Operative versus nonoperative treatment for adult symptomatic lumbar scoliosis at 5-year follow-up: durability of outcomes and impact of treatment-related serious adverse events

作者：Justin S. Smith, Michael P. Kelly, Elizabeth L. Yanik, Christine R. Baldus, Thomas J. Buell, Jon D. Lurie, Charles C. Edwards, Steven D. Glassman, Lawrence G. Lenke, Oheneba Boachie–Adjei, Jacob M. Buchowski, Leah Y. Carreon, Charles H. Crawford, Thomas J. Errico, Stephen J. Lewis, Tyler R. Koski, Stefan Parent, Virginie Lafage, Han Jo Kim, Christopher P. Ames, Shay Bess, Frank Schwab, Christopher I. Shaffrey, Keith H. Bridwell · 发表于：Journal of Neurosurgery Spine · 年份：2021 · DOI：10.3171/2020.9.spine201472 · 被引用次数：53 · 研究领域：Scoliosis diagnosis and treatment、Spine and Intervertebral Disc Pathology、Spinal Fractures and Fixation Techniques

OBJECTIVE: Although short-term adult symptomatic lumbar scoliosis (ASLS) studies favor operative over nonoperative treatment, longer outcomes are critical for assessment of treatment durability, especially for operative treatment, because the majority of implant failures and nonunions present between 2 and 5 years after surgery. The objectives of this study were to assess the durability of treatment outcomes for operative versus nonoperative treatment of ASLS, to report the rates and types of associated serious adverse events (SAEs), and to determine the potential impact of treatment-related SAEs on outcomes. METHODS: The ASLS-1 (Adult Symptomatic Lumbar Scoliosis-1) trial is an NIH-sponsored multicenter prospective study to assess operative versus nonoperative ASLS treatment. Patients were 40-80 years of age and had ASLS (Cobb angle ≥ 30° and Oswestry Disability Index [ODI] ≥ 20 or Scoliosis Research Society [SRS]-22 subscore ≤ 4.0 in the Pain, Function, and/or Self-Image domains). Patients receiving operative and nonoperative treatment were compared using as-treated analysis, and the impact of related SAEs was assessed. Primary outcome measures were ODI and SRS-22. RESULTS: The 286 patients with ASLS (107 with nonoperative treatment, 179 with operative treatment) had 2-year and 5-year follow-up rates of 90% (n = 256) and 74% (n = 211), respectively. At 5 years, compared with patients treated nonoperatively, those who underwent surgery had greater improvement in ODI (mean di...