RT Journal Article SR Electronic T1 Likelihood of Reaching Minimal Clinically Important Difference in Adult Spinal Deformity: A Comparison of Operative and Nonoperative Treatment JF Ochsner Journal JO Ochsner J FD O. P. Jindal Global University SP 67 OP 77 VO 14 IS 1 A1 Shian Liu A1 Frank Schwab A1 Justin S. Smith A1 Eric Klineberg A1 Christopher P. Ames A1 Gregory Mundis A1 Richard Hostin A1 Khaled Kebaish A1 Vedat Deviren A1 Munish Gupta A1 Oheneba Boachie-Adjei A1 Robert A. Hart A1 Shay Bess A1 Virginie Lafage YR 2014 UL http://www.ochsnerjournal.org/content/14/1/67.abstract AB Background Few studies have examined threshold improvements in health-related quality of life (HRQOL) by measuring minimal clinically important differences (MCIDs) in treatment of adult spinal deformity. We hypothesized that patients undergoing operative treatment would be more likely to achieve MCID threshold improvement compared with those receiving nonoperative care, although a subset of nonoperative patients may still reach threshold.Methods We analyzed a multicenter, prospective, consecutive case series of 464 patients: 225 nonoperative and 239 operative. To be included in the study, patients had to have adult spinal deformity, be older than 18 years, and have both baseline and 1-year follow-up HRQOL measures (Oswestry Disability Index [ODI], Short Form-36 [SF-36] health survey, and Scoliosis Research Society-22 [SRS-22] questionnaire). We compared the percentages of patients achieving established MCID thresholds between operative and nonoperative groups using risk ratios (RR) with a 95% confidence interval (CI).Results Compared to nonoperative patients, surgical patients demonstrated significant mean improvement (P<0.01) and were more likely to achieve threshold MCID improvement across all HRQOL scores (ODI RR = 7.37 [CI 4.45, 12.21], SF-36 physical component score RR = 2.96 [CI 2.11, 4.15], SRS Activity RR = 3.16 [CI 2.32, 4.31]). Furthermore, operative patients were more likely to reach threshold MCID improvement in 2 or more HRQOL measures simultaneously and were less likely to deteriorate.Conclusion Patients in both the operative and nonoperative treatment groups demonstrated improvement in at least one HRQOL measure at 1 year. However, surgical treatment was more likely to result in threshold improvement and more likely to lead to simultaneous improvement across multiple measures of ODI, SF-36, and SRS-22. Although a subset of nonoperative patients achieved threshold improvement, nonoperative patients were significantly less likely to improve in multiple HRQOL measures and more likely to sustain MCID deterioration or no change.