Analysis of a prospectively collected, multi-center database of 421 adult spinal deformity (ASD) patients (235 surgical, 186 non-surgical patients) by the International Spine Study Group showed that surgical patients were 6.2 times more likely to experience improvement in back pain, and 3 times more likely to have improvement in leg pain, measured with standardized patient quality of life and pain scales. Patient criteria were age > 18 years, ASD of scoliosis Cobb angle ≥ 20°, sagittal vertical axis length ≥ 5 cm, pelvic tilt angle ≥ 25°, or thoracic kyphosis angle ≥ 60°. At 2 years follow-up: for patients with any preoperative pain (24.3% were free of back pain, and 37.8% were free of leg pain); for patients with severe preop pain (21.0% were free of back pain and 32.8% were free of leg pain). Decompressions improved leg pain, whereas osteotomies improved back pain but could worsen leg pain. Preoperative ASD characteristics affected likelihood and types of pain improvement with surgery, with non-surgical patients more likely to have the same or worse pain. This study provides data for counseling ASD patients on benefits and expectations regarding back and leg pain after corrective surgery.
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