Self-Image in Adult Spinal Deformity: The Critical Link Between Baseline Disability, Treatment Choice, and Surgical...

Prospective, multicenter analysis.

Evaluate the impact that self-image has upon operative versus nonoperative treatment choice for adult spine deformity (ASD) patients, and evaluate the association of post-treatment self-image with treatment satisfaction.

ASD outcomes traditionally focus upon pain and physical function. Self-image is an important outcome measure for pediatric spine deformity. Little data exists regarding the impact self-image has upon ASD treatment choice and outcomes.

Factor analysis and decision tree modeling were performed upon ASD patients prospectively enrolled into a multi-center study from 2009 to 2020. Data elements from physical examination, demographics, spinal alignment, and individual questions from administered PROMs, including SRS-22r, ODI, SF36, and NRS back and leg pain were evaluated for variables that correlated most with (1) patients electing for operative versus nonoperative treatment and (2) treatment satisfaction at minimum 2-year follow-up.

Evaluation of 735 ASD patients demonstrated operatively treated patients (OP; n=548) were older (58.0±15.3 vs . 52.4±16.0 yr; P <0.0001), had similar scoliosis (44.9±20.1° vs . 45.5±16.1°; P =0.5555) but worse sagittal malalignment than nonoperatively treated patients (NON; n=187; P <0.0001, respectively). Baseline PROMs were worse for OP versus NON ( P <0.0001). Gradient-boosted decision trees, factor analysis, and logistic regression of demographic, physical examination, radiographic, and PROM variables associated with treatment choice demonstrated self-image (odds ratio=4.5; 95% CI=3.4-6.0; P <0.0001) had the greatest correlation for patients choosing operative treatment. At minimum 2-year follow-up self-image demonstrated the greatest health domain improvement for OP and self-image improvement correlated most with post-treatment satisfaction, while NON demonstrated deterioration of self-image and reported poor treatment satisfaction.

Multivariable evaluation of 735 operative and nonoperative treated ASD patients demonstrated baseline self-image strongly correlated with ASD patients pursuing surgical treatment and postoperative treatment satisfaction. Patient self-image is a critical measure that must be assessed in ASD.