{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T16:17:58Z","timestamp":1780071478793,"version":"3.54.0"},"reference-count":24,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,10,1]]},"abstract":"<jats:sec>\n<jats:title>OBJECTIVE<\/jats:title>\n<jats:p>The Adult Symptomatic Lumbar Scoliosis (ASLS) study is a prospective multicenter trial with randomized and observational cohorts comparing operative and nonoperative treatment for ASLS. The objective of the present study was to perform a post hoc analysis of the ASLS trial to examine factors related to failure of nonoperative treatment in ASLS.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>METHODS<\/jats:title>\n<jats:p>Patients from the ASLS trial who initially received at least 6 months of nonoperative treatment were followed for up to 8 years after trial enrollment. Baseline patient-reported outcome measures (Scoliosis Research Society-22 [SRS-22] questionnaire and Oswestry Disability Index), radiographic data, and other clinical characteristics were compared between patients who did and did not convert to operative treatment during follow-up. The incidence of operative treatment was calculated and independent predictors of operative treatment were identified using multivariate regression.<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>RESULTS<\/jats:title>\n<jats:p>Of 135 nonoperative patients, 42 (31%) crossed over to operative treatment after 6 months and 93 (69%) received only nonoperative treatment. In the observational cohort, 23 (22%) of 106 nonoperative patients crossed over to surgery. In the randomized cohort, 19 (66%) of 29 patients randomized to nonoperative treatment crossed over to surgery. The most impactful factors associated with crossover from nonoperative to operative treatment were enrollment in the randomized cohort and baseline SRS-22 subscore &lt; 3.0 at the 2-year follow-up, closer to 3.4 at 8 years. In addition, baseline lumbar lordosis (LL) &lt; 50\u00b0 was associated with crossover to operative treatment. Each 1-point decrease in baseline SRS-22 subscore was associated with a 233% higher risk of conversion to surgery (hazard ratio [HR] 2.33, 95% confidence interval [CI] 1.14\u20134.76, p = 0.0212). Each 10\u00b0 decrease in LL was associated with a 24% increased risk of conversion to operative treatment (HR 1.24, 95% CI 1.03\u20131.49, p = 0.0232). Enrollment in the randomized cohort was associated with a 337% higher probability of proceeding with operative treatment (HR 3.37, 95% CI 1.54\u20137.35, p = 0.0024).<\/jats:p>\n<\/jats:sec>\n<jats:sec>\n<jats:title>CONCLUSIONS<\/jats:title>\n<jats:p>Enrollment in the randomized cohort, a lower baseline SRS-22 subscore, and lower LL were associated with conversion from nonoperative treatment to surgery in patients (observational and randomized) who were initially managed nonoperatively in the ASLS trial.<\/jats:p>\n<\/jats:sec>","DOI":"10.3171\/2023.5.spine2326","type":"journal-article","created":{"date-parts":[[2023,6,10]],"date-time":"2023-06-10T17:33:22Z","timestamp":1686418402000},"page":"498-508","source":"Crossref","is-referenced-by-count":5,"title":["Failure of nonoperative care in adult symptomatic lumbar scoliosis: incidence, timing, and risk factors for conversion from nonoperative to operative treatment"],"prefix":"10.3171","volume":"39","author":[{"given":"John C. F.","family":"Clohisy","sequence":"first","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"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":"Michael P.","family":"Kelly","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Rady Children\u2019s Hospital, San Diego, California;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Elizabeth L.","family":"Yanik","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christine R.","family":"Baldus","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shay","family":"Bess","sequence":"additional","affiliation":[{"name":"Denver International Spine Center, Presbyterian St. Luke\u2019s\/Rocky Mountain Hospital for Children, Denver, Colorado;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christopher I.","family":"Shaffrey","sequence":"additional","affiliation":[{"name":"Departments of Neurosurgery and"},{"name":"Orthopedic Surgery, Duke University, Durham, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Han Jo","family":"Kim","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Hospital for Special Surgery, New York, New York;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Adam","family":"LaBore","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vy","family":"Pham","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith H.","family":"Bridwell","sequence":"additional","affiliation":[{"name":"Department of Orthopedic Surgery, Washington University School of Medicine, St. Louis, Missouri;"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"issue":"9","key":"b1","series-title":"Spine (Phila Pa 1976)","first-page":"731","article-title":"Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender","volume":"36","author":"Kebaish KM","year":"2011","unstructured":"Kebaish KM, Neubauer PR, Voros GD, Khoshnevisan MA, Skolasky RL. Scoliosis in adults aged forty years and older: prevalence and relationship to age, race, and gender. Spine (Phila Pa 1976). 2011;36(9):731\u2013736."},{"issue":"9","key":"b2","series-title":"Spine (Phila Pa 1976)","first-page":"1082","article-title":"Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population","volume":"30","author":"Schwab F","year":"2005","unstructured":"Schwab F, Dubey A, Gamez L,  Adult scoliosis: prevalence, SF-36, and nutritional parameters in an elderly volunteer population. Spine (Phila Pa 1976). 2005;30(9):1082\u20131085."},{"issue":"suppl 4","key":"b3","series-title":"Neurosurgery","first-page":"S1","article-title":"The aging of the global population: the changing epidemiology of disease and spinal disorders","volume":"77","author":"Fehlings MG","year":"2015","unstructured":"Fehlings MG, Tetreault L, Nater A,  The aging of the global population: the changing epidemiology of disease and spinal disorders. Neurosurgery. 2015;77(suppl 4):S1-S5."},{"issue":"3","key":"b4","series-title":"Spine (Phila Pa 1976)","first-page":"224","article-title":"The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases","volume":"41","author":"Bess S","year":"2016","unstructured":"Bess S, Line B, Fu KM,  The health impact of symptomatic adult spinal deformity: comparison of deformity types to United States population norms and chronic diseases. 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BMJ. 2012;345:e7745."}],"container-title":["Journal of Neurosurgery: Spine"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/4\/article-p498.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/4\/article-p498.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/downloadpdf\/journals\/j-neurosurg-spine\/39\/4\/article-p498.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,12,6]],"date-time":"2024-12-06T13:14:51Z","timestamp":1733490891000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg-spine\/39\/4\/article-p498.xml"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,10,1]]},"references-count":24,"journal-issue":{"issue":"4"},"URL":"https:\/\/doi.org\/10.3171\/2023.5.spine2326","relation":{},"ISSN":["1547-5654"],"issn-type":[{"value":"1547-5654","type":"print"}],"subject":[],"published":{"date-parts":[[2023,10,1]]}}}