{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,8,18]],"date-time":"2026-08-18T04:02:50Z","timestamp":1787025770587,"version":"build-2736575974"},"reference-count":23,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,7,1]]},"abstract":"\n OBJECTIVE<\/jats:title>\n Management of adult spinal deformity (ASD) has increasingly favored operative intervention; however, the incidence of complications and reoperations is high, and patients may fail to achieve idealized postsurgical results. This study compared health-related quality of life (HRQOL) metrics between patients with suboptimal surgical outcomes and those who underwent nonoperative management as a proxy for the natural history (NH) of ASD.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n ASD patients with 2-year data were included. Patients who were offered surgery but declined were considered nonoperative (i.e., NH) patients. Operative patients with suboptimal outcome (SOp)\u2014defined as any reoperation, major complication, or \u2265 2 severe Scoliosis Research Society (SRS)\u2013Schwab modifiers at follow-up\u2014were selected for comparison. Propensity score matching (PSM) on the basis of baseline age, deformity, SRS-22 Total, and Charlson Comorbidity Index score was used to match the groups. ANCOVA and stepwise logistic regression analysis were used to assess outcomes between groups at 2 years.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n In total, 441 patients were included (267 SOp and 174 NH patients). After PSM, 142 patients remained (71 SOp 71 and 71 NH patients). At baseline, the SOp and NH groups had similar demographic characteristics, HRQOL, and deformity (all p > 0.05). At 2 years, ANCOVA determined that NH patients had worse deformity as measured with sagittal vertical axis (36.7 mm vs 21.3 mm, p = 0.025), mismatch between pelvic incidence and lumbar lordosis (11.9\u00b0 vs 2.9\u00b0, p < 0.001), and pelvic tilt (PT) (23.1\u00b0 vs 20.7\u00b0, p = 0.019). The adjusted regression analysis found that SOp patients had higher odds of reaching the minimal clinically important differences in Oswestry Disability Index score (OR [95% CI] 4.5 [1.7\u201311.5], p = 0.002), SRS-22 Activity (OR [95% CI] 3.2 [1.5\u20136.8], p = 0.002), SRS-22 Pain (OR [95% CI] 2.8 [1.4\u20135.9], p = 0.005), and SRS-22 Total (OR [95% CI] 11.0 [3.5\u201334.4], p < 0.001).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n Operative patients with SOp still experience greater improvements in deformity and HRQOL relative to the progressive radiographic and functional deterioration associated with the NH of ASD. The NH of nonoperative management should be accounted for when weighing the risks and benefits of operative intervention for ASD.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2023.2.spine22559","type":"journal-article","created":{"date-parts":[[2023,4,14]],"date-time":"2023-04-14T11:51:12Z","timestamp":1681473072000},"page":"92-100","source":"Crossref","is-referenced-by-count":3,"title":["Natural history of adult spinal deformity: how do patients with suboptimal surgical outcomes fare relative to nonoperative counterparts?"],"prefix":"10.3171","volume":"39","author":[{"given":"Peter G.","family":"Passias","sequence":"first","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rachel","family":"Joujon-Roche","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jamshaid M.","family":"Mir","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tyler K.","family":"Williamson","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Tretiakov","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bailey","family":"Imbo","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oscar","family":"Krol","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lara","family":"Passfall","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Salman","family":"Ahmad","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jordan","family":"Lebovic","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephane","family":"Owusu-Sarpong","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tomi","family":"Lanre-Amos","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Themistocles","family":"Protopsaltis","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic and Neurological Surgery, Division of Spinal Surgery, NYU Langone Medical Center-Orthopaedic Hospital, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Renaud","family":"Lafage","sequence":"additional","affiliation":[{"name":"Hospital for Special Surgery, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Virginie","family":"Lafage","sequence":"additional","affiliation":[{"name":"Department of Orthopaedics, Lenox Hill Hospital, Northwell Health, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Paul","family":"Park","sequence":"additional","affiliation":[{"name":"University of Michigan, Ann Arbor, Michigan;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dean","family":"Chou","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UCSF Medical Center, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Praveen V.","family":"Mummaneni","sequence":"additional","affiliation":[{"name":"Department of Neurological Surgery, UCSF Medical Center, San Francisco, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kai-Ming G.","family":"Fu","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Cornell University School of Medicine, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Khoi D.","family":"Than","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, Duke University, Durham, North Carolina;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Justin S.","family":"Smith","sequence":"additional","affiliation":[{"name":"Department of Neurosurgery, University of Virginia, Charlottesville, Virginia;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"M. Burhan","family":"Janjua","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Washington University, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrew J.","family":"Schoenfeld","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Brigham and Women\u2019s Hospital, Harvard Medical School, Boston, Massachusetts;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bassel G.","family":"Diebo","sequence":"additional","affiliation":[{"name":"Deparment of Orthopedic Surgery, SUNY Downstate, New York, New York; and"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shaleen","family":"Vira","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, UT Southwestern, Dallas, Texas"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"1","key":"b1","series-title":"Global Spine J","first-page":"51","article-title":"Current status of adult spinal deformity","volume":"3","author":"Youssef JA","year":"2013","unstructured":"Youssef JA, Orndorff DO, Patty CA, Current status of adult spinal deformity. 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