What level of symptoms are patients with adult spinal deformity prepared to live with? A cross-sectional analysis of the 12-month follow-up data from 1043 patients

Eur Spine J. 2020 Jun;29(6):1340-1352. doi: 10.1007/s00586-020-06365-z. Epub 2020 Mar 18.


Introduction: Previous studies suggest that a meaningful and easily understood measure of treatment outcome may be the proportion of patients who are in a "patient acceptable symptom state" (PASS). We sought to quantify the score equivalent to PASS for different outcome instruments, in patients with adult spinal deformity (ASD).

Methods: We analysed the following 12-month questionnaire data from the European Spine Study Group (ESSG): Oswestry Disability Index (ODI; 0-100); Numeric Rating Scales (NRS; 0-10) for back/leg pain; Scoliosis Research Society (SRS) questionnaire; and an item "if you had to spend the rest of your life with the symptoms you have now, how would you feel about it?" (5-point scale, dichotomised with top 2 responses "somewhat satisfied/very satisfied" being considered PASS+, everything else PASS-). Receiver operating characteristics (ROC) analyses indicated the cut-off scores equivalent to PASS+.

Results: Out of 1043 patients (599 operative, 444 non-operative; 51 ± 19 years; 84% women), 42% reported being PASS+ at 12 months' follow-up. The ROC areas under the curve were 0.71-0.84 (highest for SRS subscore), suggesting the questionnaire scores discriminated well between PASS+ and PASS-. The scores corresponding to PASS+ were > 3.5 for the SRS subscore (> 3.3-3.8 for SRS subdomains); ≤ 18 for ODI; and ≤ 3 for NRS pain. There were slight differences in cut-offs for subgroups of age, treatment type, aetiology, baseline symptoms, and sex.

Conclusion: Most interventions for ASD improve patients' complaints but do not totally eliminate them. Reporting the percentage achieving a score equivalent to an "acceptable state" may represent a more stringent and discerning target for denoting treatment success in ASD. These slides can be retrieved under Electronic Supplementary Material.

Keywords: Adult spinal deformity; Oswestry Disability Index; Pain Numeric Rating Scale; Patient acceptable symptom state; Scoliosis Research Society (SRS) instrument.

MeSH terms

  • Adult
  • Cross-Sectional Studies
  • Disability Evaluation*
  • Female
  • Follow-Up Studies
  • Humans
  • Male
  • Quality of Life
  • Scoliosis* / diagnosis
  • Scoliosis* / surgery
  • Treatment Outcome