Standardized measures of health status and disability and the decision to pursue operative treatment in elderly patients with degenerative scoliosis

Abstract

Objective: Treatment decision making in elderly patients with degenerative scoliosis is complex. Although most patients can be adequately treated with nonoperative therapies, a subset ultimately elects for surgical treatment. However, the factors that govern this transition are poorly understood. The objective of this study was to assess whether standardized measures of health status and disability may be useful in distinguishing those patients who elect for surgical treatment.

Methods: This study is a retrospective review of a prospective database of 139 consecutive patients aged older than 60 years (mean = 70 years), with degenerative scoliosis treated by a single surgeon. Patients with severe symptoms who had failed multimodality nonoperative care were considered for surgical intervention. The Scoliosis Research Society Questionnaire (SRS-30), 12-Item Short Form Health Survey (SF-12), Oswestry Disability Index (ODI) surveys, and Charlson Comorbidity Index (CCI) were collected at the time of presentation and compared between the operative and nonoperative groups.

Results: There were no statistically significant differences between the operative and nonoperative groups in terms of age and major radiographic parameters. Significant differences between the operative and nonoperative groups were found for all 3 self-assessment survey results, with those electing for operative intervention reporting worse scores for ODI (54 versus 40; P = .001), SRS-30 (2.7 versus 3.0; P = .01), SF-12 physical component summary (23 versus 29; P = .01), and SF-12 mental component summary (46 versus 52; P = .03). Unexpectedly, patients treated surgically had a higher level of comorbidity as measured by the CCI (2.0 versus 1.3; P = .003).

Conclusion: Self-assessments of health and disability distinguish elderly patients with degenerative scoliosis electing for surgery compared with those who continue nonoperative therapies. Standardized measures of health status and disability may be useful in identifying patients nearing the threshold of crossing over to surgical treatment.