{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,10,26]],"date-time":"2025-10-26T22:55:23Z","timestamp":1761519323331,"version":"3.41.0"},"reference-count":28,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"6","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2021,6]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>Patients with nonoperative (N-Op) adult spinal deformity (ASD) have inferior long-term spinopelvic alignment and clinical outcomes. Predictors of lower quality-of-life measures in N-Op populations have yet to be sufficiently investigated. The aim of this study was to identify patient-related factors and radiographic parameters associated with inferior health-related quality-of-life (HRQOL) scores in N-Op ASD patients.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>N-Op ASD patients with complete radiographic and outcome data at baseline and 2 years were included. N-Op patients and operative (Op) patients were propensity score matched for baseline disability and deformity. Patient-related factors and radiographic alignment parameters (pelvic tilt [PT], sagittal vertical axis [SVA], pelvic incidence [PI]\u2013lumbar lordosis [LL] mismatch, mismatch between cervical lordosis and T1 segment slope [TS-CL], cervical-thoracic pelvic angle [PA], and others) at baseline and 2 years were analyzed as predictors for moderate to severe 2-year Oswestry Disability Index (ODI &gt; 20) and failing to meet the minimal clinically importance difference (MCID) for 2-year Scoliosis Research Society Outcomes Questionnaire (SRS) scores (&lt; 0.4 increase from baseline). Conditional inference decision trees identified predictors of each HRQOL measure and established cutoffs at which factors have a global effect. Random forest analysis (RFA) generated 5000 conditional inference trees to compute a variable importance table for top predictors of inferior HRQOL. Statistical significance was set at p &lt; 0.05.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Six hundred sixty-two patients with ASD (331 Op patients and 331 N-Op patients) with complete radiographic and HRQOL data at their 2-year follow-up were included. There were no differences in demographics, ODI, and Schwab deformity modifiers between groups at baseline (all p &gt; 0.05). N-Op patients had higher 2-year ODI scores (27.9 vs 20.3, p &lt; 0.001), higher rates of moderate to severe disability (29.3% vs 22.4%, p = 0.05), lower SRS total scores (3.47 vs 3.91, p &lt; 0.001), and higher rates of failure to reach SRS MCID (35.3% vs 15.7%, p &lt; 0.001) than Op patients at 2 years. RFA ranked the top overall predictors for moderate to severe ODI at 2 years for N-Op patients as follows: 1) frailty index &gt; 2.8, 2) BMI &gt; 35 kg\/m<jats:sup>2<\/jats:sup>, T4PA &gt; 28\u00b0, and 4) Charlson Comorbidity Index &gt; 1. Top radiographic predictors were T4PA &gt; 28\u00b0 and C2\u2013S1 SVA &gt; 93 mm. RFA also ranked the top overall predictors for failure to reach 2-year SRS MCID for N-Op patients, as follows: 1) T12\u2013S1 lordosis &gt; 53\u00b0, 2) cervical SVA (cSVA) &gt; 28 mm, 3) C2\u2013S1 angle &gt; 14.5\u00b0, 4) TS-CL &gt; 12\u00b0, and 5) PT &gt; 23\u00b0. The top radiographic predictors were T12\u2013S1 Cobb angle, cSVA, C2\u2013S1 angle, and TS-CL.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>When controlling for baseline deformity in N-Op versus Op patients, subsequent deterioration in frailty, BMI, and radiographic progression over a 2-year follow-up were found to drive suboptimal patient-reported outcome measures in N-Op cohorts as measured by validated ODI and SRS clinical instruments.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2020.9.spine20519","type":"journal-article","created":{"date-parts":[[2021,4,2]],"date-time":"2021-04-02T07:20:06Z","timestamp":1617348006000},"page":"907-913","source":"Crossref","is-referenced-by-count":7,"title":["Patient-related and radiographic predictors of inferior health-related quality-of-life measures in adult patients with nonoperative spinal deformity"],"prefix":"10.3171","volume":"34","author":[{"given":"Peter 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