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Eur Spine J. 2016 Aug;25(8):2390-400. doi: 10.1007/s00586-016-4413-8. Epub 2016 Jan 28.

A decision analysis to identify the ideal treatment for adult spinal deformity: is surgery better than non-surgical treatment in improving health-related quality of life and decreasing the disease burden?

Author information

1
Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, Ankara, 06700, Turkey. acaroglue@gmail.com.
2
Clinistats EU, Zurich, Switzerland.
3
Ankara Spine Center, Iran Caddesi 45/2 Kavaklidere, Ankara, 06700, Turkey.
4
Yildirim Beyazit University, Ankara, Turkey.
5
Ankara University, Ankara, Turkey.
6
Hospital Universitari Vall d'Hebron, Barcelona, Spain.
7
Acibadem Maslak Hospital, Istanbul, Turkey.
8
Hospital Universitari La Paz, Madrid, Spain.
9
Schultess Clinic, Zurich, Switzerland.
10
Bordeaux University Hospital, Bordeaux, France.

Abstract

BACKGROUND:

Adult spinal deformity (ASD) is a major public health problem. There are pros and cons of the available treatment alternatives (surgical or non-surgical) and it had been difficult to identify the best treatment modality.

AIM:

To construct a statistical DA model to identify the optimum overall treatment in ASD.

METHODS:

From an international multicentre database of ASD patients (968 pts), 535 who had completed 1 year follow-up (371 non-surgical-NS, 164 surgical-S), constitute the population of this study. DA was structured in two main steps of: (1) baseline analysis (assessing the probabilities of outcomes, assessing the values of preference-utilities-, combining information on probability and utility and assigning the quality adjusted life expectancy (QALE) for each treatment) and (2) sensitivity analysis.

RESULTS:

Four hundred and thirty-two patients (309 NS, 123 S) had baseline and 1 year follow-up ODI measurements. Overall, 104 (24.1 %) were found to be improved (a decrease in ODI > 8 points), 225 (52.1 %) unchanged (-8 > ODI > 8) and 65 deteriorated. Surgery presented with a higher chance of improvement (54.2 %) versus NS (9.7 %). The overall QALE ranged from 56 to 69 (of 100 years) and demonstrated better final QALE in the NS group (60 vs. 65, P = 0.0038), this group having started with higher QALE as well (56 vs. 65 years, P < 0.0001). There were improvements in overall QALE in both groups but this was significant only in the surgical group (S from 56 to 60 years, P < 0.0001; NS from 65 to 65 years, P = 0.27). In addition, in the subgroup of patients with significant baseline disability (ODI > 25) surgery appeared to yield marginally better final QALE (58 vs. 56 years, P = 0.1) despite very a similar baseline (54 vs. 54 years, P = 0.93).

DISCUSSION AND CONCLUSIONS:

This study demonstrated that a single best treatment modality for ASD may not exist. Conservative treatment appears to yield higher (up to 6 %) QALE compared to surgery, most probably secondary to a higher baseline QALE. On the other hand, surgery provides a significantly higher increase in QALE. Especially in patients with significant disability at baseline, the final QALE tended higher in the S group (although not significant). Finally, chances of a relevant improvement at first year turned out to be significantly lower with NS treatment.

KEYWORDS:

Adult operative surgical procedure; Decision analysis; Spinal curvatures; Treatment

PMID:
26821143
DOI:
10.1007/s00586-016-4413-8
[Indexed for MEDLINE]

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