Outcomes of Operative and Nonoperative Treatment in Patients with Adult Spinal Deformity with a Minimum 2-Year Follow-Up: A Meta-Analysis.

Abstract

More recent studies have focused on clinical outcomes of operative versus nonoperative treatment in patients with adult spinal deformity (ASD). However, scientific support for ASD surgery is weak. We compared outcomes of operative and nonoperative treatment of ASD with minimum 2-year follow-up in a meta-analysis. MEDLINE and EMBASE databases, from the earliest available date of indexing through May 10, 2018, were searched for studies evaluating outcomes of operative and nonoperative treatment of ASD. Two authors performed data extraction independently. Any discrepancies were resolved by consensus. Four comparative studies were identified. Postoperative back pain numeric rating scale and leg pain numeric rating scale scores were significantly lower with operative treatment compared with nonoperative treatment (P < 0.00001, weighted mean difference [WMD] = -2.76 [-3.45, -2.07] vs. P < 0.0001, WMD = -2.31 [-3.33, -1.28]). Postoperative Oswestry Disability Index and Scoliosis Research Society-22 questionnaire scores were significantly better with operative treatment compared with nonoperative treatment (P < 0.00001, WMD = -10.96 [-13.56, -8.36] vs. P < 0.00001, WMD = 0.68 [0.48, 0.87]). The complication rate of operative treatment was 17%-71.5%. Our meta-analysis showed that operative treatment has been demonstrated to significantly reduce disability and pain and to improve clinical outcomes compared with nonoperative treatment. Further large, multicenter, well-designed studies are necessary to substantiate our results.