{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,30]],"date-time":"2026-10-30T03:25:46Z","timestamp":1793330746641,"version":"4.5.0"},"reference-count":46,"publisher":"American Medical Association (AMA)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,6,1]]},"abstract":"\n Importance<\/jats:title>\n Long-term follow-up studies of operative and nonoperative treatment of adult symptomatic lumbar scoliosis (ASLS) are needed to assess benefits and durability.<\/jats:p>\n <\/jats:sec>\n \n Objective<\/jats:title>\n To assess the durability of treatment outcomes for operative vs nonoperative treatment of ASLS.<\/jats:p>\n <\/jats:sec>\n \n Design, Setting, and Participants<\/jats:title>\n The Adult Symptomatic Lumbar Scoliosis 1 (ASLS-1) study was a multicenter, prospective study with randomized and observational cohorts designed to assess operative vs nonoperative ASLS treatment. Operative and nonoperative patients were compared using as-treated analysis of combined randomized and observational cohorts. Patients with ASLS aged 40 to 80 years were enrolled at 9 centers in North America. Data were analyzed from November 2023 to July 2024.<\/jats:p>\n <\/jats:sec>\n \n Interventions<\/jats:title>\n Operative and nonoperative treatment approaches.<\/jats:p>\n <\/jats:sec>\n \n Main Outcomes and Measures<\/jats:title>\n Primary outcomes measures were the Oswestry Disability Index (ODI) and Scoliosis Research Society 22 (SRS-22) at 2-, 5-, and 8-year follow-up.<\/jats:p>\n <\/jats:sec>\n \n Results<\/jats:title>\n \n The 286 enrolled patients (104 in the nonoperative group: median [IQR] age, 61.9 [54.4-68.8] years; 97 female [93%]; 182 in the operative group: median [IQR] age, 60.2 [53.5-66.6] years; 161 female [88%]) had follow-up rates at 2, 5, and 8 years of 90% (256 of 286), 70% (199 of 286), and 72% (205 of 286), respectively. At 2 years, compared with those in the nonoperative group, patients in the operative group had better ODI (mean difference\u2009=\u2009\u221213.3; 95% CI, \u221216.39 to \u221210.22;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and SRS-22 (mean difference\u2009=\u20090.59; 95% CI, 0.46-0.71;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) scores, with mean differences exceeding the minimal detectable measurement difference (MDMD) for ODI (7) and SRS-22 (0.4). Mean differences at 5 years (ODI\u2009=\u2009\u221211.62; 95% CI, \u221215.53 to \u22127.71;\n P<\/jats:italic>\n &amp;lt;.001; SRS-22\u2009=\u20090.59; 95% CI, 0.45-0.73;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) and 8 years (ODI\u2009=\u2009\u221214.59; 95% CI, \u221218.08 to \u221211.09;\n P<\/jats:italic>\n &amp;lt;.001; SRS-22\u2009=\u20090.75; 95% CI, 0.58-0.91;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001) remained as favorable as at 2 years without evidence of degradation. The treatment-related serious adverse event (SAE) incidence rates for operative patients at 2, 2 to 5, and 5 to 8 years were 22.24, 9.08, and 8.02 per 100 person-years, respectively. At 8 years, operative patients with 1 treatment-related SAE still had significant improvement, with mean treatment differences that exceeded MDMD (ODI\u2009=\u2009\u221210.09; 95% CI, \u221214.81 to \u22125.37;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001; SRS-22\u2009=\u20090.64; 95% CI, 0.43-0.85;\n P<\/jats:italic>\n \u2009&amp;lt;\u2009.001).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions and Relevance<\/jats:title>\n Results of this nonrandomized clinical trial reveal that, on average, operative treatment for ASLS provided significantly greater clinical improvement than nonoperative treatment at 2-, 5- and 8-year follow-up, with no evidence of deterioration. Operative patients with a treatment-related SAE still maintained greater improvement than nonoperative patients. These findings suggest long-term durability of surgical treatment for ASLS and may prove useful for patient management and counseling.<\/jats:p>\n <\/jats:sec>\n \n Trial Registration<\/jats:title>\n \n ClinicalTrials.gov Identifier:\n NCT00854828<\/jats:ext-link>\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.0496","type":"journal-article","created":{"date-parts":[[2025,4,4]],"date-time":"2025-04-04T12:45:05Z","timestamp":1743770705000},"page":"634","source":"Crossref","is-referenced-by-count":20,"title":["Operative vs Nonoperative Treatment for Adult Symptomatic Lumbar Scoliosis at 8-Year Follow-Up"],"prefix":"10.1001","volume":"160","author":[{"given":"Justin S.","family":"Smith","sequence":"first","affiliation":[{"name":"Department of Neurosurgery, University of Virginia Health Sciences Center, Charlottesville"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of 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