View Full Version : Quality of Life 2 Years After Surgery and Non-Surgery

10-04-2009, 09:37 PM
Spine (Phila Pa 1976). 2009 Sep 15;34(20):2171-8.Click here to read Links
Does treatment (nonoperative and operative) improve the two-year quality of life in patients with adult symptomatic lumbar scoliosis: a prospective multicenter evidence-based medicine study.
Bridwell KH, Glassman S, Horton W, Shaffrey C, Schwab F, Zebala LP, Lenke LG, Hilton JF, Shainline M, Baldus C, Wootten D.

Department of Orthopaedic Surgery, Washington University School of Medicine, St. Louis, MO 63110, USA. bridwellk@wudosis.wustl.edu

STUDY DESIGN: Prospective observational cohort study with matched and unmatched comparisons. Level II evidence. OBJECTIVE: The purpose of this study is to compare results of adult symptomatic lumbar scoliosis (ASLS) patients treated nonoperatively and operatively. This is an evidence-based prospective multicenter study to answer the question of whether nonoperative and operative treatment improves the quality of life (QOL) in these patients at 2-year follow-up. SUMMARY OF BACKGROUND DATA: Only 1 paper in the peer-reviewed published data directly addresses this question. That paper suggested that operative treatment was more beneficial than nonoperative care, but the limitations relate to historical context (all patients treated with Harrington implants) and the absence of validated patient-reported QOL (QOL) data. METHODS: This study assesses 160 consecutively enrolled patients (ages 40-80 years) with baseline and 2-year follow-up data from 5 centers. Lumbar scoliosis without prior surgical treatment was defined as a minimum Cobb angle of 30 degrees (mean: 54 degrees for patients in this study). All patients had either an Oswestry Disability Index (ODI) score of 20 or more (mean: 33) or Scoliosis Research Society (SRS) domain scores of 4 or less in pain, function, and self-image (mean: 3.2) at baseline. Pretreatment and 2-year follow-up data collected prospectively included basic radiographic parameters, complications and SRS QOL, ODI, and Numerical Rating Scale back and leg pain scores. RESULTS: At 2 years, follow-up on the operative patients was 95% and for the nonoperative patients it was 45%. The demographics for the nonoperative patients who were followed up for 2 years versus those who were lost to follow-up were identical. The operative cohort significantly improved in all QOL measures. The nonoperative cohort did not improve and nonsignificant decline in QOL scores was common. At minimum 2-year follow-up, operative patients outperformed nonoperative patients by all measures. CONCLUSION: It would appear from this study that common nonoperative treatments do not change the QOL in patients with ASLS at 2-year follow-up. However, operative treatment does significantly improve the QOL for this group of patients. Our conclusions are limited by the fact that we were only able to follow-up 45% of the nonoperative group to 2-year follow-up, in spite of extensive efforts on our part to accomplish such.

10-04-2009, 11:49 PM
I'm not quite making sense of this study. They talk about patients "treated nonoperatively and operatively," but I don't see any specification of what the nonoperative treatments were. Did they mean untreated vs. treated operatively? Or was there more detail in the study itself?

10-05-2009, 12:00 AM

What I posted was the abstract for the study. I don't have access to the full text. I do, however, have the questionnaire. Non-operative treatments include medication, bracing, physical therapy, chiropractic, injections and blocks. Operative means the patient had scoliosis surgery.


10-05-2009, 04:05 AM
Thankyou for this Linda. I like to see these positive outcomes from surgery, eases my anxiety somewhat :)

I can concur with the findings from non-operative treatment. I have not felt any better, except of course from the benefits of the exercise on my overall psychological health.

10-05-2009, 05:34 AM
The testimonials here are consistent with that conclusion. At this point, I would have been surprised had Bridwell et al. found otherwise.

I wish we had one of those evidence-based chiros here to comment. They are the only hope for that profession going forward.

loves to skate
10-05-2009, 09:51 AM
Thanks Linda. I hope you don't mind, but I sent a copy of this abstract to the Chiro that I went to for non-surgical spinal decompression. I totally concur with this abstract. Sally

10-05-2009, 09:56 AM
I just have to say that after having spent a full year of consistant chiropractic year 3-4 days per week without ever missing any, physical therapy and taking joint health supplements and working out to the best of what my body would allow me, surgery was the only way to go. I couldn't even fully care for my new born son. Having him made my curve progress rapidly.

My husband will be getting underway soon on his first patrol at his new duty station the Coast Guard Cutter Bear. Without surgery I wouldn't have been able to care for my son when my husband left so we had no choice but to proceed with surgery. I have certainly hit bumps in the road along the way but the pain I had prior to surgery is gone. I have recovery pain and muscle spasms from days where I am extra busy. I never thought I would get to this point but alas, it has finally arrived! Thank God! I have been fortunate that I have had fulltime help the entire time and still will need help through to November 15 because I can't not care for my 19 month old alone. I am starting to lift him I just can't do it all day everyday. It's been hard to have someone else care for him but I am involved as much as possible. I am so thankful that this surgery is giving me my life back. I can't wait to hit that 1 year anniversary point and feel better than what I am feeling now.

Good luck to those of you out there trying to make your decision. It's not an easy one to make but in the long run I think it pays off. Sometimes throughout recovery it's hard to keep your eye on the ball but with support from family and friends you can get there.

10-05-2009, 08:49 PM
Thanks Linda. I hope you don't mind, but I sent a copy of this abstract to the Chiro that I went to for non-surgical spinal decompression. I totally concur with this abstract. Sally
Hi Sally...

I seriously doubt the chiro will "get it."

I personally think that some people can be helped by chiropractors. However, if the patient isn't getting significant results within 5-6 visits, I think it's time to move on. Many chiropractors want patients to sign up for a huge series of treatments.


dolores a
10-06-2009, 03:30 AM
Thanks Linda for posting this study, especially when most of what I see on the internet is derogatory about spinal fusion for scoliosis! This is why this forum was such a godsend when I was first considering surgery and still is!

10-06-2009, 09:55 PM
Chiro worked for me. When I was younger in my 30s, I could get adjusted and I would be superman the next day. In my 30s I would go once every 3 weeks.

Of course when I started having problems in my 40s, I had to go more often, maybe once a week.

In the 2 years right before my surgery, I went twice per week with massages about once a week.

In the last 3 months, I was getting adjusted often and the results were not working as well. You might say, I was overdue for surgery. My joints were shot. This was not my Chiros fault.

Linda is right, if you cannot get relief with Chiro in just a few visits, then its time to re-think.
Here is a problem with the ODI and its questions about pain and how they all relate pain with medication.

You can have pain without taking drugs. Taking drugs, should NOT be an indicator of pain............

If I tell a Doc I'm in major pain, and he asks me what am I taking for that pain, and I say nothing, then they don't believe I'm in major pain because of this index. I had this happen to me.

I also broke my shoulder and didn't even go to the emergency room or take any medications. I guess I didn't have any pain? LOL

This study is for ages 40-80 with a mean cobb of 54. I believe the results. QOL drops with cobbs over 50,and with each passing year after 40 or so with scoliosis.

They should do the study in a younger age bracket, with half the cobb angles. The results will be different depending on what is the definition of each persons "quality of life"