kim, Tyler R. Koski, Stefan Parent, Frank Schwab, Justin S. Smith, Lukas P. Zebala, Keith H. Bridwell · 发表于：Journal of Bone and Joint Surgery · 年份：2019 · DOI：10.2106/jbjs.18.00483 · 被引用次数：164 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Spinal Fractures and Fixation Techniques

BACKGROUND: The effectiveness of operative compared with nonoperative treatment at initial presentation (no prior fusion) for adult lumbar scoliosis has not, to our knowledge, been evaluated in controlled trials. The goals of this study were to evaluate the effects of operative and nonoperative treatment and to assess the benefits of these treatments to help treating physicians determine whether patients are better managed operatively or nonoperatively. METHODS: Patients with adult symptomatic lumbar scoliosis (aged 40 to 80 years, with a coronal Cobb angle measurement of ≥30° and an Oswestry Disability Index [ODI] score of ≥20 or Scoliosis Research Society [SRS]-22 score of ≤4.0) from 9 North American centers were enrolled in concurrent randomized or observational cohorts to evaluate operative versus nonoperative treatment. The primary outcomes were differences in the mean change from baseline in the SRS-22 subscore and ODI at 2-year follow-up. For the randomized cohort, the initial sample-size calculation estimated that 41 patients per group (82 total) would provide 80% power with alpha equal to 0.05, anticipating 10% loss to follow-up and 20% nonadherence in the nonoperative arm. However, an interim sample-size calculation estimated that 18 patients per group would be sufficient. RESULTS: Sixty-three patients were enrolled in the randomized cohort: 30 in the operative group and 33 in the nonoperative group. Two hundred and twenty-three patients were enrolled in the observa...